FAQ: HIV

Each letter stands for the following terms:

H - Human - because this virus can only infect human beings.

I - Immuno-deficiency - because the effect of the virus is to create a deficiency, a failure to work properly, within the body's immune system.

V - Virus - because this organism is a virus, which means one of its characteristics is that it is incapable of reproducing by itself. It reproduces by nestling itself in the human cell.

HIV is the virus medical researchers believe causes AIDS. Since the vast majority of researchers believe that HIV is the sole cause of AIDS, we often refer to HIV as "the AIDS virus."

Like other viruses, HIV attacks cells in the body. But what makes HIV different is that the immune system can never fully get rid of HIV because the virus attacks the immune system itself--the very thing that would normally get rid of a virus.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system and that can prevent or cure some of the illnesses associated with advanced HIV infection. As with other diseases, early detection offers more options for treatment and preventive care.

The term AIDS applies to the most advanced stage of HIV infection. Each letter stands for the following terms:

A - Acquired - because it's a condition one must acquire or get infected with, not something transmitted through the genes.

I - Immune - because it affects the body's immune system, the part of the body which usually works to fight off germs such as bacteria and viruses.

D - Deficiency - because it makes the immune system deficient (that is, the immune system cannot function properly after infection with HIV).

S - Syndrome - because someone with AIDS may experience a wide range of different diseases and opportunistic infections.

AIDS severely weakens the body's ability to fight infections and certain cancers. That is, people diagnosed with AIDS may have opportunistic infections, which are caused by viruses or bacteria that usually do not make healthy people sick. The immune system of a person with AIDS is threatened to the point that medical intervention may be necessary to prevent or treat serious illness.

STI is a term used to refer to all the sexually transmitted infections (STIs). HIV is one of the many STIs. It is however a very serious STI as there is no cure for it as yet.

You can get infected with the HIV virus by coming into contact with the following fluids from an infected person:

Semen/sperm, vaginal fluid, pre-cum, blood and mother's milk.

Contact with sweat, tears, saliva, faeces and urine from an infected person does not cause an HIV infection.

You cannot get infected with HIV by coming in to contact with the following fluidsf rom an infected person:

Sweat, tears, saliva, faeces, urine

 Fluids that contain enough HIV to infect are: Semen/sperm, vaginal fluid, pre-cum, blood and mother's milk.

• By having unprotected vaginal or anal sexual intercourse (without proper and consistent use of condoms)
• By getting (menstrual) blood or sperm in the mouth during oral sex (there is a small chance of passing HIV infection during oral sex. This can happen when the partner giving oral sex has cuts, wounds abrasions or bruised tissue in the mouth)
• Through blood to blood contact, for instance, in blood transfusions with infected blood, and sharing of sharp objects such as needles, razors and knives
• Through mother to child transmission during delivery or through mother's milk (during breastfeeding)

There are too many ways in which HIV is not transmitted to name here. Some of them include:

• Social activities such as: shaking hands, sharing a toilet, touching a water tap, touching a door knob, kissing, the swimming pool, through food (touching or sharing), hugging, sharing plates, spoons, forks, cups and glasses, playing together, coughing, eating together, sneezing and so on.
• Through insect bites such us mosquitoes, bees and wasps. You therefore need not be afraid of a mosquito bite. When a mosquito bites it sucks blood into it's stomach. If the same mosquito bites someone else it also sucks blood out of, and not into, the second person. There is therefore no blood exchange or injection into the second person, and therefore no danger of HIV infection.
• From the hairdresser, as long as s/he uses new razors.
• From the the hospital as long as needles, operating tools and so on are well sterilized. Doctors, nurses, dentists and other medical personnel are well informed and make sure only to use sterilized instruments to avoid transmission.
• Through blood transfusions: in the Netherlands, and basically all other western European countries, the chance of HIV transmission through a blood transfusion is minimal. All blood is tested and only safe blood (without HIV or other infectious diseases) is used.

No. Not all STIs are curable. Viral STIs such as HIV, Genital herpes, Genital warts(HPV) and Hepatitis B cannot be cured. Once you've caught a viral STI, the virus will remain in your body. This means that the symptoms may recur over and over again. There are however medications available to inhibit the viruses making infections manageable. You will need to take the medication exactly as advised by the doctor in order for them to be effective.

Oral sex in which sperm or (menstruation) blood of the HIV infected person gets in the mouth is unsafe. Research indicates that the presence of gum disease, cuts or sores, wounds, having had recent dental work done that bruised any tissue or having vigorously brushed or flossed your teeth can increase the chance of HIV infection during oral sex. The chance of HIV infection via oral sex whereby neither the sperm nor the (menstruation) blood of the HIV infected partner gets into the mouth is small.

