HIV stands for Human Immunodeficiency Virus. HIV spreads through the body and targets the immune system, making it hard for the body to fight off illnesses.
HIV is a virus that can be passed through unprotected sex (vaginal, anal, and oral) or sharing drug injection equipment (like needles) with someone who is HIV-positive. The HIV virus is present in bodily fluids like blood, semen, anal, and vaginal secretions.
There is no known cure for HIV but it can be treated. People who are HIV-positive can and do live long, full, and healthy lives (including family, sexual, and love lives) when the virus is managed.
Without treatment, an HIV infection can lead to AIDS (acquired immune deficiency syndrome), which is when, the body eventually loses its ability to fight off opportunistic infections and cancers. This is why knowing our HIV status is very important. It means getting the treatment we need to stay healthy.
Symptoms
*Not everyone will experience symptoms
Not everyone will experience symptoms after an HIV infection but many will. This can look like flu-like symptoms within two to four weeks of the infection (e.g., fever and body aches, swollen lymph nodes, oral or genital ulcers, fatigue, weight loss, nausea, diarrhea, and vomiting). These symptoms can last anywhere from a few days to several weeks. Other people do not feel sick at all during this stage, which is also known as an acute HIV infection.
After the early stage of HIV infection (the acute phase), the infection will move to what we call “chronic HIV infection.” During this stage, HIV is still active but reproduces at very low levels. People with chronic HIV infection may not have any HIV-related symptoms or only mild ones.
Without treatment, this stage can last a decade or longer. For some, it may progress faster. Some people may not experience any symptoms at this stage but some do. Regardless of someone having symptoms, the immune system is being damaged by the virus; the recommendation is to start HIV treatment as soon as diagnosed. Symptoms of untreated chronic HIV can include swollen lymph nodes, chronic diarrhea and flu symptoms, abnormal pap smears, shortness of breath, oral and genital lesions, chronic yeast infections, and loss of vision.
If HIV is not treated with medication, it can lead to someone being diagnosed with AIDS (Acquired Immune Deficiency Syndrome), which is the late stage of HIV. AIDS symptoms include a severely repressed immune system that can lead to severe infections, cancers, and dementia.
Transmission and Prevention
The majority of HIV transmissions happen through unprotected sex (anal, vaginal and, much more rarely, oral) and sharing needles or tools used for injection drug use. That is because HIV is present in body fluids like blood, semen, anal, and vaginal secretions. In some cases, HIV can also be transmitted through tattooing with non-sterile equipment.[2]
HIV can also be transmitted from a pregnant individual to their baby during childbirth, and through breastfeeding and chestfeeding. With medical support, the risk of that happening is very low. HIV test is part of routine prenatal care to ensure that someone who is pregnant and who may not have known they were HIV-positive will get the treatment they need to reduce the risk of transmission to their baby to less than 1 percent.
Condoms, when used consistently and correctly, are a highly effective strategy to reduce the risk of HIV transmission because they reduce the risk of being exposed to bodily fluids that may contain HIV.
To prevent transmission when using needles to inject drugs, make sure that everyone has their own equipment (needles, cookers, etc.). Needle exchange programs and safe injection/consumption sites are very important resources in our communities to make sure people can avoid sharing needles and other drug equipment and by extension, reduce the likelihood of transmitting STBBIS. Check in with your public health unit to know what harm reduction services are available in your region.
It’s important to know that HIV can still be passed even when there are no symptoms. Someone who is not treated may not have symptoms but can still pass the virus. Most transmissions happen when people don’t know their HIV status (and usually during the acute phase of the infection). When someone tests positive for HIV and starts treatment, it might mean that they will be able to suppress their viral load (the number of copies of the virus that can be detected in our blood). If the virus becomes undetectable because of medication, the virus cannot be transmitted sexually. Undetectable equals untransmittable.
Another strategy to avoid HIV transmission is to use pre-exposure prophlyaxis (PrEP). PrEP is a daily dose of HIV meditation that HIV-negative people can take to prevent them from getting the virus from HIV-positive partners. This requires ongoing consultation with a health care provider and can be particular useful if one or more of your sexual and/or romantic partners is HIV-positive or you are engaging in unprotected sex without knowing the HIV status of partners.
If exposure to HIV or likely exposure has occurred, post-exposure prophlyaxis (PEP) (a daily dose of HIV medication for a set period of time) can be taken up to 72 hours after exposure to reduce the likelihood of transmission.
STI testing is one of the most important prevention strategies when it comes to HIV. Knowing your HIV status means you can take the appropriate measures to either prevent getting the virus if you are HIV-negative or ensure you receive treatment if you are HIV-positive so your immune system stays healthy and you don’t pass on the virus to partners. We are also less at risk for an HIV infection when we don’t have other active STIs. When we get tested for STIs (like chlamydia or gonorrhea), we can get treated right away, which reduces our risk of getting HIV.
