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- What is HIV/AIDS
- Stages of HIV infection
- HIV Transmission
- HIV Prevention
- HIV antibody tests
- Test sites
HIV stands for Human Immunodeficiency Virus. Once in the body, HIV attacks the immune system, gradually weakening it until it can no longer defend the body against certain illnesses, infections and diseases.
AIDS stands for Acquired Immunodeficiency Syndrome. AIDS is the advanced stage of HIV infection.
There is no cure or vaccine for HIV or AIDS.
1) Primary infection is the time when a person first becomes infected with the HIV virus. Primary infection is followed by seroconversion. Seroconversion is when the body's immune system first starts to produce antibodies to fight the virus. You may experience flu-like symptoms during the seroconversion period. Primary infection and seroconversion are considered the first stage of HIV infection.
2) Asymptomatic infection is the period after seroconversion when you remain healthy without any symptoms of HIV disease. This may last for many years. Although you remain well, the HIV virus continues to grow.
3) Symptomatic infection occurs as your immune system is becoming weakened by HIV. You may experience symptoms such as fatigue, night sweats, diarrhea, or weight loss.
4) Advanced HIV disease or AIDS involves severe symptoms such as wasting and opportunistic infections such as CMV retinitis, pneumonia, MAC and other life threatening conditions.
- Treatment is available for HIV-infected persons who are asymptomatic (without symptoms).
- There are numerous ongoing clinical trials and treatments.
- Prevention of several illnesses affecting persons with HIV infection is possible.
- Treatment is not a cure
Many new therapies are available for HIV treatment. Since treatment for asymptomatic HIV infection is available, early diagnosis of infected persons is vitally important.
For more information please contact a HIV clinic
Janet(Administrative Support): 777-5041
Kim Burt(Nurse Practitioner): 777-5556
Debbie Kelly(Pharmacist): 777-7903
Cheryl Shultz(Social Worker): 777-5885
Post-exposure prophylaxis, or PEP, is a way for a person who may have recently been exposed to HIV to prevent HIV infection. It involves taking anti-HIV medications right after a potential exposure to HIV. Anyone who thinks they may have been exposed to HIV should contact community health. PEP is not 100% effective. PEP consists of a combination of two to three anti-HIV drugs that an HIV-negative person who may have been exposed to HIV takes to reduce their risk of HIV infection. PEP should be taken as soon as possible, within 72 hours of being exposed to HIV. These prescription drugs need to be taken every day, exactly as directed, for four full weeks.
1) HIV Must Be Present
Infection can only happen if one of the persons involved is infected with HIV. Some people assume that certain behaviors (such as anal sex) cause AIDS, even if HIV is not present. This is not true.
2) There Must Be A Sufficient Quantity of HIV
The concentration of HIV determines whether infection may happen. In blood, for example, the virus is very concentrated. A small amount of blood is enough to infect someone. A much larger amount of other fluids would be needed for HIV transmission.
3) HIV Must Get Into The Bloodstream
It is not enough to be in contact with an infected fluid to become infected. Healthy, unbroken skin does not allow HIV to get into the body; it is an excellent barrier to HIV infection. HIV can only enter through an open cut or sore, or through contact with the mucous membranes in the anus and rectum, the genitals, the mouth, and the eyes.
Infectious Body Fluids
Blood (including menstrual blood)
Non-infectious Body Fluids
Sexual Routes Of Transmission
Vaginal and anal intercourse without the use of a condom is considered high risk for HIV infection. In the genitals and the rectum, HIV may infect the mucous membranes directly or enter through cuts and sores caused during intercourse.
Oral sex carries low risk for HIV infection. However, this does not mean it is without risk. Generally speaking, the mouth is an inhospitable environment for HIV. As a result, the risk of HIV transmission through the throat, gums, and oral membranes is lower than through vaginal or anal membranes. There are however, documented cases where HIV was transmitted orally, so we can't say that getting HIV-infected semen, vaginal fluid or blood in the mouth is no risk. Avoid brushing, flossing and dental work an hour before, or immediately after, performing oral sex, as doing so can cause small tears and cuts in the mouth and provide a route of entry for HIV into the bloodstream.
Sex toys may also pose a risk for HIV infection. Transferring a sex toy directly from one partner to another allows for sharing of infected fluids that can result in direct HIV transmission. The risk of HIV transmission can be reduced by cleaning sex toys after use (soap and water, alcohol or bleach).
