HIV and AIDS

About HIV and AIDS

Human immunodeficiency virus (HIV) is a virus that can weaken the immune system to the point that it is unable to fight off some infections.

HIV is not the same thing as AIDS.

What is AIDS?

AIDS (acquired immune deficiency syndrome) is the most advanced stage of HIV infection. This is when the immune system is at its weakest and a person has one or more specific illnesses.

AIDS is now very rare in Australia. HIV treatments are highly effective – they protect the immune system by:

• preventing the virus from multiplying
• reducing the damage to the specific cells targeted by HIV.

Most people living with HIV on effective treatment in Australia can expect to live long, healthy lives without ever developing AIDS.

How HIV spreads

HIV is a blood-borne virus – it carries through blood and some body fluids. HIV can spread from one person to another by:

• blood
• semen
• vaginal fluids
• anal mucus
• breastmilk.

Having another sexually transmissible infection (STI) can increase your chances of HIV transmission.

HIV can transmit through:

• Unprotected anal or vaginal sex – not using condoms or other biomedical prevention methods.
• Sharing any needles, syringes, or other injecting equipment.
• From mother to child during pregnancy, childbirth, or breastfeeding. This can occur when the mother doesn’t know she has HIV, or is not on effective treatment.
• Rarely through tattooing or other procedures that involve unsterile or reused equipment.
• Very rarely through needle stick injuries.

People on treatment who achieve and maintain an undetectable viral load cannot transmit HIV sexually.

HIV in Australia

The number of new HIV infections diagnosed in Australia is decreasing each year, this is because:

• 90% of people are aware of their infection
• over 95% are on HIV treatment
• over 90% have undetectable amounts of virus in their blood and body fluids
• people at greatest risk of HIV are on PrEP (pre-exposure prophylaxis) to prevent transmission.

Australia is on track and close to eliminating new HIV infections by 2030.

HIV transmission myths

HIV does not spread by:

• kissing, hugging, massaging, mutual masturbation and other body contact
• social interaction (such as shaking hands)
• sharing food, dishes, utensils, drinking glasses
• air, breath (such as coughing or sneezing)
• mosquito, insect or animal bites
• use of communal facilities (such as seats, computers, mobile devices, toilet seats, drinking fountains, spas, pools or gyms).

It is safe to consume food and drinks prepared by someone who has HIV even if they’re not receiving treatment.

Preventing HIV transmission

There are many effective ways to prevent HIV. It is important to find the right prevention method (or combination of methods) that works for you and your sexual partners.

Practising safer sex is everybody’s responsibility and enables us to have healthy sex lives.

Ways to prevent HIV infection include:

• Condoms used with lubricant.
• Taking treatment for HIV – resulting in having and maintaining an undetectable viral load (U=U).
• Taking HIV medications – PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).
• Getting regular sexual health checks.
• Reducing risks associated with drug taking – such as chemsex and injecting drugs.

For people who do not have HIV, condoms are the easiest way to prevent HIV transmission.

For those at greater risk of HIV, PrEP (pre-exposure prophylaxis) is a medication that, when taken consistently as prescribed, is up to 99% effective at preventing HIV.

Talk with your doctor, health worker or HIV organisation about how to practise safer sex.

Use condoms to prevent HIV transmission

Using condoms and water-based lubricant (lube) during anal and vaginal sex can also prevent HIV.

Although oral sex is already very low risk for HIV transmission – using condoms on penises, or dental dams on vulvas and anuses can reduce the risk of HIV and other STIs (like gonorrhoea, chlamydia, and syphilis) from being passed on.

Water or silicone-based lubricants can help to reduce the chance of condoms breaking. They can also increase sexual pleasure.

Condoms come in a range of different sizes, shapes, styles, colours and flavours to suit personal preferences. Investigate what works best for you and your partner. Don’t assume that your partner(s) will feel confident about using condoms. Make sure you know how to use them correctly.

