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HIV/AIDS general information The Terrence Higgins Trust have kindly let us reproduce this booklet providing general information about HIV and AIDS. Check out their excellent website for more information. revised Jan 1998 © The Terrence Higgins Trust |
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The Terrence Higgins Trust publishes booklets which give more detailed information on most of the topics covered in this booklet. See our Publications Listing for details.  What are HIV and AIDS?HIV is a virus which attacks the human immune system, the body's defence against disease. A person with HIV may feel completely well and have no symptoms. In time, a person with HIV may develop particular rare illnesses or cancers because their immune system is weakened. When this happens, the person is said to have AIDS. How does HIV cause AIDS?HIV affects various parts of the body's immune system. The most important damage it causes is to certain white blood cells known as CD4 cells or T-helper cells. These cells are found in the lymph nodes as well as circulating round the body.CD4 cells set other parts of the immune system in motion when organisms which cause disease are present in the body. These organisms include viruses, bacteria, protozoa and fungi. They can cause disease if not controlled by the immune system. The CD4 cells of an HIV-infected person mount a defence against the invading HIV, and it may be held at bay for many years. But the virus is not completely destroyed, and it continues to attack the CD4 cells. Eventually the number of CD4 cells declines and the virus numbers rise. When the CD4 cells start to decline, the person with HIV becomes vulnerable to other infections. The organisms which cause disease in people with HIV are common organisms, easily kept under control by the healthy immune system. They are able to cause illness only when the immune system is severely damaged, so the illnesses they cause are known as opportunistic infections. Similarly, cells of the body go out of control all the time, and the immune system keeps them under control. If the immune system is damaged, these cells can cause opportunistic tumours. Government centres for epidemiology* in the United States have compiled a list of serious illnesses and tumours which may result from immune system breakdown in a person with HIV. Once a person with HIV has experienced one or more of the conditions on this list, they are said to have AIDS. HIV can also have direct effects upon the body. For example, the virus can attack cells in the brain and impair its working. One result of this is HIV encephalopathy (brain disease), and it is an AIDS-defining condition. Recent research has shown that taking a combination of anti-HIV drugs (combination therapy) can slow down the effect of HIV on the immune system. When combination therapy is successful, it can improve and sustain the health of a person with HIV and will mean they are less likely to develop AIDS-defining conditions. HIV in the UKSince the start of the epidemic in the UK 30,001 people are known to have been infected with HIV*14,719 people have developed AIDS and 10,633 have died. During 1996, 2,896 new HIV infections were reported. This is the highest annual total ever and shows that the problem of HIV is not going away. How do people become infected with HIV?In order for a person to become infected, a sufficient amount of HIV must enter their bloodstream. This sufficient amount is the amount of HIV found in some, but not all, of the body fluids of someone with HIV or AIDS.In a person with HIV or AIDS, the body fluids which contain enough HIV to infect someone else are:
Other body fluids like saliva, sweat or urine do not contain enough virus to infect another person. If HIV is present in body fluids, it still cannot enter another person's body easily. There are a limited number of routes:
HIV cannot pass through intact external skin. It cannot pass through the air like cold germs. See the Trust's booklet Preventing HIV Infection for information on preventing HIV transmission. HIV and sexHIV can be passed from one person to another during penetrative sexual intercourse, that is, sex where the penis enters the vagina or anus. Using a condom with water-based lubricant, or a femidom, during vaginal or anal penetrative sex will prevent transmission of HIV and many other sexually transmitted diseases. HIV and sexual intercourse between menSeven out of every 10 men with HIV in the UK were infected through sexual intercourse with another man. In the UK, northern Europe and parts of the United States, the most serious impact of the virus has been felt by the gay community. A large number of gay and bisexual men in the UK are still being infected every year: 1,474 tested HIV positive in 1995 and 1,634 in 1996*** HIV and sexual intercourse between men and womenIn the UK, fewer than 2 out of every 10 people with HIV were infected through sex with a member of the other sex who had HIV. In 1995, 852 people were reported to have contracted HIV as a result of sexual intercourse with a person of the opposite sex who had HIV. In 1996 the number of people reported to have been infected in this way was 779*** In Asia and sub-Saharan Africa HIV is transmitted most frequently by sexual intercourse between men and women. In the UK, HIV has had a devastating effect on communities of people from parts of Africa where HIV has taken hold. HIV and oral sexThere have been about 20 cases world-wide where someone has become infected by giving oral sex to a man with HIV (sucking his penis). Where this has happened, it was probably because infected semen was able to pass through a cut or abrasion in the other partner's mouth or throat. There are no confirmed reports of someone becoming infected through giving oral sex to a woman with HIV (licking her labia or clitoris). Someone whose genitals are sucked or licked by a person with HIV will not become infected, because saliva does not an contain sufficient HIV to infect another person. See the booklet on the Terrence Higgins website Oral Sex: a briefing for workers for a detailed discussion of oral sex and HIV transmission. HIV and other sexual activitiesOne sexual activity which may be risky if one partner has HIV is sharing a sex toy: inserting an object into the vagina or anus of more than one person without washing it carefully between users or putting a clean condom on it between users. HIV cannot be passed from one person to another through other sexual activities, including deep kissing, mutual masturbation, or via fingers inserted into the vagina or anus. HIV and bloodHIV and shared injection equipmentOne in ten (3,106 out of 30,101**) infections in the UK were acquired through sharing drug injecting equipment with someone with HIV. But sharing injecting equipment is not less risky than having sex with someone who has HIV. In Scotland, and in Southern Europe and parts of the United States, shared drug injecting equipment is the most common route of infection.People who inject drugs can avoid transmitting HIV, either to themselves or to others, if they use a new set of injecting equipment every time or sterilise equipment between users. However, there is evidence that unsafe drug injecting is on the increase in this country. HIV and blood transfusionsIn the UK, 168 men and women were infected with HIV through transfusions of blood which contained the virus.All blood donations and organ donations in the UK have been tested for HIV since 1985. The test may not be accurate if a person was very recently infected, and so people at risk of HIV are asked not to give blood. In 1997, 3 people in the UK were discovered to be HIV positive through receiving blood donated by someone who had themselves been very recently infected with HIV. These cases are the only ones to have occurred in many millions of donations since 1985. In some countries, infection through blood transfusion is still a significant risk. Blood factor treatmentsFactor 8 is a product of donated blood used in the treatment of haemophilia. Before it was known that donated blood might contain HIV, 1,196 men and boys with haemophilia became infected in the UK. Haemophilia is rare in women, and only 11 women were infected in this way. All Factor 8 is now heat treated, which kills HIV.HIV and pregnancyMothers and babiesIn the UK, the risk of HIV being transmitted from an HIV-infected woman to her baby before or during birth is about one in seven. In parts of the world where the standard of living and healthcare is not so high as here, the risk is greater.HIV can also be passed to a baby during breastfeeding if the mother has HIV. In the UK, 423 babies born to women with HIV have had HIV themselves. HIV and donated spermJust as a woman can be infected during sexual intercourse with a man who has HIV, she can also become infected through donated sperm if the donor has HIV.Men who donate sperm to clinics are tested for HIV and their donations are guaranteed free from HIV. What is an HIV test?HIV is usually diagnosed by a blood test, known as an HIV antibody test or an HIV test. This test looks for antibodies formed by the immune system if HIV is present.If HIV antibodies are found, the test is referred to as positive. The person is HIV antibody positive, often referred to as HIV-positive. If antibodies are not found, the test is negative and the person is HIV antibody negative or HIV-negative. There is a gap, or 'window period', between infection and the formation of antibodies. This can last from a few weeks to three months. During this window period,the HIV antibody test will be negative even if HIV is present. That is why people who think they may have been infected need to wait for at least three months before they have a test. Some testing centres suggest a test after six months, to be absolutely sure. HIV tests in the UK are highly accurate. A positive result is confirmed using a different technique. Negative tests are accurate so long as they are not done during the window period. Very occasionally the result may be unclear or 'equivocal'. When this happens a second test a few weeks later will give a clear result. See the booklet on the Terrence Higgin's website Testing Issues for further information about HIV tests. Testing babies for HIVBabies are born with their mothers' antibodies, which clear once the baby has developed its own immune system. Babies born to women with HIV have HIV antibodies in their blood from the mother for the first 18 months of life.An HIV antibody test on the baby's blood would show the mother's antibodies, and would not tell the doctor whether the baby had HIV. Some hospitals are now able to perform tests on much younger babies of HIV-positive women, to discover whether the baby itself is infected with HIV.What happens when someone has HIV?Becoming HIV positiveMost people who become infected with HIV do not notice that they have been infected. A few weeks after infection, the body's immune system reacts to the virus by producing antibodies. Some people with HIV have a short 'seroconversion' illness at the time these antibodies are created. The likely symptoms are the normal response to many other infections, and may include a sore throat, a fever or a rash.Asymptomatic infectionThe infected person may have no further outward signs or symptoms for many months or years. This is called asymptomatic infection. Some people with asymptomatic infection have swollen lymph nodes, but this is not a sign of immune system damage. Nor are colds or flu: people with HIV do not get colds more often than other people. People who have HIV and feel completely well may have signs of immune damage detectable in laboratory tests on their blood. Symptomatic infectionIn time, immune damage may become more severe, though the increasing use of combination therapy may result in more people with HIV remaining well for longer. We do not know whether every person with HIV will eventually become ill.Not all opportunistic infections are part of the AIDS definition, so a person with HIV may be quite ill but not have AIDS. An AIDS diagnosisAIDS itself does not have symptoms and there is no test for AIDS. The doctor will look for the specific illness causing the person's symptoms. If they are caused by one of the AIDS-defining illnesses, and if the patient has HIV, then he or she is said to have AIDS.Examples of illnesses which will result in an AIDS diagnosis, if HIV is present:
Someone with AIDS is likely to enjoy periods of comparatively good health between bouts of serious illness. Some people have lived for several years with an AIDS diagnosis. People taking combination therapy successfully will be less likely to develop AIDS-defining illnesses. Treatments for HIV and AIDSIncreasingly, it is possible to prevent or treat opportunistic infections using new drugs. For example, PCP was a frequent cause of death in people with AIDS in the early years of the epidemic. Doctors are now able to prevent PCP with drugs, or to treat it quickly if it occurs. Death from PCP is now rare among people with HIV in the UK.Research studies show that the most effective way to attack HIV is with a combination of anti-HIV drugs. Combination therapy is a huge advance in the treatment of HIV, and many people have done very well on it. Combination therapy is not easy to take (the various drugs have to be taken at different times according to a strict timetable), and there are side effects. It does not work for everyone, and where it does work we do not know how long that will last. Sometimes the drugs stop working because people develop resistance to them. Research is continuing all the time to make combination therapies more effective and easier to take. Some people with HIV and AIDS use complementary treatments to help with their symptoms. Examples are acupuncture, aromatherapy and homeopathy. There is no vaccine or cure available yet, but scientists' understanding of how the virus works continues to improve. However, drug treatments and vaccines are expensive to develop, and it is not likely that people in some countries will be able to benefit from new discoveries for the foreseeable future. Living with HIVEven though there are now more effective anti-HIV treatments, living with the knowledge of a serious and potentially life-threatening infection is likely to be stressful and difficult. Someone with HIV may remain in good physical health for several years but misunderstanding and fear about HIV and AIDS is still widespread in society. People living with the virus may encounter hostility or rejection even from friends and family and some people have lost jobs and homes due to their employers' or landlords' attitudes, and children with HIV have been banned from schools.Many people with HIV have seen friends and partners become ill before them, and may have seen friends die. Some communities have been more affected by HIV than others: for example, gay men, people from sub-Saharan African communities and injecting drug-users. In some parts of the world, and among African families in the UK, it is not unusual for whole families to die with AIDS. Many people with HIV choose to tell no one about their diagnosis except for a few trusted friends, and this burden of secrecy can be very hard to bear. Living with the knowledge that you could pass a serious infection to a someone else can also be very hard. A number of support groups have been set up round the country to help counter the isolation which HIV can cause. Many people with HIV make changes in their lives to help them cope with their diagnosis. Some choose to work at keeping fit and healthy with good food and exercise; others may read up about HIV and become their own experts in drug treatments or complementary therapies. Some people with HIV have said that focusing on living and enjoying life to the full has helped them to cope with living with HIV. HIV in the worldThe World Health Organisation (WHO) estimated that, by the end of 1996 approximately 8.4 million cases of AIDS had occurred world-wide amongst adults and children****Some areas of the world are particularly badly affected: eleven million infections have occurred in sub-Saharan Africa. The epidemic is spreading fastest in South and South-East Asia, with the estimated number of infections doubling in two years (from 1.5 million in mid-1993 to 3 million in mid-1995). Throughout the world, the numbers of men and women infected are roughly equal. HIV mainly affects young adults and people in early middle age. These are the people who raise the children, support the elderly and build the country's economy. The many lives lost in this age group has had a serious effect on the economy of some countries in sub-Saharan Africa. The world-wide, cumulative total of HIV infections for men, women and children could reach 30 million by the year 2000, of which 9 out of every 10 are likely to be in the non-industrialised world. WHO estimates that 5-10 million children may have lost their mother or both parents to AIDS by this date. Stopping the epidemicWe could slow down the world-wide HIV epidemic if everyone had the information they need about preventing infection, and had society's support to help them act on it.Young men growing up gay need access to good information about how to avoid becoming infected with HIV. In countries (like the UK) with forward-thinking programmes for injecting drug users, including needle exchange schemes and methadone schemes, rates of HIV among drug users are relatively low. In other countries, like Spain, France and the USA, HIV has spread rapidly because of public reluctance to protect the health of drug users. Religious, cultural or economic restrictions can make it hard for people to use condoms and protect themselves and their partners. A woman who is economically dependant on a man may find it impossible to ask for safer sex. World-wide,women are most commonly infected by their husbands or permanent partners. Denial by national leaders that some behaviours happen, such as sex between men or drug injecting, can make it particularly difficult for people to avoid the risks. Some governments do not accept that HIV is an issue for them at all. As the former Director of the WHO Global Programme on AIDS has said: "Denial at personal, social, national and international level has been a constant problem and remains today a grave threat to public health." People often react with prejudice and denial to things they do not understand. These reactions to HIV and AIDS hinder HIV prevention programmes, and they make life more difficult for people living with HIV and AIDS. Every one of us can make a difference to the AIDS epidemic by fighting prejudice, challenging denial and increasing understanding. References
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