Some people may use a condom over the toy as a substitute for cleaning. After using a condom with one person, replace it with a new one before the toy is transferred to another person. There is some risk involved with this method because of the possibility that the condom can break, slip off or not completely cover the surface of the toy.
Using sex toys and other objects can cause trauma to the mucosal lining of the rectum or vagina. The extent varies depending on the size of the device and the way it is used. Even if properly cleaned and therefore not directly transmitting HIV, trauma and resulting inflammation can promote the possibility of later transmission by opening a route of entry for HIV to the bloodstream through the cuts or tears in the rectum or vagina, thereby increasing the risk of HIV transmission for other activities that may follow.
Non-Sexual Routes Of Transmission
Needle sharing: Sharing a needle can pass blood directly from one person's bloodstream to another. It is a very efficient way to transmit a blood-borne virus. HIV can survive for several days in the small amount of blood that remains in a needle after use, so used needles are very risky for HIV transmission; they provide a direct path into the bloodstream. Ideally, used needles should never be reused, but if they are, they should always be cleaned with bleach or alcohol before re-use.
Tattooing, Piercing, Acupuncture, Electrolysis,and Shaving: Any procedure in which a needle or razor is used on more than one person involves a theoretical risk of HIV transmission because of the possibility of infected blood on the instrument. However, the risk can be reduced or eliminated through routine sterilization procedures. There are no documented cases of someone becoming infected through tattooing or piercing.
Blood Transfusions: Since March 1985, all blood in Canada has been screened with the HIV antibody test. This practice has almost eliminated the risk of getting HIV through a blood transfusion.
Hemophilia Treatments: Hemophilia is a genetic disease in which people (almost all men) lack the ability to clot blood. To control the condition, hemophiliacs take Factor VIII, a clotting factor. Each dose of Factor VIII comes from the pooled blood of many donors. Currently, over 90% of hemophiliacs in the U.S. have been infected with HIV because of receiving contaminated Factor VIII. Factor VIII is now heat-treated to kill the virus. In addition, there are new synthetic products that do not pose any risk for HIV and which accomplish the same function.
Other Blood Products: Besides whole blood, platelets (red blood cells) have transmitted the virus. Current blood screening, however, should prevent all but a few cases. No other blood products are suspected of transmitting HIV. Gamma globulin or hepatitis B vaccine do not transmit HIV. Gamma globulin, however, can temporarily transmit HIV antibodies, although not the virus itself. These antibodies will disappear within a few months.
Mother to Child: It is possible for an HIV-infected mother to pass the virus directly before or during birth, or through breast milk. Approximately 20% of babies born to HIV-positive women who undertake no transmission-reduction measures will be infected with HIV. Taking AZT during the later stages of pregnancy and delivery reduces this probability to 5% - 8%. Recent studies indicate that transmission is reduced to less than 2% if a cesarean section (c-section) is performed prior to labour, in combination with AZT therapy.
Breast Milk: Breast milk contains HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is a viable means of transmission to infants. infected mothers should not breast feed their infants. Despite use of AZT by the mother, approximately 5% of vertical transmission occurs via breast milk.
Semen Donor Insemination: Donor semen is checked for HIV antibodies when the semen is collected. The semen is then frozen. The donor is required to come back after six months for a second HIV test, to confirm the initial HIV screening. The semen is not used before the procedure is completed.
HIV Transmission Myths
Insect Bites: HIV is not transmitted by mosquitoes, flies, ticks, fleas, bees or wasps. If a bloodsucking insect bites someone with HIV, the virus dies almost instantly in the insect's stomach (as it digests the blood). HIV can only live in human cells.
Mosquitoes Cannot Transmit HIV For Two Reasons:
1) The mosquito draws blood and injects saliva. The blood from one person is not injected into the mosquito's next victim.
2) HIV dies in the mosquito's body. People sometimes are confused because malaria actually reproduces inside the mosquito's digestive tract, using the insect as part of its life cycle, HIV does not. These facts are confirmed by looking at infection patterns. In areas where mosquitoes are common and where HIV is prevalent, the distribution of AIDS cases in the population is not different from other areas. If mosquitoes transmitted HIV, we would be seeing a disproportionate number of children and elderly infected in those areas.
Casual Contact/Sharing Dishes or Food: HIV is not transmitted through casual, every day contact. Since HIV is not transmitted by saliva, it is impossible to get it through sharing a glass, a fork, a sandwich, or fruit.
Donating Blood: Sterilized needles are always used in taking blood from donors, so HIV is not spread in this manner.