 Some STIs are more likely to be transmitted during oral sex than others. These are:

• Herpes:

Herpes is transmitted by skin-to-skin contact with a developing or existing sore. The virus can be transmitted from genitals to mouth if the person giving oral sex has or is developing a cold sore. It can also be transmitted from mouth to genitals if the person receiving oral sex has or is developing a genital sore.

• Gonorrhoea:

Gonorrhoea is transmitted when bacteria are present in body fluids. A person giving oral sex can get a gonorrhoea infection of the throat if their partner has gonorrhoea.

• HIV/AIDS:

For the person receiving oral sex, there's little chance of contracting HIV, although it's difficult to pinpoint when HIV has been transmitted because people rarely engage in only one type of sexual activity. In the case of fellatio (oral sex on a man), the HIV virus theoretically could gain entry from the mouth to the opening on the tip of the penis, or through an open cut or lesion on the penis. If you receive oral sex, however, you mainly expose yourself to saliva, which has negligible concentrations of HIV.

For the cunnilingus (oral sex on a woman) recipient, the chance of HIV transmission is also low, although the entire vagina is a mucous membrane through which, theoretically, the virus can be transmitted. A woman receiving cunnilingus is more at risk of getting herpes or gonorrhoea from her partner than HIV.

The risk of HIV infection is greater for the partner who performs oral sex. A person performing oral sex on a woman should avoid it during her period, for menstrual blood can carry the HIV virus. Research suggests that HIV transmission by oral sex is associated with cuts, lesions, or irritation of the tissues in the mouth.

Some other STIs are less often transmitted through oral sex. These are:

• Genital Warts (HPV)
• Hepatitis B
• Syphilis
• Chlamydia
• Chancroid

There are many places you can go for confidential and professional help in The Netherlands. Both for examination and treatment of STIs. These include: Your GP (huisarts), a GGD clinic (these are all over the country). You can find more information on: www.soaaids.nl/soacentra.html

The fact that it is best to talk about condoms before having sex does not make it easier. Many people, even those who already have experience with having sex,  can be quite embarrassed by the topic of condoms.

The best time to bring up the topic of condoms is long before you're in a situation where you might need a condom. When people are caught up in the heat of the moment, it might be more difficult to say no or to think logically.

One idea to make speaking about condoms easier is to practice opening lines. Especially if you think your partner will object, work out your response ahead of time. Here are some possibilities:

• Your partner says: "It's uncomfortable."

• Your partner says: "It puts me right out of the mood."

Say that having unsafe sex puts you right out of the mood. Permanently.

• Your partner says: "If we really love each other, we should trust each other."

Say that it's because you love each other so much that you want to be sure you're both safe.

• Your partner says: "Are you nervous about catching something?"

The natural response: "Sometimes people don't even know when they have infections, so it's better to be safe."

• Your partner says: "I won't enjoy sex if we use a condom."

Say you can't enjoy sex unless it's safe.

• Your partner says: "I don't know how to put it on."

This one's easy: "Here, let me show you."

• Try bringing up the topic in a matter-of-fact way. You might mention that you've bought some condoms and checked them out. Offer to bring the unopened condoms along. Or suggest that your partner buy his or her favourite brand (make sure to bring some of yours with you, just to be on the safe side). Offer to try different types of condoms to find which works best for both of you.

• Make it clear that you won't have sex without a condom.

Firstly it is very wise that you and/or your partner have taken the HIV or other STI test. Now you are informed and can make some choices. If one and not both of you have tested, then let the untested partner also get tested.

Once you know your status you should get yourself on treatment as soon as possible to avoid further complications, and further infection of others. If you are pregnant it is also very important to get on treatment as your unborn child could also get infected, or worse still die before or after birth.

Is your partner not informed about your infection, let him/her know so that he/she too can get tested and get treatment and/or advise on how to stay healthy. GGDs and other health providers can inform your sexual partners for you should you not want to do it yourself. This can also be done anonymously should you so wish.

Yes you can. There are measures that can dramatically reduce the risk of you passing on HIV to your baby.  The risk of mother-to-child transmission is as low as 2% in some areas such as in developed countries, and treatment possibilities have prolonged life expectancy for many potential parents with HIV.

You can reduce the risk for your baby by:

• Taking certain anti-HIV drugs during your pregnancy (the doctor will know which).
• Having an ‘elective caesarean'. This means not giving birth naturally but having your baby via a caesarean. For HIV positive women, this is often done in the 38^th week of pregnancy.
• Not breastfeeding your baby. The chance of you infecting your baby through breast milk can be as high as 8 out of 10. Do not breastfeed if you are HIV positive! Feed your baby formula from birth. Formula is often as healthy as mother's milk. If people ask why you do not breastfeed you can always say your baby does not want to (it is common knowledge that some babies refuse to breastfeed) or that you have no milk.

ART/ARV's is short for ‘Antiretrovirals'and refers to the medications used to treat HIV. ‘Combination therapy' or ‘HAART' (Highly Active Anti-retroviral Therapy) are two terms that are used to refer to a combination of 3 or more different medicines which inhibit the multiplication of HIV in the blood.

