HIV
What is HIV?
HIV stands for Human Immunodeficiency Virus. HIV weakens a person’s immune system, which reduces the body’s ability to fight infections. If left untreated, HIV can cause AIDS (Acquired Immune Deficiency Syndrome) which is when the immune system is severely affected. This can result in serious illness and disease. Modern treatments for HIV are so effective that very few people develop AIDS now – this only happens in people who are not on treatment. Even if you are diagnosed with AIDS, starting treatment immediately can help your immune system recover, often back to normal levels.
How can you catch HIV?
The HIV virus is found in blood, genital fluids (semen, vaginal and anal fluids) and breast milk. If a person living with HIV is not on treatment and has a high viral load, it is possible to become infected from these fluids. However, people living with HIV who are on treatment and whose virus is undetectable CANNOT pass on the virus.
The most common way HIV is passed on is through unprotected vaginal or anal sex (sex without a condom). It can be less commonly passed on through sharing sex toys without the use of condoms, by sharing equipment used to inject or snort drugs, or from a mother (birthing parent) to their baby during pregnancy, birth or breastfeeding.
There are lots of myths surrounding HIV. HIV is NOT transmitted through normal social contact – you can’t get HIV from:
- Sharing food or cutlery
- Kissing
- Shaking hands, hugging or any other social contact
- Using the toilet or swimming pools
- Sneezing
- Spitting or biting
What are the symptoms of HIV?
The virus can be present in the body for months or years before any health problems begin, so many people will not have any symptoms of HIV for a long time. However, some people experience a short flu-like illness in the first few weeks after becoming infected – this is called a seroconversion illness. This can include a rash, sore throat, swollen lymph nodes and a high temperature. These symptoms are similar to other common viral illnesses, which is why the only way to be 100% sure is to get an HIV test. In those whose HIV infection is not picked up until the later stages, symptoms can include weight loss, night sweats and serious infections such as pneumonia or tuberculosis.
Where and how do I get tested?
A blood test for HIV is offered to everyone as part of our routine sexual health screening at Highland Sexual Health. Results are usually back within 1 week. Routine appointments can be made online but if you have particular worries or symptoms, please contact us by telephone and we will discuss the best options for you. If you are unable to come to one of our clinics, many GP practices will be happy to arrange testing if you specifically request it. In the past we have offered self-sample postal kits for HIV and Syphilis testing. However, many patients have reported difficulty obtaining enough blood using the finger prick method and so we have temporarily paused this option. You are still able to request self-sample postal kits for Chlamydia and Gonorrhoea testing as these do not require a blood sample.
What if my result is positive?
If your HIV test comes back positive you will be asked to come back for repeat testing to confirm the result. You will then be referred onto our specialist team of healthcare professionals for support and treatment. If you are resident in Scotland, HIV treatment is free regardless of visa status. Being told you have HIV may be a massive shock but remember it is now a treatable medical condition, like diabetes or high blood pressure. Life expectancy for people living with HIV who are taking treatment is now virtually the same as those without HIV. Modern treatments have little to no side effects and help you stay healthy and well, long into your old age. Being HIV positive doesn’t mean that you can’t live a normal life. Under the Equality Act (2010), people living with HIV are legally protected against discrimination, in the same way that people cannot be discriminated against based on their sex, age, sexual orientation or religion.
Treatment and living with HIV
It is now recommended that everyone with HIV starts treatment as soon as possible after diagnosis, giving the immune system the best chance of full recovery. HIV treatment can’t currently cure HIV but can reduce the amount of virus in your body to undetectable levels. Modern treatment for many people living with HIV involves just taking one or two tablets every day and seeing a specialist for regular check-ups.
Large studies also now show that people living with HIV who have been taking HIV medication for at least 6 months and have undetectable levels of virus cannot transmit HIV to their sexual partners. This is called U=U: undetectable equals untransmittable.
Further information about treatment and U=U is available:
PREVENTION
The best and simplest way to prevent all sexually transmitted infections, including HIV, is to practice safer sex – this means using a condom every time for vaginal or anal sex.
There are also medications available to prevent the transmission of HIV – these are called PrEP and PEP. PrEP (pre-exposure prophylaxis) is medication taken before sex which significantly reduces the chance of HIV infection. It is available for free from all sexual health services in Scotland, for those at higher risk of HIV infection. Please make an appointment if you would like to discuss this and follow this link for more information [link to PrEP pages that Bridie has prepared]
If you think you have been at higher risk of catching HIV within the last 72 hours you may be able to take an emergency course of PEP (post-exposure prophylaxis). This involves taking 3 tablets a day for 28 days, and aims to stop the virus multiplying before it takes hold in your body. It is not 100% effective but the sooner you take this medication, the more effective it is. Please call us as soon as possible if you think you need PEP. If we are not open, it is also available from A&E. It is not available from GPs or community pharmacies.
Other ways to prevent HIV include never sharing injecting equipment and engaging with harm reduction services if you are struggling with drug or alcohol dependence, or are having risky sex whilst under the influence of substances.
