HIV 101

Question: How many people have HIV/AIDS?

Worldwide: UNAIDS estimates that as of December 2000, there were an estimated 36.1 million people living with HIV/AIDS (34.7 million adults and 1.4 million children under 15). Since the epidemic began, an estimated 21.8 million people have died of AIDS (17.5 million adults and 4.3 million children under 15).

An estimated 5.3 million new HIV infections occurred in 2000. During 2000, HIV- and AIDS-associated illnesses caused deaths of an estimated 3 million people, including 500,000 children under the age of 15.

In the United States, there are between 800,000 and 900,000 people living with HIV, with a third of them not even knowing their status. Through December 2000, a total of 774,467 cases of AIDS have been reported; of this number, 448,060 persons (representing 58% of cases) have died.

In San Francisco, there are approximately 15,000 people living with HIV/AIDS, the majority of them being gay men. This represents approximately 33% of all gay men in San Francisco who are already infected with HIV, with an estimated 1 in 3 of these men are unaware of their HIV-positive status. Because of this high prevalence, with every unsafe sexual encounter for MSM in San Francisco there is a greater risk for HIV transmission as compared to other US cities.

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Question: What is difference between HIV and AIDS?

HIV (Human Immunodeficiency Virus) is a virus that attacks and breaks down the body's immune system - the "internal defense force" that fights off infections and disease. When the immune system becomes weak, we lose our protection against illness and can develop serious, often life-threatening, infections and cancers.

AIDS (Acquired Immune Deficiency Syndrome) is the name for the condition that people with HIV have if they develop one of the serious infections connected with HIV, or if blood tests show that their immune system has been very badly damaged by the virus.

It usually takes many years before HIV breaks down a person's immune system and causes AIDS. Most people have few, if any, symptoms for several years after they are infected. But once HIV gets into the body, it can do serious damage to the immune system. People who appear perfectly healthy may have the virus, without knowing it, and pass it on to others.

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Question: How do you get HIV?

HIV can be found in the blood, cum/pre-cum, vaginal fluid, or breast milk of an infected person. An uninfected person can get HIV if blood, cum/pre-cum, vaginal fluid, or breast milk from an infected person enters their body and gets into their bloodstream. HIV can enter the body through a vein (by IV drug use), the asshole/vagina/cock/mouth (by unprotected sex), other mucous membranes (like the eyes or inside of the nose), or any open cuts/sores.

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Question: What are the most common ways that HIV is transmitted from one person to another?

The three most common ways that HIV is transmitted are:

• By having sex, particularly unprotected sex (anal, vaginal, or oral) with an HIV-infected person,
• By sharing needles, syringes, or injection equipment with an intravenous (IV) drug user who is infected with HIV, and from HIV-infected women to babies before or during birth, or through breast-feeding after birth (which isn't common in San Francisco).
• Through transfusions of infected blood or blood clotting factors.

However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world. Some health-care workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood came into contact with a worker's open cut, or through splashes into a worker's eyes, or inside his/her nose, but this is not a common occurrence. There has only been one instance of any patients being infected by an HIV-infected health-care worker. This involved HIV transmission from an infected dentist to six patients (the dentist's instruments weren't properly sterilized).

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HIV TESTING

Question: Why should I get tested for HIV?

Because you should consider at what risk you put your partner(s) if you don't know your own HIV status, or if you are HIV+. The only way to tell if you have been infected with HIV is by taking an HIV antibody test. The advantages to knowing your HIV status are:
You can prevent infection to others if you find out you are HIV+, and you can seek medical therapies earlier.

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Question: How often should I get tested if I'm sexually active?

The current HIV tests detect the presence of HIV antibody. HIV antibody is your body's response to the presence of HIV virus. In most persons it takes a few weeks to develop antibodies that are detectable by current tests. 95% of people develop antibodies within 3 months after being infected. It is recommended that people take a second test in 6 months, because 99% of those infected will develop antibodies within 6 months. A positive test is positive no matter when the test was. A negative test becomes more and more a true and accurate result the longer after the possible exposure.

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Question: How can I tell if I’m infected with HIV?

You can't unless you get tested for HIV. The early symptoms of HIV infection are often flu-like, but not everyone exhibits these early symptoms, so you may not even know or think you’re infected. The only way to know for certain whether or not you have the virus is to be tested.

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Question: How long after a possible exposure should I wait to get tested for HIV?

