What is AIDS? What is HIV?

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is caused by a virus known as the Human Immunodeficiency Virus or HIV.

How does HIV infection lead to AIDS?

HIV attacks the body's immune system, its defense against disease, and weakens it over time. A person who has HIV gradually loses the protection of his or her immune system and the person begins to experience health problems. These may be fairly small problems at first —skin problems or yeast infections— but over time the illnesses become more serious. The amount of time that it takes HIV to begin to affect a person's health varies widely from one individual to another. When a person is diagnosed with one of the serious illnesses or cancers which are "AIDS-defining", the person is then said to have AIDS.

HIV attacks the immune system chiefly by damaging the CD4 (also known as T4 or T-helper) cells which help the body fight off diseases. HIV can also have direct effects upon the body. For example, the virus can attack cells in the brain and impair the brain's function.

How could I become infected with HIV?

HIV does not get passed through your skin when there are no cuts or abrasions on it. HIV does not get passed through the air like a cold or flu. HIV does not get passed from one person to another through deep kissing, mutual masturbation or inserting fingers into the vagina or anus ("ass", "bum" or "butt").

HIV is a fragile virus that cannot survive outside of the body. That is why you cannot be infected with HIV from toilet seats or from sharing dishes or utensils.

You can be infected with HIV if you do certain things that allow enough HIV to get into your bloodstream from the body fluids of a person who is already infected with this virus.

There are only four body fluids which have enough HIV in them to infect someone:

blood
semen (cum)
vaginal fluids (including menstrual fluids)
breast milk

You cannot get HIV from any other body fluids. You cannot get HIV from saliva (spit), sweat or urine (pee). The only body fluids that have enough HIV in them to infect someone are blood, semen, vaginal fluids, and breast milk.

You become infected with HIV when one of these four body fluids, infected with the HIV virus, comes into contact with your body in a way that allows the virus to get into your bloodstream.

Sex: The most likely way that enough HIV gets into a person's bloodstream is through the interior skin or linings — the mucous membranes— of the vagina, the cervix (which is inside a woman's vagina), the rectum ("ass", "bum" or "butt"), or the urethra (this is what we pee through- it's the tube inside a man's penis, or in front of the vagina in women). HIV can be transmitted if you have anal or vaginal sex without a condom or if you share sex toys — like a dildo, vibrator or butt plug — that have not been cleaned each time someone uses them.

Anal or vaginal sex without using a condom, or sharing sex toys without washing them carefully, or not using a new condom between partners are very risky activities.
HIV can get into the bloodstream through the mouth and throat. This is rare. Some people have gotten HIV when they have performed oral sex (given a man a 'blow job' or 'gone down' on a woman) but it is rare. No one ever got HIV from someone going down on them.

When a person has a sexually transmitted infection (STI) like gonorrhea, warts, or herpes, his or her risk for getting HIV increases a lot. Regular STI check-ups are important as one way of preventing HIV transmission.

Most people get infected with HIV when they have anal or vaginal sex without a condom or when they share a needle that has not been cleaned.

Needles: Another common way that HIV gets into the blood is through a puncture from a needle that has already been used by someone else and had not been cleaned. When people who are injecting drugs share the works (needle, cooker) but do not clean them each time they use them, it is easy to get HIV.

Pregnancy: HIV can be transmitted from mother to child during pregnancy, labour or delivery. Without anti-HIV drug treatment there is about a 25% chance the child will be infected. With treatment, the rate drops to about 8%. However, the long term effects of the drugs on the child are not yet known. HIV can also be passed to a child through breast feeding if the mother has HIV.

Blood transfusions and blood products: Some people have been infected with HIV through blood transfusions and blood products used to treat illnesses like hemophilia. Since 1985 all donated blood in Canada is tested for HIV. You cannot become infected when you donate blood.

How do I know if I have HIV?

You can't tell if you have HIV by how you look or feel. You can't tell whether another person has HIV by looking at him or her. People with HIV can look and feel healthy for many years.

The only way to know if you have HIV is by having a blood test. This test is known as an "HIV test" or an "HIV antibody test". You may have heard it referred to as an "AIDS test" but the test does not tell you if you have or will get AIDS; it tells you only that you have been infected by HIV.

This test looks for antibodies that are made by the immune system when a person is infected with HIV. It is a very accurate test.

If antibodies to HIV are found, the test result is referred to as "positive". The person is HIV antibody positive (or "HIV positive", or "HIV+"). This means that the person has been infected with HIV.

If antibodies are not found, the test result is referred to as "negative" and the person is HIV antibody negative (or "HIV negative", or "HIV-"). This means that the person has not been infected with HIV.

There is a gap between the time a person is infected with HIV and the time when the antibodies are formed. This period can be from three to 14 weeks. It is called the "window period". For this reason, it is important to wait for fourteen weeks after having done something that may have caused HIV infection, to ensure an accurate HIV
antibody test result.

What happens after someone is infected with HIV?