HIV and COVID
We are still learning about how COVID-19 affects people living with HIV. For older patients and those with low CD4 counts, there is a higher risk of severe symptoms and hospital admission. However, the majority of people living with HIV will not become seriously ill. COVID vaccination is still recommended for those at higher risk of COVID-related complications and this includes all people living with HIV regardless of your viral load or CD4 count. You will be contacted directly by NHS Scotland if you are eligible for COVID-19 vaccination. If your GP is not aware of your HIV diagnosis, you may miss out on this automatic letter.
More information about COVID, vaccinations and treatments is available at: NHS Inform - COVID19
Injectable HIV treatment
A new type of treatment for HIV is now available in Scotland. For some people, injectable Cabotegravir (Vocabria®) and Rilpivirine (Rekambys®) is available as an alternative to taking daily tablets. These injections are given every 8 weeks so require you to attend appointments more frequently than if you remain on tablets. Injectable treatment may be a good option for some people who have difficulty taking tablets. This might include:
· People who find taking a pill every day has a significant effect on their mental health and wellbeing (such as those who fear disclosure of their HIV status)
· People who have physical difficulty swallowing tablets
· People who struggle to take tablets every day – even though they have a suppressed viral load
However, injectables are not suitable for everyone. To be eligible for injectable treatment you must:
· Have an undetectable viral load (less than 40 copies) for at least 6 months on your current medication
· Be able to attend for injections (one in each hip muscle) every 2 months - If you cannot commit to attending clinic every 2 months, then injectable treatment is not the best option for you
· Have no resistance to certain HIV medications on your previous blood tests
· Not require Tenofovir treatment for chronic Hepatitis B infection
There is a small risk of the injections not working (called virological failure), even if every injection is given correctly and on time. This affects about 1 in every 60 people after 2 years so a blood test to check your viral load is needed at every injection appointment. If this happens, the virus often becomes resistant to these medications and therefore you would need to go back onto different tablets. There are also a few other factors in your medical history that you would need to discuss with your clinic doctor or nurse before considering injectables.
If you think that injectables might be an option for you, ask your clinician at your next appointment. More information is available BHIVA
useful links
GENERAL SUPPORT
HIV TESTING
Having an HIV test is the only way to know for sure whether you have HIV. If you have HIV, it’s very important that it’s diagnosed as soon as possible. This will give you the best chance of getting the treatment and care you need to stay well. For more information about testing, follow this link: HIV testing
WHAT IS HIV?
The AIDSMAP website has lots of information about HIV, symptoms, the stages of infection, how treatment works and future treatment options:
MYTHS ABOUT HIV
There are a lot of myths about how you can get HIV. This link will give you the facts:
HIV & STIGMA
HIV stigma refers to irrational or negative attitudes, behaviours or judgments towards people living with or at risk of HIV. Breaking down HIV stigma is a critical part of ending the HIV epidemic. You can play an important role in reducing stigma and discrimination by offering support and speaking out to correct myths and stereotypes about HIV that you hear from others. Reputable sources of information are available at:
Stigma | Terrence Higgins Trust (tht.org.uk)
HIV & SLEEP PROBLEMS
Sleep is an essential part of a healthy life – it’s when your body is able to rest and repair. Living with HIV can affect your sleeping pattern, especially in the first few weeks to months after diagnosis whilst you are coming to terms with things. If you’re not getting enough sleep you may feel tired, sluggish or low in mood. Many people will have short term problems sleeping at some point in their life but there are lots of resources available to help with this:
HIV & MENTAL HEALTH
Almost every person faces mental health challenges at some point, but living with HIV can make this more likely for some people. You may find that a diagnosis of HIV challenges your sense of well-being or complicates existing mental health conditions. Good mental health will help you live your life to the fullest and is essential to successfully treating HIV. To help manage your mental health, it is important to know when, how, and where to get help. Having a trusted friend or relative to talk to can be very helpful but if this isn’t possible, there are national organisations that can help with support:
Online MBSR/Mindfulness (Free) (palousemindfulness.com)
Active Health Project — velocity cafe and bicycle workshop (velocitylove.co.uk)
HIV & DIABETES
People over the age of 40, including people living with HIV, are more likely to develop diabetes. People living with HIV should have an annual blood test to look for diabetes as part of their HIV care. This link describes type 2 diabetes and how it can be managed: HIV and diabetes
HIV & THE HEART
Strokes and coronary heart disease (angina, heart attacks and heart failure) is usually caused by a narrowing of the arteries known as atherosclerosis. This is where fatty deposits gradually build up on the walls of the arteries, making it harder for blood to get through. When this blockage become severe, the heart and brain don’t get enough oxygen and become damaged. People living with HIV are more likely to develop these problems, even if they are on effective treatment. A recent large study showed that being on a statin tablet significantly reduces the risk of major cardiovascular events (such as heart attack or stroke) and therefore BHIVA guidance now recommends offering a statin tablet alongside your HIV medication for those aged 40 and older. More information about the REPRIEVE trial and the recommendations are available here: Statin Recommendations
However, it’s also important to remember that many other lifestyle factors such as diet, exercise and smoking also affect your overall health and the risk of heart disease, so it’s important you try to maintain a healthy lifestyle for long term good health.
Further information, support and advice is available at: