Human Immunodeficiency Virus (HIV) is the virus that causes AIDS. It's only spread from people to people through body fluids. Once inside the body, the virus makes copies of itself and kills CD4 white blood cells. These cells are an important part of the body's immune system. Over time, so many CD4 cells die that the immune system gets weak. HIV also causes chronic inflammation. Medication can help slow HIV's impact on CD4 count and can decrease damage caused by chronic inflammation.
What is AIDS?
Acquired Immune Deficiency Syndrome (AIDS) is a collection of illnesses people get due to HIV after their immune system is severely damaged. Some of these illnesses are called opportunistic infections. People with normal immune systems can also get some of these illnesses, but with HIV they occur at a much higher rate. It also takes longer for a person with HIV to recover. These illnesses occur as a sign of later-stage HIV disease called AIDS. A person with HIV can also be diagnosed with AIDS when their CD4 count falls to 200 or below. HIV antiretroviral drug therapy (ART) can delay the onset of AIDS for many years. We don't know yet, but it could be indefinitely.
How many people get HIV?
Anyone who has unprotected sex, shares needles, or has certain other risks can get HIV. Each year about 300-325 people get infected with HIV in King County. There are about 7,200-8,000 people now living with HIV or AIDS in King County. Local experts believe that about 15% of people who have HIV don't know it, usually because they have not been tested recently. Some groups of people are disproportionately affected by HIV in King County, including African Americans, African immigrants, Latinos, injection drug users, and men who have sex with men.
HIV can be found in body fluids including blood, semen, vaginal fluid, and breast milk
HIV is spread in 3 main ways:
Vaginal or anal sex without a condom is very unsafe with a person who has HIV or an STD, even when they don't know it. During sex, HIV in semen or in vaginal fluid can enter the other partner's body through the soft lining inside the anus or vagina. If one person has an STD, HIV is even more likely to be transmitted. Although HIV is more likely to enter through the vagina or the anus, it can also enter the penis.
HIV risk from oral sex is low, but there are known cases. It is possible to get HIV when giving oral sex if you have any cuts or openings in your mouth or gums, for example after brushing or flossing or if you have an open sore. Other STDs, like syphilis, chlamydia, and gonorrhea, are easily transmitted during oral sex.
Sharing items to inject drugs
Blood is the body fluid that most easily transmits HIV. Any needle, syringe, cooker, or cotton can have blood in it after it has been used. Blood may also stay in the water or other liquid used to mix or divide drugs. If any of these items are shared, this blood can enter the body of the next user. If needles for body piercing or tattooing are shared, there is also risk of passing HIV.
From an infected mother to her infant
An HIV-infected mother can pass HIV to her baby during pregnancy or birth from blood transmission, during breast-feeding, or in some cases by sharing chewed food. If the mother is taking HIV medications, the risk to the fetus or baby is much smaller.
Getting HIV from a medical procedure is very rare
You cannot get HIV from:
sweat, saliva (spit), tears, urine, or mucous
hugging, touching, kissing
coughing or sneezing
sharing household items except razors and toothbrushes*
toilets, swimming pools, or hot tubs
*Public Health does not recommend sharing razors or toothbrushes because of possible blood transmission.
How can I stay safer if I have sex?
There is no risk for HIV from:
abstinence (not having sex)
sex with just one partner who:
is not infected and
never unprotected sex or shares needles with anyone else (and you don't either)
masturbation or hand jobs (where you keep your fluids to yourself)
non-sexual massage or touch
Most other sexual activity carries some risk of spreading HIV. Talk with your partner(s) about HIV and other STDs before you have sex. Agree with your partner on things you will do and won't do. You can both get tested for STDs to know you are in the clear or get treated if you are not. To reduce your sexual risks, don't let blood or sexual fluids get into your body. Be aware, withdrawal or pulling out before ejaculating or cumming will not prevent HIV or other STDs.
Here are some risk reduction techniques you can use to decrease your risk of getting HIV:
Be aware of your body and your partner's. Cuts, sores, other STDs, or bleeding gums increase the risk of spreading HIV. Rougher sex can cause bleeding or small tears that give HIV an easier way to get into the body.