Swimming Pools and Hot Tubs: The chemicals used in swimming pools and hot tubs would instantly kill any HIV, if the hot water hadn't killed it already.
Pets: Humans are the only animals that can carry HIV. People sometimes think they can get HIV from pets, because some animals carry viruses that produce similar immune deficiencies in their own species, e.g. FIV, feline immunodeficiency virus, in cats, and SIV, simian immunodeficiency virus, in some types of monkeys. However, FIV cannot be transmitted to people, nor can HIV be transmitted from humans to pets such as cats and dogs.
Contact with Saliva, Tears, Sweat, Feces or Urine: Transmission can only occur when a sufficient amount of HIV enters the bloodstream, through cuts or mucous membranes. These body fluids either contain no HIV or it exists in a quantity too small to result in transmission. HIV is not transmitted by saliva.
To prevent becoming infected by HIV, avoid behaviour that might result in contact with blood, semen, vaginal secretions, or body fluids with visible blood. Specifically, practice safer sex with your partner(s), and do NOT share equipment used to inject drugs.
The following prevention measures apply to personal sex practices and injection drug use:
- To prevent sexual transmission of HIV always practice safer sex.
- Always use a latex condom during vaginal and/or anal sex. If used properly, latex condoms offer greater protection against sexually transmitted diseases, including HIV.
- Use only water-based lubricants. Do not use saliva or oil-based lubricants such as petroleum jelly or vegetable shortening during vaginal or anal sex. Saliva or oil-based lubricants will damage a latex condom which could result in breakage of the condom during sex.
- Oral sex is not high risk for HIV transmission. This does not mean no risk. You should be aware of any cuts or tears in either your or your partners mouth and genitals which may provide an entry point for HIV. Oral sex can be high risk for other STDs such as gonorrhea.
- If you inject drugs, do not share any injecting drug equipment such as needles or cookers.
- Do NOT share personal items such as toothbrushes, razors, and devices used during sex which may be contaminated with blood, semen, or vaginal fluids.
Universal Body Fluid Precautions
The chances of becoming infected with HIV by handling a body fluid are extremely small, because that fluid will rarely have access to a person's bloodstream. However, anyone handling blood, semen or vaginal fluids should be careful to avoid touching them with broken skin or getting them into mucous membranes (such as those around the eye). Spills of blood should be mopped up, cleaned with soap and water, then cleaned with bleach. For maximum safety, the person cleaning the spill should also wear latex gloves, and should wash the hands thoroughly after the cleanup.
There are established universal body fluid precautions which are designed to minimize the risk of HIV infection and other blood-borne illnesses such as hepatitis. The guidelines state that any instruments designed to penetrate the skin such as tattoo or acupuncture needles either should be used only once and discarded, or should be thoroughly cleaned and sterilized after each use.
If you are worried about occupational risk you should discuss infection control precautions with your employer.
HIV Survival Outside of the Body
Generally, when people ask the question, "How long can HIV survive outside the body?" they have come into contact with some body fluid that they think might contain HIV and are worried about transmission. Almost always these questions are about casual contact, and we know the virus is not transmitted except during unprotected sex, sharing needles, or through significant and direct exposure to infected blood.
HIV is very fragile, and many common substances, including hot water, soap, bleach and alcohol, will kill it.
Air does not "kill" HIV, but exposure to air dries the fluid that contained the virus, and that will destroy or break up much of the virus very quickly. The Laboratory Centre for Disease Control at Health Canada reports that drying HIV reduces viral amount by 90-99 percent within several hours.
HIV Antibody Tests
As the body fights viruses, it creates antibodies to that virus. HIV antibody tests measure the presence of antibodies to HIV. They do not measure or detect the virus itself. There are three commonly used antibody tests.
The ELISA is almost always the first screening tool; it is inexpensive and very sensitive. In most cases, a blood sample is tested, but other types of ELISA's that use saliva and urine have also been developed. The actual ELISA takes 3.5 to 4 hours, but most test sites send samples to outside labs, where they are tested in batches, so you may have to wait one to two weeks for results. Beyond the "window period," discussed above, ELISA tests are very rarely "false negative." This means if you have a negative test result, and you were tested at least six months after the last potential exposure, you are really HIV negative. An ELISA test may rarely be "false positive." False positive ELISA results can occur if someone is tested right after events that temporarily stimulate the immune system, such as viral infections or immunizations. They could also occur because of lab error, or because of the test's very high sensitivity, discussed below. For these reasons, positive ELISA results must always be confirmed with a Western Blot or IFA (below), and at reputable test sites this is commonly done automatically -- meaning you don't have to come for another blood draw.
