HIV

What is HIV and AIDS?

HIV stands for Human Immunodeficiency Virus. HIV is a virus that takes over certain immune system cells to make many copies of itself. HIV causes slow but constant damage to the immune system.

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the condition diagnosed when there are a group of related symptoms that are caused by advanced HIV infection or when someone has less than 200 CD4 cells (immune cells). AIDS makes the body vulnerable to life-threatening illnesses called opportunistic infections.

How does HIV affect the body?

Normally, the human immune system is the body’s protection against bacteria, viruses, etc. It acts like a coat of armor. When HIV enters the body, it starts poking holes in the armor. Eventually, the armor becomes very weak and unable to protect the body. Once the armor is very weak or is gone, the person is said to have AIDS.

An AIDS diagnosis is generally made when either the body's protective T-cells drop below a certain level, or the HIV-positive individual begins to experience opportunistic infections. An opportunistic infection is an infection that would not be life-threatening to an otherwise healthy person. Oftentimes, it's these infections that are the cause of illness or death in HIV-positive individuals -- not the virus itself. If people do not get any treatment for HIV disease, it takes an average of 8-10 years to progress from HIV to AIDS.

How is HIV transmitted?

HIV is transmitted through four body fluids: blood, semen (and precum), vaginal fluid, and breast milk.

In order to pass HIV from one person to another, HIV-infected fluid from one person needs to get into the bloodstream of another person. HIV is usually transmitted through sharing needles, unprotected anal, vaginal, and sometimes oral sex, and from mother to infant before or during delivery or while breastfeeding.

Special note for HIV-positive mothers:

In developed countries like the U.S., formula feeding is strongly recommended over breastfeeding for babies of HIV-positive mothers. Whether choosing breastfeeding or formula, there should be little or no switching between the two, as doing so could put the child at a higher risk of contracting HIV, since baby formula can be harsh and weaken the lining of a baby's stomach, giving a path for HIV to enter the baby's bloodstream.

How can I prevent myself from contracting HIV?

Becoming educated about HIV and understanding how it is transmitted is the first and perhaps most important way to prevent the spread of HIV. It is essential for people to make informed decisions about the level of risk they are willing to take, based on what is realistic for them.

Abstaining from sex and not sharing needles are the most effective ways for people to protect themselves from HIV and other sexually transmitted diseases (STDs). However, abstinence is not a realistic option for everyone.

Safer sex

When abstinence is not an option, the proper use of barrier protection such as latex or polyurethane condom (male or female) with a water based lubricant is the next best thing for vaginal or anal sex.

Note: Some water-based lubricants (including those already on some condoms) contain a spermicide called Nonoxynol-9 (N-9). Many people are allergic to N-9 and the resulting genital irritation can increase the risk of HIV and STD transmission by providing a direct entry point. You can test for a N-9 allergy by rubbing N-9 lubricant on the inside of the elbow the day before you plan to use the product for sex. If there is no irritation, there is likely no allergy.

What about oral sex?

The best way to reduce the risk of HIV transmission while performing oral sex is to maintain good oral hygiene. That, in addition to not flossing or brushing your teeth right before or after will also reduce the risk of transmission.

Performing oral sex on a woman ("go down", "eat pussy")

When performing oral sex on a woman, a dental dam or common kitchen plastic wrap can be used as a barrier to protect from HIV transmission. It covers the area you are performing oral sex on (vagina or anus). If you do not have a dental dam, you can also use a new, unused, non-lubricated or flavored condom by stretching it out and cutting it down the side, then stretching it out in the same way you would a dental dam or plastic wrap.

Performing oral sex on a man ("blowjob", "head")

In addition to good oral hygiene, proper use of a non-lubricated or flavored condom on a man can significantly decrease risk of HIV transmission. If a condom is not available or an option, not accepting semen into the mouth or spitting rather than swallowing will reduce the risk. You can also use the "harmonica method" by focusing on the shaft of the penis while avoiding the head.

Performing oral sex on the anus ("rimming", "eating ass")

For oral to anal contact, or rimming, a dental dam, plastic wrap, or a condom can be used in the same way described above under the heading “Performing Oral Sex on a Woman.” This can be a great barrier against not only HIV, but possible Hepatitis A exposure.

Receiving oral sex

Since HIV is not transmitted by saliva, there is generally no risk in receiving oral sex (unless there is a lot of blood in their mouth).

How do I use male and female condoms?