Always use a safety barrier. For vaginal and anal sex, use a latex, polyurethane, or polyisoprene male condom or female condom. Condoms are also recommended if sharing sex toys. Pieces of latex or plastic wrap over the vagina or anus called dental dams, or latex condoms over the penis, are good barriers during oral sex. There are flavored condoms for this purpose. Even if you are HIV positive and your partners are too, it is safest to use condoms to prevent the spread of STDs like syphilis.
Here is a video demonstrating the use of dental dams and how to make one out of a condom:
Lubricants reduce the chance that condoms or other barriers will break. Don't use oil-based lubricants (Vaseline, Crisco, oils, or creams). They damage latex condoms. Only use water-based or silicone-based lubricants.
Have sex with fewer people. More partners = more risk!
Get tested and treated for STDs. If you have an STD, it is easier to get HIV from an infected partner. And if you have HIV, it is easier to get STDs. Insist that your partners get tested and treated for STDs too.
Serosorting is when a person chooses a sexual partner known to be of the same HIV status. This can be a helpful strategy when both people know they are positive. But for people who are negative (or think they are negative), it's risky. One may have become infected since his or her last negative test result and not know it yet.
PEP is short for Post Exposure Prophylaxis. It is when a person who does not have HIV takes HIV medications to prevent infection after a possible exposure. PEP should be started within the first 48 hours -- but no later than 72 hours -- after exposure. Obtain medical treatment IMMEDIATELY if you think you were exposed to HIV.
PrEP or Pre Exposure Prophylaxis may become part of comprehensive HIV prevention services. With PrEP, people who are HIV negative take antiretroviral medication daily to lower their chances of becoming infected with HIV if they are exposed to it.
Male circumcision has been shown to reduce the risk of HIV transmission from women to men in Africa. However, there's no clear benefit for men who have sex with men. No one is recommending circumcision as a way to prevent HIV for U.S. adult males at this time.
Birth control methods (the IUD, pill, patch, ring, or shot) do not protect you from HIV!
How do I use a condom?
Condoms can reduce the risk of HIV and other STDs if they are used correctly and used each time you have sex. All condoms must meet the same safety standards, and it is very rare for a condom to break due to defects. The best brand is the one you like to use and feel most comfortable with.
Using a male condom:
Use only latex, polyurethane, or polyisoprene condoms.
Don't use "natural skin" or lambskin condoms. They have holes large enough to let HIV through.
Don't use condoms with Nonoxonyl-9, or if they say "spermicide" or "spermicidal". Spermicides can cause irritation in your body which can make HIV infection more likely.
Check the date on the package. Don't use a condom if the package is torn or expired. Do not store condoms in hot or sunny places.
Do not use two male condoms at the same time. The extra friction may cause them to break.
If you want to see how to put on a male condom, see this video:
Despite the name, anybody can use the female condom for anal sex. Never use a male condom and female condom at the same time.
The outer ring covers the area outside the vagina or anus. The inner ring is used to insert the condom and hold it in place during sex.
To insert the female condom into the:
Vagina: Squeeze the flexible inner ring with your thumb and second finger so it becomes long and narrow. Gently slide the inner ring into the vagina. Place a finger inside the condom and push the inner ring up as far as it will go. Be sure the condom is not twisted.
Anus: You can use the same method as above. Some people take out the inner ring once the condom is in. Others put the condom (without the inner ring) over their partner's erect penis and insert both the penis and the condom at the same time into the anus.
The outer ring should lie flat outside of the vagina or anus. Gently guide your partner's penis into the condom's opening. Be sure that the penis does not enter on the side, between the condom and bare skin.
To remove, twist the outer ring and gently pull the condom out.
If you want to see how to insert a female condom, see this video:
How can I stay safer if I inject drugs?
The only way to be 100% safe is to not use drugs.
If that isn't possible, use a brand new syringe every time you inject or divide drugs. Cookers, cottons, barrels, plungers, or water used for mixing or bleaching also can transmit HIV. Do not share any of these items.
There are several local needle exchange sites that can trade new syringes for used ones. They also have information on drug treatment.
Go to the Needle Exchange Schedule website to see where and when used needles can be exchanged. Pharmacies in Washington State may also sell syringes to injection drugs users to prevent the spread of blood-borne disease.
Any drug, including alcohol, can impair your judgment and coordination, making condom use more difficult or reducing inhibitions. Be aware and seek support if you think you have a problem with substance abuse.