Female, (or internal) condoms are also an excellent way to prevent HIV and STIs. Internal condoms can be used for either vaginal or anal sex.

Condoms are widely available at most pharmacies (chemists), supermarkets, or from your nearest sexual health or family planning clinic.

HIV and undetectable viral load (U=U)

Undetectable viral load means a person with HIV who is receiving treatment achieves and maintains very low levels of the virus in their body. This is sometimes referred to as ‘treatment as prevention’ (TasP) or promoted as ‘Undetectable = Untransmittable’ or U=U.

People cannot transmit the virus if their viral load is undetectable.

For people with HIV, starting treatment as soon as possible helps your viral load become undetectable faster, preventing HIV transmission.

Once HIV antiretroviral treatment starts:

• most people will achieve an undetectable viral load usually within 2-3 months
• for some, it may take 6 months.

The threshold for undetectable viral load is less than 200 copies/ml for TasP. Even if this strict threshold is not met, there is still a significant reduction in the amount of HIV in the body, and an improvement in health. The risk of HIV transmission is lower but not eliminated.

It is important to wait until viral load suppression occurs before engaging in condom-less sex or other risky behaviour. Your treating HIV specialist will let you know when the risk of transmission of HIV to others is zero.

Remember, being on HIV treatment and having and maintaining an undetectable HIV viral load does not protect you from other STIs. If you are having casual sex, it’s best to use condoms and lube.

Get tested for STIs and check your viral load regularly.

Living Positive Victoriahas more information about the science behind U=U.

PrEP (pre-exposure prophylaxis)

PrEP (pre-exposure prophylaxis) is an anti-HIV medication used to prevent HIV.

It can be taken by people who do not have HIV but are at risk of HIV infection.

PrEP is up to 99% effective when taken consistently as prescribed.

It does not provide protection against other STIs.

PEP (post-exposure prophylaxis)

PEP (post-exposure prophylaxis) is an anti-HIV medication that can be prescribed after someone has had a known or suspected exposure to HIV.

It must be taken for 28 days, and started within 72 hours of a possible sexual exposure to HIV.

Reasons for taking PEP include:

• having sex without a condom with someone who has HIV and is not on treatment
• having sex without a condom with someone whose HIV status is uncertain
• sharing needles or other injecting equipment.

Reducing HIV risks from chemsex and drug use

Some people use drugs – such as ice (or crystal meth), GHB, ecstasy (or MDMA), ketamine and cocaine) to enhance their sexual experiences (known as ‘chemsex’). Chemsex can make you lose your inhibitions and be risky if you:

• Inject drugs.
• Have sex without condoms.
• Forget to take your HIV medications.

Practise safer injecting

If you inject drugs, always use clean injecting equipment (such as sterile needles and syringes) for protection against HIV and other blood-borne viruses (like hepatitis B and hepatitis C).

Never share or re-use injecting equipment – such as needles, syringes, spoons, swabs, filters, water, ties, or tourniquets.

Sterile injecting equipment is available from needle and syringe program (NSP) sites throughout Victoria, including most pharmacies. Many of these sites can offer more information about HIV and hepatitis, safer injecting, and referrals to doctors.

Get tested regularly for HIV and STIs

Regular testing for HIV and other STIs can help find infections earlier, get them treated sooner, and prevent them from being transmitted to others.

Some practices don’t reduce your risk of HIV

Some people use unreliable methods to reduce their risk of HIV. These include:

• Serosorting – choosing your sexual partner based upon them having the same HIV status as you.
• Strategic positioning – where an HIV-negative person penetrates someone with HIV.
• Withdrawal – when the ‘insertive’ partner pulls out before ejaculating (coming).

None of these strategies are reliable, so you are at risk of HIV transmission.

Having sex only with people who have the same HIV status can be very risky. For example, a person may think they are HIV-negative, but may have been exposed to HIV since their last test, or been tested at all.

