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Pop culture is a double-edged sword when it comes to diseases such as HIV. Young adults report that they get much of their knowledge about HIV from popular media such as T.V. shows and movies (Johnson, 2013). And while movies and T.V. shows showing people living with HIV can help reduce the stigma of HIV/AIDS, they’re no substitute for a solid HIV/AIDS education.
Below, we’ve outlined some essential points you need to know about HIV that tend to get glossed over.
What is HIV?
The human immunodeficiency virus (HIV) attacks the body’s immune system—specifically, CD4 cells. These white blood cells that help your body fight off infections from other viruses, bacteria, or parasites, are also called T-cells, or helper cells. HIV’s attack on these cells damages the immune system. In turn, this increases the risk of serious infections (and even some types of cancer) from pathogens that wouldn’t be a threat to people without an immune disease. An HIV infection can be divided into the following stages (Waymack, 2020):
- Acute HIV infection
- Asymptomatic chronic HIV infection without AIDS
- Acquired immunodeficiency syndrome (AIDS)
The acute illness stage happens during the first four weeks after infection. People may experience flu-like symptoms such as fatigue, sore throat, fever, muscle aches, rash, and headaches, but not everyone will experience symptoms. HIV tests that look for antibodies to the virus might still be negative during this time and miss an infection because your body has not created enough antibodies (Waymack, 2020).
After the acute illness phase, people often experience no symptoms. During the chronic HIV infection stage without AIDS, called asymptomatic HIV infection or clinical latency, the virus multiplies but at a much slower rate. Untreated, people can be in this stage for up to 8–10 years. With antiretroviral therapy (ART), they may stay in this phase for decades (Waymack, 2020).
The last stage of HIV infection is acquired immunodeficiency syndrome (AIDS). AIDS can be defined in two ways. A person is considered to have AIDS once the number of CD4 cells has dropped below a certain threshold. Someone is also considered to have AIDS if they have a so-called AIDS-defining illness. AIDS-defining illnesses are certain types of infections (known as opportunistic infections) or rare cancers that people with an intact immune system usually don’t get (Waymack, 2020). With treatment, it’s possible for an HIV-positive person never to develop AIDS.
Digging deeper: 9 things you need to know about HIV
Now that you understand the basics of HIV, let’s look at some other things you need to know.
1. HIV can affect anyone
Men who have sex with men are the group most affected by HIV in the United States. Adult and adolescent gay and bisexual men accounted for 70% of new HIV diagnoses in America in 2018 (CDC, 2019-a).
Racial and ethnic disparities continue to exist. Black men who have sex with men are more affected by HIV than any other group in the United States. They account for 26% of all new HIV diagnoses in the U.S. and 37% of new diagnoses among gay and bisexual men. But it’s important to remember that anyone can contract HIV, regardless of race, gender, or sexual orientation, which is why practicing safe sex is essential for everyone. As of 2018, 24% of new HIV infections were heterosexual transmissions (CDC, 2019-b).
2. One in seven people with HIV is unaware of their infection
According to the Centers for Disease Control and Prevention (CDC), by the end of 2018, 1.2 million people in the United States had HIV. Approximately 14% (or one in seven) did not know that they had the virus (CDC, 2019-b). People who don’t know they’re HIV positive do not receive treatment and can easily transmit the virus to others, which is why testing is so important. In fact, a CDC report that looked at people infected with HIV in 2014 found that almost one-quarter of the people diagnosed (23%) were simultaneously diagnosed with AIDS, meaning they had likely been infected for years without knowing it (CDC, 2016-b).
The CDC recommends that everyone between the ages of 16 and 64 gets tested for HIV once in their lives. For those at higher risk for HIV, the CDC recommends getting tested at least once a year (CDC, 2020).
3. People living with HIV often have a normal life expectancy
You can be HIV positive and still live a long, healthy life, thanks to early diagnosis and treatment. Many portrayals of HIV/AIDS in movies are more reflective of outdated treatment. Life expectancy and treatment of the virus have far outgrown these depictions. A recent study found that the life expectancy of HIV-positive adults is close to that of people without HIV infection (Marcus, 2020).
