The facts about HIV and AIDS and why we make a big deal about it on December 1st.
(Here’s the more general guide to STIs)
What are HIV and AIDS and are they the same?
HIV is a virus which attacks and destroys CD4 cells in the body, which are the cells which help to fight illnesses. This is our immune system – the thing that helps us get over colds. Unless someone with HIV gets treatment, the number of CD4 cells can become so low that they can’t fight off illnesses and so get seriously ill. When someone’s immune system is this low from HIV they have AIDS. That’s the difference between HIV and AIDS: HIV is when the virus is present in the body; AIDS is when someone is ill because their immune system is low from the virus. Got it?
How do we get HIV?
The main way that people in the UK get HIV is by someone having sex with someone, who already has detectable levels of HIV, without a condom. Mostly this is sex with a penis going inside a vagina or anus (arse), without a condom.
So we need to:
- either use a condom (an external or an internal condom) for sex.
- only have sex with someone we know for sure doesn’t have the virus
- only have sex with someone who has undetectable levels of HIV (more on that below).
- just have safer kinds of sex (dry humping, snogging, wanking, sex without having ‘sex’).
It’s also possible to get HIV from sharing needles with someone who has HIV. It’s also possible to be born with HIV from a parent who already has it and isn’t getting treatment for it.
We can not get HIV from kissing, stroking, licking, massaging, rubbing or using the same toilet seat or towel or anything like that. OK? Got that?
How do we know if we have it?
We can have HIV without knowing and mostly people only know about their HIV status once they’ve had a test (see below). Last year, around half of the people who found out they had HIV were only diagnosed when the virus had already made them very ill. It’s thought that over 6600 people in the UK living with HIV don’t know they have it. It’s super important that people with HIV are diagnosed so they can get treatment (see below).
When a person first gets HIV, their symptoms might resemble those of a heavy cold or flu which might be around for about a week. Obviously, a lot of people would just assume that they had a heavy cold or flu.
If someone hasn’t had any treatment then they might start getting symptoms of the serious illnesses that can happen when someone has AIDS.
Symptoms can include:
- weight loss
- chronic diarrhoea
- night sweats
- a fever
- a persistent cough
- mouth and skin problems
- regular infections
- serious illnesses or diseases
So if you’ve ever had sex without a condom you might want to get a check-up, or you think you might have been put at risk of HIV, you might want to get a test done.
You can get tested at a clinic, which are all free and confidential (for your nearest clinic visit here). The test usually involves a little pin prick to the end of your finger to get a few drops of blood. With a lot of the testing kits (which you can also do at home if you want to) you don’t even see anything, which is great for people like me who are well squeamish. Most people would say that it really doesn’t hurt too. If you don’t fancy this you can also ask your local service if they will do a mouth swab for you.
Tests are free and confidential in the UK.
The good news is that HIV is extremely treatable nowadays. In fact, treatment for HIV is so effective that people with the virus can expect to live just as long as anyone else. Also when someone gets treatment for HIV then the virus can be made so small in the body that it is undetectable by tests. This is important because it means that the virus can’t be passed on, even without condoms: remember undectectable = untransmissable (which is the well catchy campaign to promote this).
HIV is easier to treat the earlier that we get diagnosed, so this is why it’s a good idea to get treated regularly. Particularly if the group of people you have sex with might be more likely to have HIV.
PrEP and PEP
PEP and PrEP are pills that you can take to avoid getting HIV. PrEP is taken before having sex, and it stops transmission of HIV even if having sex without condoms. However, unlike condoms, PrEP does not protect against other STIs or pregnancy.
PEP is taken if you’ve had sex without a condom and think there was a risk that you’ve been exposed to HIV. It is effective up to 72 hours after exposure to HIV.
PEP and PrEP are both now available via NHS for free throughout the UK. You can find your local sexual health service here.
Why is there stigma about HIV?
