Understanding and managing HIV

The days of school kids calling each other AIDS are over, because fortunately, kids don’t know what AIDS is any more.

However, this doesn’t mean that HIV infection rates have slowed. In fact, HIV infections are increasing since the campaigns of the 80s ended, and there are generations of young people who have no idea what HIV (Human Immunodeficiency Virus) is, what it can do to them, and how they can contract it.

HIV is a virus transmitted via body fluids, particularly blood and sexual fluids like semen and vaginal secretions. It attacks the immune system, leaving the body open to infections. This is the part formerly called AIDS (Acquired Immunodeficiency Syndrome), though now it is called late-stage HIV infection.^​1​

These days, so long as you have enough money to pay for treatment or a free healthcare system, it’s rare for anyone to die from complications from HIV, and they can live a healthy, long life.^​2​

Any sexually active person is susceptible to HIV infection, but particularly vulnerable are women and gay men, who both act as receptacles for virus-infected blood and semen.

It is much harder for a cisgender man to contract HIV from a cisgender woman through vaginal sex, but it can definitely still happen. Infections with HIV can also occur via shared needles, open wounds or other, rarer methods.

Understanding how HIV affects the body

HIV is a retrovirus that attacks CD4 T cells, white blood cells, and a big part of the immune system.^​3​

HIV multiplies within these cells and cannot be destroyed by them; it lives inside the cells that would usually kill it. This is makes HIV difficult to treat as it keeps changing the coating of the cell, like an invisibility suit. Once the immune system is weakened, it’s easy to catch just about everything going around, which makes it essential to take ART drugs.

If you have HIV, it does not mean you will develop AIDS; AIDS is unlikely to eventuate if you are treated early enough with ART drugs. There is almost always a bit of a lag, even if you don’t know you have HIV, between becoming infected with HIV and AIDS developing. This is because it takes quite some time for CD4 T cells to decrease in number, leading to decreased immunity.

What happens inside your body?

Once inside the CD4 T cells the virus makes a copy of itself, and the new virus ‘bit’ breaks out of the old cell, killing the cell. The new virus then goes into a new CD4 T cell, and the same thing keeps happening.

Every day millions of virus ‘bits’ are made inside the CD4 T cells, and every day millions of cells die. Your body, being the trooper it is, makes more and more CD4 T cells, though over time, your body becomes exhausted and your immune system starts to fail.

This usually takes a little while. You notice then because you start to catch bugs that would normally pass you by. You become like an open wound.

Symptoms of HIV infection

If you have been infected with HIV, symptoms may or may not be obvious. Most people experience some symptoms, but not everyone. The three most common symptoms are a sore throat, fever and blotchy red rash.

These symptoms can extend to feeling sick, diarrhoea, headache, feeling tired and achy, with swollen glands. These symptoms look like an ordinary flu, but can last up to three weeks.

Swollen lymph glands and night sweats may hang around. Once this part is done, you may be symptom-free for years, which is why people can go for a long time without realising anything is wrong.

Sometimes, mouth ulcers, recurring herpes or shingles infections, or dermatitis may appear. If you had tuberculosis (TB) at some point in the past, it may flare up again. Signs that AIDS may be impending are diarrhoea, rashes, feeling tired and losing weight.

Who contracts HIV?

When HIV broke out in the 80s, it was known as ‘the gay disease’ because it predominantly affected gay men who were having unprotected sex. Gay men, in general, tend to have a great deal of sex, often with multiple partners in short spaces of time, which means that the spread of HIV was fast and deadly.

Of course it wasn’t just gay men who were affected, because in the 80s there were still a lot of gay and bisexual men who were married to women. Now in the UK 49% of HIV diagnoses are in heterosexuals, vs 45% in gay and bisexual men.

In Australia, there were 722 new cases of HIV in 2023, up from 553  in 2022, but cases are down dramatically (33%) from a decade ago.