Treatment
While there is no cure for HIV, HIV can be managed with treatment and people living with HIV can live long and healthy lives. Treatment through antiretroviral therapy (ART) is effective in managing the virus and protecting the immune system and can even result in an undetectable viral load (a reduction of the number of copies of the HIV virus in your blood). When your viral load is undetectable, you cannot transmit HIV to a partner. For more on this, see Undetectable = Untransmittable.
Treatment regimens should be selected and discussed with a health care provider. Having a solid health care team is invaluable when managing HIV.
Testing
Testing for HIV is performed by blood work. The different types of HIV testing include:
Point of Care HIV Testing (or Rapid Testing)*
*This is not available everywhere. Check with your public health unit to see if Point of Care testing is offered near you.
Point of Care HIV Testing (or Rapid Testing) is done by pricking your finger and testing your blood while you wait. If you test negative, you receive your results immediately. If you test reactive (or the test result is uncertain), the clinic will take a blood sample and send it to the public health laboratory for standard testing. It can take up to two weeks and you will have to return to the clinic to get your results.
The Standard Test
The Standard Test uses a small sample of blood taken from a vein in your arm. The blood sample is sent to a lab for testing and results come back one to three weeks later. You usually need to go back to the doctor’s office or clinic to get the results.
Prenatal HIV Testing Program
Canada’s provinces and territories have different rules around prenatal testing but HIV testing is important when someone is pregnant. If you are pregnant and are HIV-positive, you can take important steps to stay healthy and to prevent HIV transmission to the baby.
Anonymity and Confidentiality
HIV testing can occur anonymously or health care providers may take your name and some identifying information.
Anonymous Testing
When you take an anonymous test, your name or your identity is not requested, recorded, or reported. You are given a code to receive your results.
Although anonymous HIV testing sites do not ask for your name, they do ask for information about your age, assigned sex, and risk factors. This gives public health officials important data that is used to help understand the prevalence of HIV and to monitor trends in transmission and infection rates.
The fact that you got tested, as well as your test results, are not added to your health care record. It is only you who can decide to give your name and include the HIV test result in your medical record through disclosing your status to your health care provider. If your test is positive, when you disclose this information to a health care provider and begin receiving treatment and care for HIV, this information will be recorded in your medical chart and your result will no longer be anonymous.
Depending on where you are, you may be able to access anonymous testing in some sexual health and specialized clinics. To help you find a site that offers anonymous testing (or to know if anonymous testing is available in your province), contact your local AIDS Service Organization or public health unit.
Nominal or Name-Based HIV Testing
Nominal or name-based HIV testing is offered in many places like health care clinics and doctor’s offices. The test is ordered under your name and you may be asked for information like possible HIV transmission risk factors.
If the HIV test result is positive, your health care provider is required by law to notify public health officials in your region of a positive test. They do not need to know your name, just that there was a positive result, because public health units track important data on HIV infections on an anonymous basis. This means that while a positive HIV test result will be in your health record,* the public health data gathered at the provincial level is not attached to any name.
*while a positive HIV test result is not anonymous, it is confidential. Your health care provider is held to professional standards around sharing this information about you.
Non-Nominal or Non-Identifying HIV Testing
Non-nominal or non-identifying HIV testing is similar to nominal testing but the test is ordered using a code or your initials. It does not include your full name. If the HIV test result is positive, your health care provider is required by law to notify public health officials in your region of a positive test result as they track important data on HIV infection on an anonymous basis. When the test result is positive, it will then be recorded in your health care record so you can access treatment. This should be treated as confidential information.
[1] It’s important to be mindful that many people in Canada experience barriers when it comes to getting screened regularly, including having a family physician who can schedule routine check-ups. Different circumstances can also mean dealing with one emergency after another, like being housing insecure or homeless, or facing barriers like racism, socioeconomic status, or geographical location. Others may feel real discomfort with procedures that involve their genitalia due to transphobia or trauma. Precancers may also progress faster and be more aggressive in HIV-positive people. In these cases, prevention tools such as the HPV vaccine are crucial because other methods may or may not be accessible.
[2] When we talk about HIV, there is a lot of stigma that clouds our view of how much risk we face. Click here to access a table prepared by CATIE (Canada’s source of information on HIV and hepatitis C) that breaks down the risk of HIV infection for each sexual act with someone who is HIV-positive or who does not know their HIV status (and may be HIV-positive without knowing it). This may be helpful in making decisions in terms of safer sex strategies we may wish to use and what kind of sex we are comfortable having and with whom.
For example, someone might be comfortable having unprotected vaginal and/or anal sex with a monogamous partner who knows their HIV status (and who got tested in a recent time). The same person may want to use a condom to have sex with a more casual partner, someone who may not know their HIV status or someone who is HIV-positive. Someone else might only be comfortable having oral sex with casual partners or with people who don’t know their HIV status. Someone else may be comfortable with having unprotected sex with an HIV-positive partner whose viral load is suppressed because of their medication. What it comes down to is having the right information to make the decision that is right for each of us at different moments, depending on the partner and/or the circumstances.