If your exposure was within 72 hours, you could be eligible for a study that might prevent the virus from taking hold in your body. The study, called P.E.P., or Post-Exposure Prophylaxis, would give you a course of anti-HIV medications that may decrease the odds of infection by 81%. Call 415-514-4737 (or 4PEP) for more info.

Otherwise, since the tests commonly used to detect HIV infection are actually looking for the antibodies produced by your body to fight HIV, rather than HIV itself, it’s suggested that you wait at least 2-3 weeks after a possible exposure to take the test. This will allow your body to develop more HIV antibodies if you have been exposed and can make for a more accurate test result. Most people will develop detectable antibodies within 3 months of the initial exposure, with the average being about 25 days. In rare cases, it can take up to 6 months for detectable antibodies to develop. For this reason, the CDC currently recommends testing 6 months after the last possible exposure (from unprotected vaginal, anal, or oral sex, and/or sharing needles). It's extremely rare for it to take longer than 6 months to develop detectable antibodies. It's also very important during the 6 months between a possible exposure and taking the HIV test that you protect yourself and others from further possible exposures to HIV (from unprotected sex or sharing needles).

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Question: What kinds of HIV testing are available?

There are two different types of HIV testing—anonymous and confidential.
The difference between anonymous and confidential HIV testing is that anonymous HIV testing means that absolutely no one besides you will have access to your test results since your name is never given or recorded at the testing site. Instead, you are given a unique identifier code, and you (the person being tested) are the only one who is ever made aware of the test results. This protects you from any risk of discrimination or adverse impact, especially in applications for insurance. Anonymous testing is available in many states. Confidential HIV testing, also called names reporting, does record your name. Confidentiality laws and regulations protect this information, but medical personnel and, in some states, the state health department will have access to your test results. Also, if you choose to sign a release form to have your personal physician notified, the information will become a part of your medical record. Health care workers, insurers, or employers may see it once it becomes part of your medical record. Your status may become known if you make a claim for health insurance benefits, or apply for life insurance or disability insurance. Confidential testing is available in all states.

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Question: What is non-names HIV reporting?

A coded, non-names based form of comprehensive HIV infection reporting implemented in California in mid-summer 2002. California joins several other states—including Texas, Maryland, Illinois, Massachusetts, and Hawaii—that have already adopted a coded system of HIV infection reporting.

To facilitate the state’s efforts to plan for future HIV/AIDS services, California implemented a non-name based HIV reporting system in the summer 0f 2002. Laboratories and physicians are now responsible for reporting confidential demographic and risk information about individuals testing positive for HIV or receiving others tests, such as T-cell or viral load tests, that are indicative of HIV infection. It is hoped that this will minimize the extent to which people are deterred from seeking HIV testing and/or appropriate medical care by the fear that their name and HIV status is being collected by the government.

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Question: Are there different kinds of HIV tests?

There are currently four kinds of HIV test available, though all four may not be available at every testing site.

• Blood Antibody HIV Tests. Blood antibody tests are used to detect HIV antibodies in the bloodstream. The most common screening tests used today are the EIA (enzyme immunoassay) and the ELISA (enzyme-linked immunosorbent assay). A second test, referred to as the Western Blot test, is run to confirm a positive result. When the EIA or ELISA is used in conjunction with the Western Blot confirmation test, the results are more than 99.9% accurate. Results from EIA/ELISA HIV tests are usually available several days to several weeks later.
• Oral Antibody HIV Tests. Oral HIV antibody EIA and oral HIV antibody Western Blot tests are alternatives to blood tests. Oral testing is done with samples of mucous from inside the cheeks and gums rather than with blood. Oral tests have been approved by the FDA and are as accurate as blood tests. This test is done to detect the presence of HIV antibodies, not the virus itself. No cases of HIV transmission have been attributed to saliva.
• Home HIV Testing Kits. Consumer-controlled test kits (popularly known as "home HIV test kits") were first licensed in 1997. The testing procedure involves pricking your finger with a special device, placing drops of blood on a specially treated card, then mailing the card in to be tested at a licensed laboratory where your HIV status will be determined. The test results are accessed by using an anonymous identification number, which customers are given in the kit. They use this number when phoning for their test results several weeks later. Home testing kits are sold in drugstores and health clinics throughout the country and are available by mail. The Home Access test kit can be found at most local drug stores.
• OraQuick Rapid HIV-1 Antibody Test. A rapid test for detecting antibodies to the human immunodeficiency virus (HIV) is a screening test that produces very quick results, in approximately 20-60 minutes. In comparison, results from the commonly used HIV antibody screening test, the enzyme immunoassay (EIA), are not available for 1-2 weeks. Three rapid HIV tests have been approved by the Food and Drug Administration (FDA) for use in the United States, though one has since been removed from circulation. Of the remaining two, the OraQuick Rapid HIV-1 Antibody Test was approved November 7, 2002, for use by trained personnel in the diagnosis of HIV infection. OraQuick is a simple, rapid test that can detect antibodies to HIV in finger-stick whole-blood specimens and provide results in as little as 20 minutes. A second FDA-approved moderate-complexity rapid HIV test, Reveal, remains available in the United States for use with serum or plasma specimens. These rapid tests are considered to be just as accurate as the commonly used EIA.