Using a combination of proven, reliable strategies – like condoms, PrEP, and undetectable viral load – is the best way to prevent HIV transmission.

HIV signs and symptoms

You may not know you have HIV, because some of the symptoms of HIV are like other illnesses (such as glandular fever or flu).

Also, not everyone shows symptoms when they become infected with HIV.

Symptoms of HIV can include:

• flu-like symptoms (runny or blocked nose, sore throat, cough, fever)
• extreme and constant tiredness
• fevers, chills, and night sweats
• rapid weight loss for no known reason and decreased appetite
• swollen lymph glands in the neck, underarm, or groin area
• continuous coughing or a dry cough
• diarrhoea.

If you think you have been exposed to HIV, and have any symptoms see your doctor.

Symptoms usually occur between 1 and 3 weeks after exposure to HIV.

Where to get tested for HIV

Getting an HIV test is easy. Tests for HIV and other STIs are confidential and available from your local doctor (GP), or a sexual and reproductive health clinic.

It is a good idea to have some pre-test counselling. Doctors, nurses, or peer testers can discuss any concerns including your level of risk and what a positive result may mean.

How often do you need to get tested for HIV?

Timing of testing depends on people's personal practices and whether and how often they engage in risky behaviours.

For most people, it is important to have a full sexual health test at least once each year. This includes:

• HIV
• chlamydia
• gonorrhoea
• syphilis.

Even if you always use condoms, get tested annually as condoms don’t provide 100% protection against HIV and STIs.

Regular testing for people with a greater HIV risk

If you are at greater risk of HIV, get tested regularly:

• Gay, bisexual, trans and other men who have sex with men should get tested every 3 months (or 4 times each year).

Test timing may vary depending on how many sexual partners you have during the year.

Talk with your doctor or sexual health specialist for advice. They can also provide information on how to reduce your risk for HIV and other STIs.

Diagnosing HIV

Blood tests are the most common and reliable tests for HIV. The virus is detected by taking a sample of your blood – either with a conventional blood test or a rapid test (a pin prick).

There is a short period of time between exposure to HIV and the ability for tests to detect HIV or its antibodies. This is often referred to as the 'window period' – between 2 and 12 weeks.

Most tests used in Australia can detect HIV as early as 2 to 4 weeks after infection.

If your blood test shows that HIV or its antibodies are present, you are HIV-positive.

If you have no antibodies in your blood, you are HIV-negative. Sometimes negative results might also mean you are in the window period. Do a follow-up blood test if you're unsure.

HIV test costs

Unlike rapid tests, blood tests for HIV are covered by Medicare, which means doctors can order them free of charge.

If you are not eligible for Medicare, testing costs may be claimed through private health insurance. Check with your provider to see if you’re eligible.

HIV rapid tests

Rapid HIV tests are a convenient method for people at greater risk of HIV and need to test more frequently. Rapid tests can be done by:

• GPs
• peer workers at HIV community organisations
• purchasing a self-test through a pharmacy or online.

The test takes a drop of blood from a finger prick. Results are usually available in 15-20 minutes.

HIV rapid test reliability

For most people, standard blood tests are the best choice. Rapid tests may not be as reliable as blood tests, and have a longer window period.

Rapid tests only detect HIV antibodies. These take longer to produce and detect in blood compared with standard HIV blood tests.

A blood test detects both parts of the virus and antibodies. For this reason, your doctor will give you a blood test to confirm the rapid HIV test result is accurate.

HIV rapid test costs

In Australia, rapid HIV tests are not currently subsidised under Medicare. A limited number of doctors and other health providers may offer rapid testing for a small fee.

HIV rapid self-testing

Self-testing is like a rapid test for COVID, except finger prick blood is used in the cartridge instead of a nose or throat swab.

Self-tests cost between $25-30. They allow people to test when and where they wish to (including the privacy of their home).