How can I tell if I've been infected with HIV?
You need to get tested for HIV.
You can have HIV and not know it. Many people with HIV infection do not have symptoms for many years. Many of the symptoms of early HIV infection are the same as other, less serious illnesses.
More than 50% of people have at least one symptom when they get infected. Symptoms may appear 2-4 weeks after getting HIV.
Symptoms of recent HIV infection include:
Swollen tonsils or lymph nodes
Joint or muscle aches
Nausea or vomiting
Most people don't have all these symptoms. Having these symptoms does not mean you have HIV. It may be the flu, mono, or something else like strep throat. But if you develop any of these symptoms after a possible exposure, it's a good idea to get tested.
Getting an HIV test 1-3 months after exposure is a sure way to know if you have HIV. An RNA test may be appropriate for some people and can give accurate results 2 weeks after infection.
How can I get tested for HIV?
There are several ways to test for HIV. Some tests look for antibodies your body makes to fight HIV; others look for the virus itself. Some take about a week to get the results; others can give results in under 20 minutes. Some require a blood draw from the arm or just a finger stick; others use an oral swab.
The most standard HIV tests look for antibodies to the virus rather than the virus itself. HIV antibodies are proteins that your body produces to fight off HIV. Antibodies almost always show up 1-3 months after infection. Newer tests called 4th generation tests look for both antibodies and antigens. Antigens are proteins on the outside of HIV and show up sooner than HIV antibodies. The RNA test looks for the genetic material (ribonucleic acid or RNA) of the virus itself. HIV RNA can be detected within 1-2 weeks after getting infected. An RNA test can also tell how much virus you have. This measure is called viral load.
Your doctor will tell you which test is right for you.
If a test finds any of these substances -- HIV antigens, antibodies, or RNA -- the lab will do additional tests to confirm you have been infected with HIV.
HIV RNA, antigens, and antibodies are not detectable immediately after infection. The time between HIV infection and when it will show up on a test is called the window period. If you test during the window period, the result may not be accurate. The window period for antibody tests is 1-3 months. For RNA tests, the window period is 1-2 weeks.
An HIV test does not tell you if you have AIDS or how long you have been infected or how sick you might be. It just tells you whether or not you have the virus.
A negative test means you do not have HIV at the time of the test. A negative result does not mean that you are safe from future HIV infection.
A positive result means:
you have HIV
you can give HIV to others, even if you don't have symptoms or you are on treatment
you may or may not have AIDS
Is there a cure for HIV and AIDS?
Not yet. There are drugs that can slow down the virus and protect your immune system. Researchers are still looking for a vaccine to prevent HIV infection and treatments to cure it after infection happens.
How are HIV and AIDS treated?
HIV treatment is often called anti-retroviral therapy, ARV, or ART. The drugs can't kill HIV, but they can slow down the damage HIV does. Someone taking these drugs might have a viral load that is not detectable by standard blood tests. However, very low levels of HIV can often be found with a more sensitive test, or with tests that sample lymph nodes, tissues, or other body fluids like semen.
There are different classes of ARV drugs. Each class attacks HIV in a different way. As it makes more copies, HIV can change slightly and the drugs may stop working. This is called developing resistance. It's very hard for HIV to get past several drugs at once, so doctors often prescribe drugs in combination. Nowadays most people can get by on 3-4 medications for HIV.
People who develop AIDS may also take other drugs to prevent or treat opportunistic infections. When to start treatment and what drugs to use are very complex decisions. Therefore, everyone with HIV should see a healthcare provider who is an expert in HIV disease and treatment.
There are programs in King County and Washington State to help people access and pay for HIV treatment. For health care and other HIV resources in King County, call the HIV/STD Program at 206-296-4649.
All information is general in nature and is not intended to be used as a substitute for appropriate professional advice. For more information, please call 206-296-4600 (voice) or TTY Relay: 711 or toll-free, 800-325-6165. Mailing address: 401 5th Ave., Suite 1300, Seattle, WA 98104 or click here to email us. Because of confidentiality concerns, questions regarding client health issues cannot be responded to by e-mail. Please read the Notice of Privacy Practices. For more information, contact the Public Health Privacy Office at 206-263-8255.