Western Blot (WB) Assay
The WB is a confirmatory test. It is only performed if the ELISA is positive. The WB can be positive, negative, or indeterminate. Indeterminate tests are neither positive nor negative. An indeterminate result usually means that a person has just begun to seroconvert at the time of their test. In the rare cases in which this occurs, the person ,will need to be re-tested, usually about one month later. False positive results are extremely rare with the WB, so it confirms whether HIV antibodies are present.
A relatively new test, called a detuned ELISA, which has been used in research settings, will soon become more widely available to other test sites. The detuned test, which is used only after HIV antibodies are confirmed by a Western Blot, can determine if the HIV infection is recent (within the last six months), which may be useful for deciding upon possible early treatment options.
Testing Issues for Specific Populations
The antibody test may not be appropriate for a pregnant woman who has had recent exposure to HIV. If she is trying to decide whether to continue or terminate her pregnancy, she cannot afford the three to six month waiting period the antibody test requires. In such cases, the viral load test may be ordered by a physician to help the woman make more informed decisions. Research conclusively indicates that even short-term AZT therapy during the late stages of pregnancy and delivery reduces mother-to-child HIV transmission. Knowledge of one's HIV status can help a pregnant woman make informed decisions about her care.
Newborns and Children
During pregnancy a mother transfers her immunities to the child. If she is infected, her antibodies to HIV are transferred. Therefore, after a child is born and for the first 12 to 18 months, the child will test positive with an antibody test. This may not mean that the child is infected. After 12 to 18 months, the child will shed the mother's antibodies. If infected, the child will continue to test positive with an antibody test.
The recently developed IgA antibody test may offer a cheaper alternative than the viral load test for determining infant infection as early as six months after birth. Unlike HIV, IgA antibodies do not travel across the placenta to the fetus. This simple and relatively inexpensive test appears to reveal the child's, rather than the mother's, response to HIV.
HIV testing presents special problems for children under 12 years old and infants under 18 months old. When an HIV-positive mother gives birth, her child may be HIV-negative yet still have the mother's antibodies in its bloodstream. For this reason, the antibody test is not a reliable indicator of HIV status for children under 18 months. In cases such as these, the viral load test may be used to provide additional information about the child's immune system.
Why Be Tested: PROS AND CONS
If you know you are HIV-positive, you can take advantage of immune system monitoring and early treatment and intervention. By taking the test, you can find out whether or not you can infect others. Regardless of the result, testing often increases your commitment to overall good health habits. If you test negative, you may feel less anxious after testing. Women and their partners considering pregnancy can take advantage of treatments that potentially prevent transmission of HIV to the baby.
Whether or not to take the antibody test is an extremely personal decision. We cannot make that decision for anyone. We can only advise you of the implications of testing. The decision to test is yours.
When we become infected with any virus (cold, flu, HIV, etc.), our immune system produces antibodies which are used to destroy that particular virus. However, the antibodies we produce to fight HIV are not capable of destroying HIV. The "window period" is the time it takes for a person who has been infected with HIV to produce antibodies to the virus. This production of antibodies is called seroconversion. Antibodies to the HIV virus will appear within 3 months of infection.
You may be anxious to be tested soon after an encounter which you perceive to be risky. You may want to know: can I be tested without waiting three months? How accurate is the test after six weeks? Think about this: if you got a negative test at six weeks, would it be accurate? It is best to wait until 3 months after the risky encounter before getting tested so that it is entirely accurate. If testing will make you less anxious then go ahead and get tested. But remember, to be certain, you will need to get tested again after 3 months following the risky encounter.
Confidential HIV Testing
HIV antibody testing is available through physicians, some clinics, and hospitals. If you give your name, even if the test site says your name is known only to them and not the lab, the test is confidential, not anonymous. Confidential antibody testing means that you and the health care provider know your results, which may be recorded in your medical file. Some physicians might agree to omit the test results from the medical file.
Some reasons for confidential testing are:
- A written result is required for immigration purposes or for some international travel visas.
- A pregnant woman who is clearly at risk might choose to be tested through her doctor, rather than anonymously, since the result is of key importance to the course of her medical care.
- Potentially faster linkage to medical care.
- Some people may want written results for the wrong reasons, e.g. to be a "card-carrying HIV-negative sexual partner." We discourage this reasoning, as no written test result can accurately indicate a person's negative HIV status. Remember the three to six month window period and the fact that someone could have been exposed to HIV after being tested.
St. John's and Area