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With National HIV Testing Day around the corner on June 27, I wanted to offer a much needed refresher course on the basics of HIV/AIDS .

What is HIV?

HIV stands for human immunodeficiency virus.

H – Human – This particular virus can only infect human beings.
I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A “deficient” immune system can’t protect you.
V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

Currently, there is no cure for HIV/AIDS, but there are medications that can dramatically slow disease progression. Once you have HIV, you will have it for life.

What is AIDS?

AIDS stands for Acquired Immunodeficiency Syndrome. To understand what that means, let’s break it down:

A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.
Once a person receives an AIDS diagnosis, it means that he or she has met a predetermined set of criteria as defined by a doctor: 1) You are considered to have progressed to AIDS if you have one or more specific opportunistic infections, or 2) the CD4 cells have fallen below 200. Only a doctor can diagnose someone as having AIDS.

What Happens when HIV Enters the Body?

When HIV enters the body, it attacks a key part of your immune system – your T-cells or CD4 cells. HIV invades the cells and uses them to make more copies of itself, and then destroys them. Normally, our body has the ability to fight infections and disease, but a person with a compromised immune system can not fight off HIV.

During the initial onset or primary/acute infection of HIV, usually within two to eight weeks, the majority of people develop flu-like symptoms after the virus enters the body. This illness is known as primary or acute HIV infection; this stage of infection may last for a few weeks.

Possible signs and symptoms include:
• Fever
• Headache
• Muscle aches
• Rash
• Chills
• Sore throat
• Mouth or genital ulcers
• Swollen lymph glands, mainly on the neck
• Joint pain
• Night sweats
• Diarrhea

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, and or not be detected on an HIV test, the amount of virus in the bloodstream (viral load) is particularly high at the time of onset. HIV can be spread if an individual is engaging in risky behaviors.

It is important to know that even though the level of the virus may be low or undetectable, that does not mean that a person no longer has HIV or that they can not transmit HIV:

• HIV may still be found in a person’s genital fluids (e.g., semen, vaginal fluids). The viral load test only measures the virus in an individual’s blood.
• A person’s viral load may go up between tests. When this happens, they may be more likely to transmit HIV to partners.
• Sexually transmitted diseases (STDs) increase the viral load in a person’s genital fluids.

Another particular danger during the initial onset of acute infection is people assuming they have the flu, and treating the signs and symptoms with over-the-counter meds, or ignoring the symptoms altogether. After the initial onset of acute infection, the immune system loses the battle with HIV and symptoms go away. HIV infection goes into its second stage, which can be a long period without symptoms, called the asymptomatic (or latent) period. This is when people may not know they are infected and can pass HIV on to others. This period can last 10 or more years. During this time without symptoms, HIV is slowly killing the CD4 T-cells and destroying the immune system.

Over time, HIV destroys so many of your T-cells that the immune system begins to break down. When that happens, HIV infection can lead to the third stage of HIV — an AIDS diagnosis — which is the final phase of HIV infection. However, not everyone who has HIV will progress to AIDS. With proper treatment and maintaining medical adherence, an individual infected with HIV can keep the level of if in their body low.

What Are the Fluids That Transmit HIV?

HIV is transmitted by coming in contact with certain bodily fluids from a person who is infected with HIV. These body fluids include:

• Blood
• Semen (cum)
• Pre-seminal fluid (pre-cum)
• Vaginal fluids
• Breast milk

These bodily fluids must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to occur. Mucous membranes are the soft, moist areas just inside the openings of your body, like the inside of the rectum, the vagina, the opening of the penis, and the mouth.

How Is HIV Spread?

HIV is spread through the following:

• Unprotected anal, oral, or vaginal sex with a person who is infected with HIV. Anal sex carries the most risk because the lining of the anus is thin and does not lubricate naturally, causing it to rip and tear easily. Vaginal sex is the second most risky type of sex followed by oral sex. Keep in mind that the receptive partner is the partner that is most at risk because she or he is receiving the penis inside their anus or vagina. This increases their risk given the exposure to the fluid.
• Sharing needles and “works” with a person who is infected with HIV. Needles include those that are used for tattoos, body piercings, injectable drugs – prescriptions, non-prescription and/or illegal, and steroids.
• Mother-to-child transmission. HIV can be passed from mother to child during pregnancy, birth, or breastfeeding. Transmission of HIV during pregnancy and childbirth can be greatly reduced with the use of HIV medications during and after pregnancy.
• Any blood-to-blood contact with a person infected with HIV. Such as: blood brothers/sisters, occupational work hazards like being stuck by a needle from and HIV-infected person, or coming into contact with HIV-infected blood as medical personnel, firefighter, EMT, etc.

HIV is NOT spread by: air, water, insects, including mosquitoes or ticks, saliva, tears, sweat or casual contact, including shaking hands, hugging, sharing dishes/drinking glasses, drinking fountains or toilet seats.

How Do You Lower Your Risk For HIV?

There are several steps you can take to reduce your risk of getting HIV through sexual contact, and the more of these actions you take, the safer you can be. These actions include:

• Getting tested for HIV and other sexually transmitted infections together
• Asking your sexual partner about their sexual history
• Using condoms
• Practicing abstinence
• Remaining faithful
• Reducing your number of sexual partners
• Changing the type of sex you’re having
• Being careful about the substances you use
• Loving yourself enough not to put yourself at risk

Getting Tested for HIV

Current CDC guidelines recommend that individuals aged 13-64 get tested at least once in their lifetime, and those with risk factors, direct and indirect, get tested more frequently. HIV is most commonly diagnosed by testing your blood or saliva for antibodies and/or the virus. Most people who get tested for HIV will show accurate results after about two to eight weeks from infection. In rare cases, it may take up to six months for enough HIV antibodies to build up in the blood and be detected on an HIV antibody test.

While it is important to get tested for HIV, it is more important to go back and get your results together. When getting tested for HIV, you may also want to consider getting tested for other STIs. Some STIs, such as chlamydia and gonorrhea are asymptomatic and may go undetected. Additionally, if a person has an STI, he or she is five times more likely to get HIV.

HIV testing is the only way to determine if you are infected with HIV. Most individuals who are at the highest risk for HIV have not been tested, usually because they do not realize that they are at risk. Others avoid testing because they are worried about the possibility of having a positive test result. However, testing is encouraged because treatment for HIV is highly effective and learning about the infection can improve your chance of living longer and being healthier.

While getting tested is great, it should not be your method of prevention. Changing behaviors that put you at risk for HIV, open and honest communication, and mutual monogamy should be your goal.