HIV must be the only illness in the world where people are abused and attacked and treated unfairly for having an illness. So because of this it can be hard to openly live with HIV. One of the reasons that this stigma exists is because not enough people know the facts about HIV (so if you could share this post with pals that would be grand thanks).
The other reason that there is stigma about HIV is because of racism and homophobia and biphobia. It’s a tricky area so let me explain.
There are groups of people who face a higher risk of getting HIV than others – there are more cases of HIV in some communities of men who have sex with men and black African communities. This is how most STIs work, they affect groups of people, because that group of people have sex with each other. Other illnesses work in the same way – ever wondered why so many people get colds in the first couple of weeks of school, college or uni?
So it makes sense for sexual health organisations to target the groups most affected because if that group gets tested and treated then it can dramatically reduce the overall number of people with an infection. This is actually what has happened in the last couple of years as you can see in the stats here. So that’s why we talk about some groups being at higher risk in order to protect those people. Other people stigmatise those groups by saying that AIDS only affects them, or that all members of that group have AIDS, this does the opposite of protecting them and is a way of deliberately hurting them – just like other forms of racism, homophobia and biphobia.
Just because some communities face a higher risk of HIV, doesn’t mean that it’s only those communities that are at risk of HIV, anyone having sex with anyone is at risk of HIV, simply because many people don’t know that they have it. For example, last year in England around 38% of new cases of HIV were in straight men and women. Just because some groups are at a higher risk of HIV, doesn’t mean that other groups are not at risk at all.
AIDS is not just an illness
So AIDS is more than just an illness, it’s a symbol of how stigma and discrimination work. It’s also an example of how health inequalities work. If you look at the history of Aids in this excellent timeline by Avert, you’ll see how regular people had to fight really really hard to get treatment.
AIDS was ignored by successive governments around the world for too long, which is why so many people got it in the first place. Do you know how long it took the US president to publicly talk about Aids after the first cases were confirmed? Four years. Four.
HIV and AIDS is still very much with us and thrives in areas and populations where good healthcare is not evenly distributed. Of course this is also linked to wealth inequalities around the world, with poorer countries being denied the kinds of resources that wealthy countries have. Also the laws governing sex workers, gay and bisexual men, trans people can prevent access to services. AIDS is an example of how vulnerable people are made more vulnerable.
Viruses and government
To understand some of this in the modern day let’s consider what we have learned from another pandemic. Covid-19 and HIV and AIDS are very different viruses in the way they spread and the effects they have. But there are similarities and differences between the pandemics. We’ve had the same inaction and denial that we had with AIDS, but generally the world has acted way more quickly for Covid-19 than it did (and still does) for AIDS.
In areas where healthcare systems and governments were prepared and ready, Covid-19 has less of an impact. Where this wasn’t the case it disproportionately affected: black and south Asian communities (in the UK), precarious self-employed people, and frontline workers: all of whom are more likely to be from poor communities.
So as we can see, viruses are never just neutral, government action or inaction cause inequalities in who they affect.
Read more about this in the context of stress and mental wellbeing
World Aids Day
So this is why we have World Aids Day and why it’s important. It’s not just about sex education, but about also about justice and rights. For that reason we mark it on December 1st every year and make noise about it. It’s an important act of solidarity, and let’s face it this year all you can do this year is share stuff on social media.
So, check out the World Aids Day website from the National Aids Trust. See also these great campaign ideas from the Terrence Higgins Trust. Here’s the UNAIDS website. And there’s a huge amount of really great information (including that timeline I mentioned above) at AVERT.
If you’re an RSE teacher, check out the amazing new schools pack from the NAT.
Comment below if you like. I moderate all comments before they appear, so don’t be cheeky!
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© Justin Hancock, 2023
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Justin Hancock has been a trained sex and relationships educator since 1999. In that time he’s taught and given advice about sex and relationships with thousands of young people in person and millions online. He’s a member of the World Association for Sexual Health.