The UK, by comparison, had 3,043 new cases in 2024, down dramatically from 8,000 in 2006 and 6,660 in 2010.

In the United States, 31,800 people were newly diagnosed with HIV in 2022, down from about 50,000 a decade ago. There are estimated to be over 170,000 people in the USA living with HIV who don’t know about it. Heterosexual men and women account for the highest number of new infections, far surpassing gay men.

Contracting HIV through sex

You can transmit HIV to others, even if you have no symptoms, via unprotected sex and blood. The virus enters the body through the mucosa of the vagina, rectum, penis, vulva or mouth during sex. Oral sex presents a much lower risk of infection unless you have ulcers or bleeding gums.

Giving penile oral sex if you have a sore throat can do it. Kissing, sneezing and spitting do not pass HIV on. The protective bacteria in the vagina offer some protection from HIV.^​4,5​ In fact, one researcher said that Lactobacillus crispatus is ‘better than a condom’, which is high praise indeed.

Another main way people contract HIV is sharing needles when administering drugs; however, community needle initiatives have vastly reduced this as a transmission method. Success! Needle and syringe programs work.

In the past, before anyone really knew about it, HIV was passed on via blood transfusions, but mandatory testing of donated blood in developed countries has put an end to this.

Developing countries still have HIV in donated blood as an issue, because they need the blood but can’t afford to have it tested. Rule here? Watch out where you get your blood transfusions!

HIV and babies

Testing during pregnancy is recommended, since, amazingly, doctors can now save the baby from contracting it from the mother.^​6​

Having a caesarean is usually advised in these cases to reduce the risks of birth trauma. Breastfeeding can occasionally transmit the virus, but bottle feeding prevents that very easily.

With early detection, life can continue as usual, with a few minor side effects from antiretroviral therapy (ART) drugs. Ok, sometimes they are not so minor, but still: you don’t need to die from HIV.^​7​

If you are having sex with someone who hasn’t been tested recently, and who is or has been having sex with other people, always use condoms and get regular tests.

If you do develop AIDS, life can feel pretty grim. Children tend to suffer more because their already-underdeveloped immune system gets bombarded.

Getting tested for HIV

You can test for the infection one month after you get infected, which is an improvement on old tests, which took three months. Sexual health clinics often offer a fast service, with a 30-minute turnaround, but results will be back within a week otherwise.^​8​

Everyone, but especially gay and bisexual men, are recommended to get tested at least once a year if they have sex without a condom, multiple partners, have been diagnosed with another STI, or develop suspicious symptoms.^​9​

Treatment of HIV using ART

Antiretroviral medications slow down HIV’s ability to replicate. These medications all work in different ways, but slowing replication is their ultimate goal. This treatment also reduces the risk of passing the virus on.

Taking three medicines is better than taking just one or two, and it helps reduce virus resistance. There is now a pill you can take that contains all three medicines. People who are HIV positive are given medicine when their CD4 T cell count goes below a certain level (350 cells per c/ml of blood or less).^​10​

Side effects of HIV meds

Side effects of ART can include nausea, vomiting and headaches.

Outlook for life with HIV

If you are treated early enough, HIV does not develop into AIDS. AIDS means getting sick with everything going around, including fungal infections. Constant illness is very depleting.^​11​ With early treatment with ART medications, AIDS is avoided.

The virus keeps mutating, and it’s even possible to be infected with two different strains at once. In 2022, people with HIV on long-term ART with high CD4 cell counts can expect to live close to the general population, regardless of when they began ART.

For people with HIV with low CD4 cell counts, life expectancy is up to 30 years less than in the general population. Early detection and treatment are key to a healthy life.

Anyone diagnosed late typically has a less cheery outlook, but treatments are improving all the time. Healthy lifestyle habits make a big difference.^​12​

If you have been diagnosed with HIV, find your local support centre online. To be tested, visit your local sexual health clinic or doctor.

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