CD4 cells are white blood cells that protect the body against infections. They are also known as ‘Helper T-cells', ‘T4 cells' or ‘CD4 Lymphocytes'. These cells form the natural defence system of the body, the immune system.

The CD4 count is the amount of CD4 cells one has is his/her blood. This amount determines the body's ability to defend itself against infections. The higher the number of CD4 cells, the better one's immune system works. A healthy person has between 600 and 1500 CD4 cells/mm3 of blood. Moderate immunosuppression in adults is associated with a CD4 cell count between 200 and 500 cells/mm3, while severe immunodeficiency is associated with counts below 200 cells/mm3.

These are however also the cells used by the HIV-virus to multiply itself. HIV weakens immune system function by attacking and killing CD4 cells.

This is the amount of HIV virus in the blood or other tissues. It is expressed by the number of virus particles per millilitre. The more the virus there is in the blood or tissues, the more the chance of the person becoming sick (and therefore developing AIDS). With medication, the amount of the virus can be reduced in the blood, warding off opportunistic infections. It is however very important to take medication very faithfully in order for it to be effective, and to prevent the HIV virus in your body from becoming resistant to it. 

If HIV medication works well, the viral load can be reduced to less than 50 copies per millilitre. This is called undetectable. It means that there is hardly any virus in the blood. There is still a discussion amongst scientists on whether one can infect another when they are undetectable. The answer at this moment is yes. So even when your partner is undetectable it is important to practice safe sex (i.e. vaginal, anal and oral sexual contact with a condom).

Post-Exposure Prophylaxis refers to drugs given immediately following exposure to an infectious organism in an attempt to prevent the infection from taking hold in the body. In the case of HIV, the drugs are given in order to prevent infection with the HIV virus after exposure to the virus (for instance, if a condom tears during sex, after a rape, and so on). There is however no real evidence that PEP really works. Prevention of infection still remains the best option.

Resistance means that the HIV (or other) virus has adapted itself to a particular medication such that the medication is no longer effective. In the case of HIV medication, resistance can develop quite easily. This can for instance occur when there is an insufficient amount of medication in the body to prevent the virus from multiplying. This can be caused by not adhering to one's medical regime as prescribed by the doctor.

This refers to the length of time between the point of infection and the point when there are enough antibodies to be detected by a HIV test.

Tests commonly used to detect HIV infection look for the presence of antibodies that fight HIV. Most people develop detectable antibodies against the HIV virus within 3 months of infection. For a few number of people it could take longer, but in hardly any cases is this more that 6 months. If an HIV test is negative 3 months after a high risk experience, an individual should consult their medical provider to determine if the test should be repeated.

No it does not. An HIV infection can be detected by testing urine or a saliva because these two substances can contain anti-bodies of HIV, but not the HIV-virus itself. Anti-bodies are substances the body produces to fight a particular infection or disease it might be having. So if one has malaria, the body will produce malaria anti-bodies to fight it and get better.

This refers to always taking (HIV) medication precisely as prescribed by the doctor. Correct amount, combinations, times, with correct feeding and consistently. If it's twice every day, once at 7AM and once at 7PM, after a meal, then one does this without fail. There is a danger of the virus becoming resistant if one does not adhere to the doctors prescription, making the particular medication, and others that are similar to it, ineffective.

If you go on HIV medication, the doctor will advice you on what foods to eat, which medication(s) should be taking before or after meals, and which foods to avoid. Some medications should be taken after eating fatty foods, some with a lot of water and so on. It is important to follow the doctors instructions in order for the HIV medication to work properly, and in order to avoid the virus from developing resistance to particular medication.

This refers to infections that are not prevalent in people with healthy immune systems. This is because the immune systems of healthy people would be able to keep them away. These infections can however easily attack a person with HIV and cause damage because his/her immune system has been weekend by the virus, making it very difficult, and sometimes even impossible for the body to fight off the attack. This is why for instance people with HIV can die from tuberculosis (TB) or develop uncommon cancers such as Kaposi's Sarcoma.

HIV seroconversion refers to the time between infection and development of HIV. It is the time  in which a person develops antibodies for HIV but does not yet test positive for it. Seroconversion means that your serostatus is converting from being HIV negative (not containing HIV antibodies) to being HIV positive (containing HIV antibodies)

Seroconversion usually occurs one to 3 months after infection but usually takes several months. It is for this reason that people are advised to have an HIV test 3 months after suspected exposure to the HIV virus. In very very few cases will the body take more that 3 months to develop HIV antibodies. Should want to be extra sure you can always have an additional HIV test after 6 months.

The only way to know if you are HIV-positive is through an HIV test. If you have recently been exposed to HIV, or think you may have been exposed to HIV, then contact a doctor or sexual health clinic.