What To Know About HIV This World AIDS Day

Yesterday, we asked 10almonds readers to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:

❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞

…and got the above-depicted, below-described, set of responses. Of those who responded…

• Just over 60% said “rush to hospital; maybe a treatment is available”
• Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
• Just over 10% said “despair; life is over”
• Two people said “do the most rigorous washing down there you’ve ever done in your life”

So, what does science say about it?

First, a quick note on terms

• HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
  • It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
• AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
  • Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.

People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.

HIV/AIDS are only a problem for gay people: True or False?

False, unequivocally. Anyone can get HIV and develop AIDS.

The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on, then if we go with the statistically most likely arrangements here:

• If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
• If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
• This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
• This is why “men who have sex with men” is the generally-designated higher-risk category.

There is medication to cure HIV/AIDS: True or False?

False so far (though there have been individual case studies of gene treatments that may have cured people—time will tell).

But! There are medications that can prevent HIV from being a life-threatening problem:

• PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
  • This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
• PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
  • Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
• ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
  • Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.

If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?

True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.

U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.

See: NIH | HIV Undetectable=Untransmittable (U=U)

If you’re thinking “still sounds risky to me”, then consider this:

You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)

Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.

If you’re concerned about potential stigma associated with HIV testing, you can get kits online:

CDC | How do I find an HIV self-test?

(these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)

If I get HIV, I will get AIDS and die: True or False?

False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.

However, if you get HIV, it does currently mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.

So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:

HIV.gov | Taking HIV Medication Every Day: Tips & Challenges

(as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)

Summary

Some quick take-away notes-in-a-nutshell:

• Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
• Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
• Washing will not help, by the way. Safe sex will, though!
  • As will celibacy and/or sexual exclusivity in seroconcordant relationships, e.g. you have the same (known! That means actually tested recently! Not just assumed!) HIV status as each other.
• If you do get it, it is very manageable with ARVs, but prevention is better than treatment
• There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.

Want to know more? Check out:

CDC | Let’s Stop HIV Together

Take care!