There are plenty of sexually transmitted infections out there. The saving grace of infections like chlamydia and gonorrhea is that they’re easy to get rid of with the right medication. But of the STIs that don’t yet have a cure, HIV and AIDS loom large. Over 1.1 million people in the United States have HIV, or human immunodeficiency virus, according to AIDS.gov. It seems like the scariest STI because when left untreated, the illness can progress and end up having fatal consequences. But thanks to celebration-worthy advances in medicine, HIV is far from the death sentence it used to be. Treatment can even get the virus down to undetectable levels in people’s blood. In addition to being manageable, there’s another key thing to keep in mind: HIV is preventable, too. Here, doctors explain what you need to know. 1. HIV and AIDS are not the same thing. HIV is a virus that attacks the immune system. Without treatment, it can become AIDS, or acquired immunodeficiency syndrome, which leaves people vulnerable to dire infections. There’s no immediate sign a person’s developed HIV. Often there are no indications at all. Some people might develop a reaction to the virus that causes flu-like symptoms—a fever, rash, sore throat, headache, or other annoyances that are easy to write off as a normal illness. But while this tends to clear up on its own, HIV is still in the body, and it’s not until later that the damage becomes obvious—and dangerous, Chris Carpenter, M.D., section head of infectious disease and internal medicine at Beaumont Hospital in Royal Oak, Michigan, tells SELF. “Most people recover from [the initial reaction] and in general do well for several years, but inside, the virus is chipping away at their immune system to the point that they develop AIDS,” Carpenter says. Specifically, the HIV virus attacks a white blood cell known as the CD4 cell or T-cell. “It’s a lymphocyte that’s very important in protecting us against certain types of infections and cancers,” Carpenter explains. Healthy people usually have 500 to 1,600 T-cells per cubic millimeter of blood, says AIDS.gov. When someone’s number of T-cells drops below 200 per cubic millimeter of blood, their HIV has officially progressed to AIDS. 2. Anyone can get HIV. “Folks with HIV come from all walks of life. It’s not just one socioeconomic class that struggles with this, although some do more than others,” Carpenter says. Gay and bisexual men of all races are most severely affected, but women made up 19 percent of the United States’ over 44,000 new HIV diagnoses in 2014. “In some communities, HIV has experienced a little bit of a resurgence,” Idries Abdur-Rahman, M.D., a board-certified ob/gyn, tells SELF. HIV diagnoses are increasing in black and Hispanic/Latino gay and bisexual men, and they’re also rising in older populations. Post-menopause, safe sex can fall by the wayside because it’s no longer necessary for pregnancy prevention, Abdur-Rahman says, which leads to a disproportionate number of STDs, including AIDS, among seniors. 3. There’s a common misconception that people die from AIDS itself, but that’s not true. AIDS can cause symptoms like chills, fever, sweats, swollen lymph glands, weakness, and weight loss, but it doesn’t usually kill people. Instead, the culprits are “opportunistic infections,” like pneumonia or various cancers, that a person’s weakened immune system can’t fight off. Without treatment, people with AIDS usually survive for around three years. Once they’re infected with an opportunistic infection, life expectancy drops to a year. The exact length of time depends on the illness, what doctors can do to treat it, and how much someone's damaged immune system can take. 4. Certain sexual acts are more likely than others to pass HIV from one partner to another. The virus is only transmitted through certain bodily fluids: blood, semen, pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk. For infection to occur, these fluids need to come into contact with mucous membranes, which are found inside the mouth, penis, vagina, and rectum. Anal sex is most likely to transmit HIV. “It’s namely because of the trauma, mucosal breakdown, and bleeding,” Carpenter says. While less likely, it can also be passed through vaginal sex. And while the risk is “extremely low,” it’s also possible to pass it through oral sex. But HIV can’t be transmitted through kissing (unless both people are making out deeply and have open sores or bleeding gums), sitting on a toilet seat, using the same utensils as someone who has the virus, or other forms of casual contact. Beyond sex, HIV can also be transmitted when injecting drugs with needles because of the blood involved. 