Most male condoms are made of latex. Since some people are allergic to latex (your doctor can test for it if you've ever experienced irritation from latex) there are also polyurethane condoms available. When used properly, both latex and polyurethane condoms are effective ways of significantly reducing the risk of HIV transmission.

Note: Lambskin (aka "natural") condoms will not protect against HIV or other sexually transmitted infections (STIs).

When using either latex or polyurethane condoms for vaginal or anal sex, water based lubricants on the outside of the condom will help to reduce friction that could cause the condom to tear. If desired, a small amount can be placed inside the tip of the condom as well.

Important Note: Use of oil based lubricants such as Vaseline can deteriorate latex condoms and significantly increase their chance of breaking. Oil based lubricants should only be used with polyurethane condoms.

When using a male condom

1. Keep it fresh! Always store condoms in a cool dry place (not a wallet) and check the expiration date.

2. Check it! Squeeze the package gently to make sure there are no punctures and be sure to not use your teeth to open the package. Your teeth could rip the condom!

3. Heads Up! Unroll the condom a little before putting it on and make sure it's able to roll easily down the penis. Squeeze the tip (so semen can collect) and roll the condom from the tip of the penis all the way to the base. If uncircumcised, pull the foreskin back before putting the condom on.

4. Don't Double Up! Be sure to never use more than one condom at a time. Doubling up can lead to friction and possibly the condom breaking. One condom is sufficient.

5. Lube it Up! Apply lots of water based lubricant to the condom to prevent friction which could cause breakage.

6. Take It Easy! After ejaculation (cumming), remove the penis from the vagina/anus/mouth while still erect and carefully unroll and remove the condom. Be careful to not spill any semen on your partner.

Never use a condom for more than one session. Always use a new condom each time you have sex, or when you switch from oral to vaginal or anal sex. This will reduce the risk of the condom breaking.

When using a female or reality condom

Although it is referred to as the female condom, it can be used by both men and women. For the female condom, make sure to put it into place before your partner's penis comes into contact with the vagina or anus. Once in place, carefully guide the penis into the condom, making sure to enter the condom and not outside of the condom's external rim.

For vaginal sex

1. Press the inner ring between your fingers to narrow it and make it easier to insert.

2. Hold the condom with its open end pointing down, and insert the closed end into the vagina, letting the wider end remain around the opening of the vagina (it's easier to insert if the knees are spread apart). You can also place the female condom on an erect penis or dildo to insert it.

3. Push the condom up into the vagina, until it is just past the pubic bone (you can tell where the pubic bone is by curving the index finger when it has gone a couple inches into the vagina).

4. When removing the female condom, squeeze the end, twist the condom to keep the semen inside, and pull out. DO NOT FLUSH.

For anal sex

1. Remove the internal ring and place the condom on the partner's erect penis or a dildo.

2. Use the penis/dildo to carefully insert the condom into the anus of the receptive partner.

3. To remove, squeeze the end of the condom, twist to hold the semen inside and remove.

What activities are safe?

While certain sexual activities have little or no risk of HIV transmission (i.e. mutual masturbation, protected oral sex, oral to anal contact (rimming, fingering) possibilities sometimes exist for other sexually transmitted infections (STIs) to be transmitted. While HIV is transmitted only by blood, semen, vaginal fluid, and breast milk, other STIs can be transmitted by simple genital skin-to-skin contact or oral sex. For questions or concerns regarding the risks of particular activities, call the AIDS Action HIV/STD Hotline at 800-235-2331.

If I inject drugs, what should I know?

Since HIV and hepatitis C are blood borne viruses (viruses that exist in and are transported via the bloodstream), any direct blood-to-blood contact is a risk for HIV and hepatitis C transmission.

Sharing needles or works (cotton, cookers, water, etc.) presents a significant risk for transmitting these blood borne viruses. Whenever possible, it is best for each person to use their own needles and works. Click here to learn about needle safety.

Needle exchange sites have been set up to trade in used needles and get new ones. There are four state funded Needle Exchange Sites in Massachusetts -- in Boston, Cambridge, Northampton, and Provincetown.

If you are not near a Needle Exchange site, or cannot get to one, there is another way to get clean syringes. The Pharmacy Access Bill allows individuals 18 and older to purchase needles at a pharmacy without a doctor's prescription. To learn more about needle exchange programs or the Pharmacy Access Bill in Massachusetts click here or call the Pharmacy Access Hotline at 800-988-5209.

Proper disposal of used needles is important as well. Used needles should not be disposed of in the garbage since this creates a risk for anyone handling the trash who may get stuck by an infected needle. Sharps containers are heavy-duty containers used for disposal of needles, and can be acquired through some pharmacies. If a sharps container is not available, an empty plastic liquid detergent or bleach bottle can be used as well. These should then be turned into a designated needle disposal site. For information about acquiring sharps containers, needle disposal sites, or any other questions related to needle handling and safety, please call our Pharmacy Access Hotline at 800-988-5209.

Is there a safe way to share needles?

Needle Safety

The only way to completely avoid potential transmission of blood borne illnesses when using IV drugs is by not sharing needles. If people do share needles, cleaning the needles and works properly with bleach and water before and after each person uses them will help reduce the risk.

How Do I Clean My Used Needles?

The most effective way to sterilize used syringes is the 3x3x3 method:

1. Fill your syringe with water, shake it, and push out the water. Do it three times.

2. Fill your syringe with bleach, shake it, and push out the bleach. Do it three times.

3. Fill your syringe again with clean water, shake it, and push out the water. Do it three times.

4. If bleach isn't available, you can use soap and clean water, or even just water to clean your works. ANY steps you take to clean syringes before use will reduce your risk of HIV and hepatitis C transmission.

Where can I get clean needles/syringes?

Prior to September 2006 the only way to acquire clean needles in MA was via a prescription or through needle exchange programs. As a result of the Pharmacy Access Bill, it is now legal for pharmacies to sell medical syringes over the counter without a prescription. Anyone 18 or older (with proof of age) can purchase clean needles at many pharmacies in MA. They are relatively inexpensive. Although pharmacies are allowed to sell syringes, they are not required to do so. A phone call to the pharmacy in advance can save a trip to the drug store.

If you have questions about the law allowing pharmacy sales of syringes or if you have any positive or negative feedback about specific pharmacies pertaining to this matter, please call our Pharmacy Access Hotline at 800-988-5209.

What should I know about HIV testing?

When thinking of getting tested for HIV, there are a few important things to consider:

1. Window Period: The HIV test is looking for antibodies, which are the body’s response to having HIV in it. For most people, it takes 6 weeks for the body to produce enough antibodies for a standard HIV antibody test to be accurate. Some people call this the "window period". The Massachusetts Department of Public Health recommends waiting 6 weeks between an individual's possible HIV exposure and the time they get tested, providing there are no risks within that time period. For a conclusive test result, it’s recommended to wait 3 months before getting tested.

2. Anonymous vs. Confidential Tests: An anonymous test does not require an individual to provide their name at the time of testing, while a confidential test does require a name. In either case, written consent from the patient is the only way the results will be released, and otherwise will be kept private. Doctor's offices use confidential testing while some private clinics and testing sites will still do anonymous HIV testing, although it is becoming increasingly difficult to find.

3. Standard vs. Rapid Testing: A standard HIV test refers to a blood draw, typically done at a doctor's office. Results are usually received within 5 to 10 business days. Rapid tests (sometimes referred to as OraQuick, OraQuick Advance, or Unigold) involve either a finger prick or a mouth swab. Results are given in about 30 minutes. See below for descriptions of different types of HIV-Antibody tests.

4. Cost: Depending on where you get tested, either insurance will cover the cost, pricing may be based on a sliding-scale which will depend on your income, or you may be able to get a free test.

For more information about testing, please call the AIDS Action Hotline at 800-235-2331.

What are the different types of HIV antibody tests?

There are a couple of different types of tests being used to help people determine their HIV status. When people say "HIV test", they are usually referring to a standard antibody test. However, there are several other screening tests used to detect HIV antibodies that you may want to know about:

1. Standard Test/ELISA: This is the most common HIV antibody test used by most doctors and laboratories and involves a full blood draw which is sent to a laboratory for testing. The extreme sensitivity of the test makes a negative result conclusive (provided the appropriate window period has passed). Sometimes, the test is so sensitive that it will react to other antibodies besides HIV (usually related to auto-immune disorders). In this case, the lab would perform a Western Blot test. The Western Blot is a HIV-specific confirmation test that will either confirm or rule-out HIV infection. Results are usually given in 5-10 business days.

2. OraSure: The OraSure test is perfect for anyone who doesn't like blood. A swab is rubbed between the cheek and lower gum to collect an oral mucosal specimen, which is then sent out for testing. It's recommended that you not eat, drink, smoke, etc., 20 minutes before the test is administered. At the lab, an ELISA (and, if necessary, a Western Blot) is performed on the sample. Results are typically given in 5-10 business days.

3. Rapid Test: A rapid HIV antibody test provides results in about 30 minutes. The administrator pricks the patient's finger and takes a few drops of blood which will then be placed into a solution to develop. The extreme sensitivity of the rapid test means that a negative result (after the window period) is conclusive. If the test does react, the patient will receive a "preliminary positive" result, meaning the test reacted to something in the blood, however not necessarily HIV antibodies. To confirm a reactive rapid test, blood is drawn and sent to a lab for the Western Blot test. Results are ready in 5-10 business days.

4. Home Access: The only FDA approved home collection kit for HIV testing is called Home Access. The kit, costing somewhere between $50-$70, is sold in many large pharmacies (i.e. CVS, Walgreens, etc.), online, and by phone. It involves placing drops of blood onto a card in the kit which is then mailed back for testing. The patient then calls a toll-free number 3-5 business days later, gives the barcode from their testing kit, and receives results. It is an anonymous test, but little to no counseling or support is involved, which is an aspect of testing that many people value. To find out more about Home Access, visit the manufacturer's website here:http://www.homeaccess.com/.

To find a convenient testing site, to talk about testing options, or learn more about the testing process, call the AIDS Action Committee Hotline at 1-800-235-2331.

Why do some sources advise waiting longer than 6 weeks for HIV testing?

Most people will test accurately for HIV after 6 weeks have passed since their last risk. In some cases where a person has a highly compromised immune system, such as those in which a person has recently undergone chemotherapy or an organ transplant, it may take 3-6 months for their body to develop enough antibodies to test positive.

These are very extreme situations, however, and other more common conditions such as colds or the flu, diabetes, asthma, and many others, will not affect the body's development of HIV antibodies in that way. Those who suggest window periods longer than 6 weeks are trying to account for all those who may also have compromised immune systems. The CDC (Centers for Disease Control and Prevention) recommends waiting 3 months for a conclusive test result.

How is HIV treated?

Current HIV antiviral treatments and treatments for opportunistic infections are prolonging the lives of many HIV+ individuals. However, many of the drugs used to treat HIV are very harsh on the body, very difficult to take, and don’t work for everybody. Research is making great strides toward developing vaccines and better medications for people who are living with HIV, but there is still no cure.

Most people who are taking HIV treatments are taking two or more medications at the same time. This is called Highly Active Anti-Retroviral Therapy (HAART). It may also be called combination therapy or “the cocktail”. Combination therapy has been found most effective at combating HIV by attacking the virus in many different ways. There are currently three main classes of medications that are used to treat HIV:

• Entry Inhibitors
• Reverse Transcriptase Inhibitors (Nucleoside, Non-Nucleoside, Nucleotide)
• Protease Inhibitors

If you have specific questions regarding medications, side effects, interactions, etc. please contact the AIDS Action Health Resource Library at 617-450-1432.

I am HIV-positive and pregnant. Will my baby be born with HIV?

Being an HIV-positive mother-to-be does not guarantee that your child will be born HIV-positive. HIV transmission usually occurs during delivery, but can also before birth in the mother's womb.

If an HIV-positive mother receives appropriate care throughout her pregnancy, including medication to lower the amount of virus in her blood, HIV may not spread to the child. Without treatments, risk of HIV transmission to the child is higher, but with medications taken regularly throughout the pregnancy, as well as delivery by Caesarian section, the risk of transmission is lowered dramatically to about a 1-2% chance of transmission.

It is important to note that all children are born with their mother's antibodies, and will therefore test positive on HIV antibody screening tests, regardless of their actual status. These antibodies will usually clear sometime between 6-18 months after birth, and viral load testing can be done around 6 months to determine the infant's actual HIV status.

Note: Mothers-to-be should have regular check-ups, and inform their doctor of their HIV status so that these risk reduction steps can be taken.

What if I have more questions?

If you or anyone you know has any questions about HIV/AIDS or STIs, the AIDS Action Hotline is a great resource! The Hotline is open Monday through Thursday: 9:00am-8:00pm and Friday: 9:00am-5:00pm.

To reach the HIV Hotline, call 1-800-235-2331. For TTY users, the Hotline number is 617-437-1672.

Click here to access our hepatitis FAQs.