Soon after infection, some people experience a brief, flu-like "seroconversion illness" at the time when antibodies to HIV are being created. But most feel completely well and have no symptoms. During this period, the person is said to be "asymptomatic". They may not even know that they have been infected. They may continue to feel well for a long time. In fact, some people who were infected with HIV over ten or fifteen years ago continue to feel completely well today. During the period when the person with HIV is feeling healthy, their CD4 cells are defending the body against HIV. Lab results would likely show that the person's CD4 count to be fairly high and their viral load (which measures the amount of HIV in the blood) to be fairly low.

Although researchers are working to try to produce treatments that will remove all traces of HIV from an infected person's body, at this point in time we understand that once a person is infected with HIV, the virus cannot be completely destroyed or eradicated. It continues to reproduce and to attack the immune system. At a certain point, the CD4 cells are overpowered and can no longer keep HIV under control. The person's CD4 count then declines and their viral load rises.

As their CD4 cells decline, a person with HIV becomes vulnerable to various infections and illnesses. This period of declining health is sometimes referred the "symptomatic period". The organisms that cause these infections are quite common and present in most people's bodies but are kept under control by a healthy immune system. As HIV weakens the person's immune system, these organisms can no longer be controlled, and illness occurs. These illnesses are known as "opportunistic infections" and include such diseases as pneumocystis carinii pneumonia("PCP") and toxoplasmosis ("toxo").

Early in the epidemic, The U.S. Centres for Disease Control compiled a list of serious illnesses that result from the weakening of the immune system in people with HIV. Once a person has experienced one or more of the diseases on this list of "AIDS-defining conditions", he or she is said to have AIDS.

A person with AIDS likely has periods of relatively good health in between serious illnesses. People have lived for years with an AIDS diagnosis. There are drugs that can prevent certain AIDS-defining illnesses, such as Septra for PCP, and there are drugs that can control and treat other AIDS-defining illnesses.

Are there treatments for HIV & AIDS?

In addition to drugs and other treatments that can treat, control or prevent opportunistic infections, in the past few years, progress has been made in producing effective drugs that combat HIV directly. These drugs, often known as "combination therapies" or "the cocktail", slow down the effect of HIV on the immune system by interfering with the replication of HIV.

This form of therapy usually consists of a number of drugs taken on a strict timetable. Although these drugs are not easy to take and have side effects, when combination therapy is successful it can improve the health of people with HIV, sometimes causing remission of their symptoms in addition to reduced viral load (that is to say, reduced amount of HIV in their body), increased number of CD4 cells, and reduced likelihood of progressing to AIDS.

Combination therapy does not work in everyone. The length of time that the drugs are effective against the virus varies, and drug resistance can set in, making the drugs ineffective.

Additionally, some people with HIV use "complementary therapies" such as acupuncture, vitamin supplementation, massage, etc. in addition to drug therapies to alleviate side effects, reduce stress and improve immune function.

Once thought to be an invariably fatal illness, we can no longer say that every person with HIV will become ill or die of AIDS. However, there still is no cure for AIDS.

Living with HIV

Living with a serious, stigmatized and potentially life-threatening illness can be extremely stressful and difficult. Although someone with HIV may remain in good health for many years, there is a lot of fear, prejudice and misunderstanding in society about HIV/AIDS and the people who have this disease. People with HIV/AIDS may encounter hostility and rejection even from the people closest to them. They may lose their jobs, their homes or important relationships as a result of people's negative attitudes about AIDS.

Because of the stigma attached to AIDS, people may find it difficult to tell others about their diagnosis and may tell only a few close friends. The burden of secrecy can be hard to bear.

Expressing your sexuality when you know that you could pass a serious infection on to someone else can also be extremely difficult. Many people find support through counselling or by participating in support groups for people with HIV/AIDS.

People with HIV may also choose to make some adjustments in their lives to help them to cope with their diagnosis. They may try to stay healthy by eating good food, exercising or using complementary therapies. They may read lots of information about HIV and HIV therapies.

Although living with HIV can be a difficult and challenging experience, many people with HIV live meaningful, satisfying and happy lives and contribute in important ways to their communities.

People with HIV/AIDS from communities which have been heavily impacted by the HIV/AIDS epidemic, such as gay men or injection drug users or people from countries hard hit by AIDS, have seen many people around them become sick and die. Even though these people may not be infected with HIV themselves, their involvement in the epidemic makes their lives very difficult in a number of ways. They may be burdened by the demands of care giving, guilty about their own survival, and uncertain whether AIDS will be their fate as well. They may find it difficult to practice safer sex or safer drug use, given the perceived inevitability of infection and the lack of value society may place on their continued health.

Where can I find more information about HIV/AIDS?

For more information on a variety of issues related to HIV and AIDS, please visit the AIDS Committee of Toronto (ACT) Access Centre at 399 Church Street, 4th floor, Toronto, Ontario. We are open Monday to Thursday from 10:00am to 9:00pm and on Friday from 10:00am to 5:00pm. You can also call ACT's Information and Support

Hotline at 416-340-8844. Or, search the ACT website (www.actoronto.org).

For more information about HIV/AIDS treatment, call the Community AIDS Treatment Information Exchange (CATIE) at 416-944-1916 or 1-800-263-1638.