5. HIV treatment is leaps and bounds from where it was in the past. When HIV was first discovered in the 1980s, it was a terminal illness. “In the '90s, there were medications that were effective but difficult to tolerate. In the 2000s, there were more tolerable medications, but people still struggled with side effects,” Carpenter says. “Now, we’re very good at handling HIV.” HIV treatment is based on antiretroviral therapy, or ART. “If taken the right way, every day, this medicine can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others…Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV,” says the Centers for Disease Control and Prevention. ART can come with side effects, like anemia, diarrhea, fatigue, and more, but doctors work with patients to find the drug cocktail least likely to cause these issues. Although ART is not a cure, it can bring someone’s viral HIV load to undetectable levels. Their immune systems can rebuild without being under constant siege, and their chances of passing the virus to others lower dramatically. ART is necessary to prevent HIV from progressing to AIDS. 6. But despite the improvement in treatment, prevention is still absolutely crucial. “Abstinence is the obvious way to protect yourself, but we all live in the real world,” Carpenter says. Next step: safe sex. “Nothing is 100 percent, but you need to use barrier protection,” Abdur-Rahman says. Condoms, female condoms, and dental dams are all good options. And if you have a choice in material, opt for latex or polyurethane—lambskin doesn’t prevent transmission of STDs. Also, use lube! It helps stop condoms for breaking, says the CDC. Just be sure to avoid ones with the spermicide nonoxynol-9, an ingredient in some lubes that can irritate the vagina and anus, increasing the risk of microtears and getting HIV. 7. Everyone should be tested for HIV—yes, everyone. Everyone between the ages of 13 and 64 needs to be tested for HIV at least once, but many doctors recommend HIV testing at least once a year if you’re having sex. There are different kinds of HIV tests, but the most common one looks for antibodies in the blood, not for the virus itself, Abdur-Rahman explains. The body often needs three to 12 weeks to mount that antibody response, so it can take around that long or longer for a test to show up positive, according to the CDC. There’s nothing shameful about getting tested, or talking about it. In fact, both are important. “If you’re going to have a sexual relationship, you need to be able to sit down and discuss all the things that can happen: pregnancy, HIV, and other STDs,” Abdur-Rahman says. 8. At-risk people have options to prevent HIV infection. If someone is at continued risk of getting HIV, either because of their sexual activity or drug use, they can use pre-exposure prophylaxis to drastically reduce their odds of getting the virus. PrEP, as it’s commonly known, is a medication marketed under the name Truvada. Daily use of PrEP, which is a combination of two HIV drugs, can lower the risk of getting HIV from sex by over 90 percent and from injection drug use by more than 70 percent. It can cause side effects like nausea but they usually goes away. If you’re part of a “mixed-status” couple, or a pairing in which one person has HIV and the other doesn’t, PrEP can be a great idea. But barrier methods are still a must for lowering the risk of getting the virus (and other STDs), says Carpenter. 9. Pregnant women with HIV won’t necessarily pass it to their babies, if they take the right precautions. Abdur-Rahman has diagnosed pregnant women with HIV, which means they could pass it to their offspring. If a pregnant person starts on ART treatment as early as possible, the risk of transmitting HIV to the baby can be 1 percent or less, according to the CDC. Doctors may also decide on a C-section to further lower the risk. And since HIV is transmissible via breast milk, doctors advise against breastfeeding for new moms with HIV. 10. If you think you’ve been exposed to HIV, you can get post-exposure prophylaxis to potentially prevent infection. PEP, which needs to be started within 72 hours of exposure to work, can reduce your risk of getting HIV if you were exposed during sex, during drug use, or if you were sexually assaulted. It needs to be taken once or twice daily for 28 days. If you think you were exposed, talk to your doctor, call a healthcare clinic, or go to an emergency room. Any one of these options should be able to get PEP for you as quickly as possible, or better direct you to someone who can. Source