Both the rapid test and the EIA look for the presence of antibodies to HIV. As is true for all screening tests (including the EIA), a reactive rapid HIV test result must be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be given.

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Question: Are there other HIV tests available?

There are six other HIV tests available to people.

• The EIA (enzyme immunoassay) is the standard screening test used to detect the presence of antibodies to HIV. The EIA should be used with a confirmatory test such as the Western blot. Tests that detect other signs of HIV are available for special purposes, such as for additional testing of the blood supply and conducting research. Because some tests are expensive or require sophisticated equipment and specialized training, their use is limited. In addition to the EIA, other tests now available include:
• Radioimmunoprecipitation assay (CONDOMA): A confirmatory blood test that may be used when antibody levels are very low or difficult to detect or when Western blot test results are uncertain. An expensive test, the CONDOMA requires time and expertise to perform.
• Rapid latex agglutination assay: A simplified, inexpensive blood test that may prove useful in medically disadvantaged areas where there is a high prevalence of HIV infection.
• Dot-blot immunobinding assay: A rapid-screening blood test that is cost-effective and that may become an alternative to conventional EIA and Western blot testing.
• p24 antigen capture assay: Also known as the HIV-1 antigen capture assay. This blood test was added as an interim measure by the Food and Drug Administration (FDA) in 1996 to HIV-antibody testing to protect the blood supply further until other tests become available to detect early HIV infection before antibodies are fully developed. Because some activity of p24 antigen is unpredictable, this test is not useful for helping people find out if they have HIV.
• Polymerase chain reaction (PCR): A specialized blood test that looks for HIV genetic information. Although expensive and labor-intensive, the test can detect the virus even in someone only recently infected. To further protect the blood supply, the FDA has indicated that the development and implementation of tests for HIV genetic material such as PCR is warranted.

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Question: If I test HIV–, does that mean that my partner is HIV– also?

No. Your HIV test result reveals only your HIV status. Your negative test result does not tell you whether your partner has HIV. HIV is not necessarily transmitted every time there is an exposure. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected. Testing should never take the place of protecting yourself from HIV infection. If your behaviors are putting you at risk for exposure to HIV, it is important to reduce your risks.

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TESTING SITES

Question: Where can I get tested?

Besides getting tested through your primary care physician, gay men in San Francisco can get tested at numerous sites and clinics that offer both anonymous and confidential testing.

Access this LINK to see the major HIV and STD testing sites in San Francisco.

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ALL ABOUT PEP

Question: I think I was exposed to HIV. Is there anything I can do about it now?

Yes. In many cities, like San Francisco, after having a known exposure to HIV -- being topped by an HIV+ guy and then the condom breaks -- a guy can start PEP, or post-exposure prevention, which is a combination of anti-HIV medications. The important thing is that these medications have to be started as soon as possible, ideally within four hours, but it may be OK within 72 hours after exposure. Most emergency rooms and doctors know about PEP and can prescribe it. It's not one dose -- you have to take meds for a month and they can make you ill -- so I don't recommend it except in real emergencies. To learn more about PEP, go to the UCSF HIV Insite Web site and type PEP in the Search box.

PEP is usually not provided to people who have been exposed to HIV through oral sex. Oral sex carries a very, very low risk of HIV transmission. One recent study has shown the risk to be as low as zero, but there are case reports out there of men who have gotten HIV from participating in oral sex only. Best to speak to your doctor, or get a recommendation to another local provider if you want another opinion for how to move forward.

Being exposed to HIV, even possibly, is a very anxiety-provoking experience. For some people, the anxiety leading up to the 3-month HIV test and its results is debilitating. They suffer from irritability, sleeplessness, fatigue, depression, personality changes, headaches, and more. If you are experiencing any of these symptoms, speak to a counselor who can help you work through them.

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