Thorne Harbour Health (formerly the Victorian AIDS Council) runs PRONTO!, a free rapid HIV testing service.

PRONTO! is a peer-based service for those with a high risk for HIV (primarily gay, bisexual, and other men who have sex with men).

Getting HIV test results

Most HIV test results are available within a week.

If the test result is negative, you may receive your results within a few days.

Testing positive for HIV

If your initial test is positive for HIV antibodies, then additional testing is required to confirm the accuracy of the first test. Sometimes this involves a second blood test. It can take up to a week for a result.

Getting diagnosed with HIV

When you are first diagnosed, you will probably experience strong emotions. During this time, do not try to cope on your own. Seek support by speaking with your doctor, or contact your local community health organisation. They have trained peer workers available to help you through the initial stages of a positive diagnosis, but also through your journey of living well with HIV.

Part of testing best practice includes pre- and post-test counselling. Post-test counselling is important, regardless of the outcome.

If you test positive, counselling can provide emotional support, further information about living with HIV, and referrals to support services.

If the test is negative, counselling can provide education about HIV and how to reduce your HIV risk in the future.

Living Positive Victoria and Positive Women are community organisations that provide support and advocacy for people with HIV. Peer workers are also available to help you navigate living with HIV.

If you have recently been diagnosed with HIV, more information is available from:

• Thorne Harbour Health
• Living Positive Victoria
• Victorian HIV Service
• HIV Hepatitis STI Education and Resource Centre.

HIV testing and your rights

Testing for HIV is voluntary and can only be done with your informed consent, except in exceptional circumstances.

Before you are tested, you will be provided with information about what is involved. what the results might mean for you, and how to prevent HIV transmission in the future.

Under Australian and Victorian law, it is unlawful to discriminate against anyone who has HIV. Test results, and details on whether someone has been tested are strictly confidential. It is illegal for any information about a person being tested or a person with HIV to be disclosed without their permission.

Letting partners know you have HIV

If you have just been diagnosed with HIV, it will likely be a difficult time. You might still be struggling to come to terms with diagnosis.

During this time, it is important to let any sexual or injecting partners know they may have been exposed to HIV as soon as you can, so they can be tested and offered PEP (post-exposure prophylaxis) if appropriate.

You do not have to do this alone. Your doctor or the Department of Health Partner Notification Officers can help you through this process and ensure your identity is not revealed.

You can also get support from Living Positive Victoria or Positive Women. Both groups can provide information, support, and guidance for people living with HIV.

HIV treatment

Australians can live well with HIV. Treatments have changed over time, dramatically improving the quality and length of life for someone who has HIV.

It is also important to have a strong support network. Evidence suggests that involving others (such as partners, doctors, counsellors, peer support workers and loved ones) can improve your mental health and wellbeing and help you maintain treatment.

How HIV ART (antiretroviral treatment) works

HIV treatments are medications that reduce the amount of virus in a person’s body by preventing it from making copies of itself (multiplying). This is sometimes referred to as ART (or antiretroviral treatment).

ART treatment has transformed HIV into a manageable chronic condition (like high blood pressure or diabetes), and enables people to live long and healthy lives.

Treatment can reduce the amount of virus in a person’s body to such low levels that it is undetectable on the blood tests used to measure the amount of virus in the blood – which means the person cannot transmit HIV to others.

The sooner treatment begins after diagnosis, the greater impact it will have on controlling HIV. You are also less likely to experience illnesses related to HIV and able to reach and maintain undetectable virus levels sooner.

HIV treatment usually involves taking several different medications that target the virus in different ways. Many medications can be combined into a single tablet that is taken once a day.

Work with your doctor to determine which treatment is best for you.

If you are unable to take your HIV medication as prescribed, the virus can multiply again and become resistant to the antiretroviral medication you are currently taking and will not be as effective. If this happens, you may then need to change to a different combination of medications.

Stopping treatment (even for short periods) can cause the virus to become resistant to medication, or damage your immune system. Do not change your treatment without talking to your doctor first.

There is currently no cure for HIV. For people with HIV to remain well, treatment options are:

• daily tablets
• long-acting injectable antiretrovirals given every 8 weeks – these may be a good option for many people.

The Victorian HIV Service at the Alfred Hospital has services for people living with HIV, such as getting support with taking their medications. There are also support services and peer workers available through Living Positive Victoria, and Positive Women.

HIV treatment side effects

HIV treatments may cause mild side effects including:

• tiredness and fatigue
• nausea and digestive discomfort
• diarrhoea
• difficulty sleeping
• headaches
• weight gain
• skin rashes.

If you are on treatment, see your doctor every 3 to 6 months.

Regular blood tests are necessary to make sure your treatment is working and not causing serious side effects. It is recommended that you also get tested for STIs, and talk to your doctor about your sexual health and overall wellbeing. Ensure you are having routine screening for cancers and keep your vaccinations up to date.

HIV-positive women – contraception choices

Women with HIV who are sexually active, should check with their HIV treating doctor about their contraceptive choices.

Some contraceptives (including drugs or medical devices containing hormones) may cause interactions with HIV treatment.

Other medications can also interact with hormonal contraceptives, so it is important that any treating health professional knows about any other medication you take (including over-the-counter medicines and herbal remedies).

When considering your contraceptive choices, things to think about include:

• Whether a contraceptive is compatible with your HIV treatment.
• How well a contraceptive method will suit your lifestyle.
• How often you will use a contraceptive.
• Any pregnancy plans.
• How to protect yourself and partner(s) from infections.
• Possible side-effects of different contraceptives.

HIV stigma and discrimination

HIV can prompt intense feelings in people, regardless of their HIV status. It is sometimes viewed with a sense of unacceptability or disgrace.

A person with HIV may feel shame and despair about their status. An HIV-negative person may be fearful or angry when they discover someone has HIV. The relationship of these feelings to HIV is referred to as stigma.

Felt stigma

‘Felt stigma’ (or internalised stigma) refers to deep feelings of shame and self-loathing, and the expectation of discrimination. It can have serious negative impacts on the health and wellbeing of people living with HIV by discouraging them from getting tested, receiving support, or taking treatment. It may also lead people to engage in high-risk behaviours that harm their health, and contribute to new HIV infections.

Enacted stigma

‘Enacted stigma’ is the experience of unfair treatment by others. For people living with HIV this can be in the form of being treated differently and poorly, or through rejection, abuse, or discrimination.

HIV stigma is particularly harmful when it overlaps with other factors that are stigmatised – such as if a person uses drugs, is a sex worker, is trans or gender diverse.

Breaking down stigma is a community response where:

• Doctors and health care providers ensure their services are free from stigma, and support people with HIV to build resilience against it.
• People with HIV have access to organisations like Living Positive Victoria or Positive Women to address their internal stigma, and get the support they need in order to live well with HIV.

If you have experienced stigma or discrimination from a health care provider, and are unable to resolve your complaint with them directly, contact the Health Complaints Commissioner (1300 582 113) for assistance.

Where to get help

• Your GP (doctor)
• Your local community health service
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Get PEP If you believe you may have been exposed to HIV. Tel. 1800 889 887
• Living Positive Victoria Tel. (03) 9863 8733
• Positive Women Victoria Tel. (03) 9863 8747
• Victorian HIV Service, Alfred Health Tel. (03) 9076 6081
• Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795 (for country callers)
• Multicultural Health and Support Service, Centre for Culture, Ethnicity and Health Tel. (03) 9418 9929
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Equinox Gender Diverse Health Centre Tel. (03) 9416 2889
• PRONTO! Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 Or (03) 5448 1600
• Gateway Health Clinic 35, Wodonga Tel. (02) 6022 8888 or 1800 657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic
• Women's sexual and reproductive health hubs (throughout Victoria)