4. Some sex practices are riskier than others
Having vaginal or anal sex with someone who has HIV without using a condom or taking PreP (see below) is the most common way the virus is spread in the U.S. In general, unprotected anal sex is the highest-risk sexual activity for HIV transmission.
But even that is a simplification. According to the CDC, the risk of getting HIV is 13 times higher for the person receiving the penis in their anus than for the person who inserts the penis (CDC, 2019-a). One reason is that the lining of the inside of the rectum is thin and fragile, which can allow HIV to enter the body.
5. The risk of getting HIV from oral sex is very low
Receptive oral sex (i.e., getting a blowjob or someone licking your vagina) is considered exceptionally low-risk. When performing oral sex on someone, HIV transmission can theoretically happen if an HIV-positive man ejaculates in their partner’s mouth during oral sex (CDC, 2019-c). That’s because semen (“cum”) and pre-seminal fluid (“pre-cum”) is one of the body fluids that can have enough HIV to infect another person.
However, the risk of getting HIV through any type of oral sex is generally still considered much lower than with anal or vaginal sex. Sores or other infections in and on the mouth, vagina, penis, or anus can increase the risk of HIV transmission. One thing to remember: even though it’s unlikely you will get HIV from oral sex, you can still contract other sexually transmitted infections (STIs) (CDC, 2019-c).
6. Having other STIs increases your risk of getting HIV
Suppose you have a sexually transmitted infection (STI) like syphilis, gonorrhea, chlamydia, or herpes. In that case, you are also more likely to get infected with HIV than someone who doesn’t have an STI (Pathela, 2013; CDC, 2021-a). One of the reasons is that STIs often come with inflammation, sores, or breaks in the skin, which can help HIV to enter your body more efficiently.
Genital herpes (HSV-2), for example, is associated with a higher risk of contracting HIV, a study found. It’s believed that herpes may increase your odds of HIV infection by damaging the skin during an outbreak (i.e., you may have open sores that the virus could pass through) and by bringing more CD4 into the genital area, which can then be targeted by HIV (Looker, 2017). If you have HIV and another STI, you are also more likely to transmit HIV to others (CDC, 2021-a).
7. There’s a highly effective pill that can prevent HIV infection
You may have seen ads for pre-exposure prophylaxis (PrEP). PrEP is a daily pill that can prevent HIV-negative people from getting HIV. It’s highly effective—when taken daily, PrEP has been shown to decrease the risk of infection through sex by up to 99% (Anderson, 2012). Talk to your healthcare provider to see if PrEP is right for you. Before beginning PrEP, you will need to take an HIV test to make sure you don’t have HIV. And while taking the drug, you’ll have to visit your health care provider every three months for follow-up visits, STI tests, and prescription refills (CDC, 2021-b).
8. Thanks to treatment, HIV is now manageable
People with HIV have to take medicine called antiretroviral therapy (ART) to treat their infection, which is why HIV testing and knowing your status is crucial. When taken as prescribed, HIV drugs reduce HIV in the body to such low levels that a test can’t detect HIV anymore. This is called an undetectable viral load. It means that HIV is still present in the body, but in such small numbers, the virus doesn’t affect the immune system anymore. Another benefit of an undetectable viral load: it’s highly unlikely that you’ll infect others through sex, even if it’s unprotected sex (NIH, 2020).
Large studies involving couples in which one partner was HIV positive and taking ART, and the other was negative, found no HIV transmission to the HIV-negative partner, despite condomless vaginal or anal sex. That is thanks to ART and an undetectable viral load in the HIV-positive partner (Rodger, 2016; Bavinton, 2018).
9. If you’ve been exposed to HIV, you can still avert the infection
If you suspect you have been recently exposed to HIV (for example, if the condom broke during sex or if you’ve been sexually assaulted), see your healthcare provider or go to an emergency room or urgent care within 72 hours of that possible exposure. Your healthcare provider might consider prescribing post-exposure prophylaxis (PEP), which can stop the virus from taking hold and spreading in your body. If you’re prescribed PEP, you’ll need to take it daily for 28 days (CDC, 2021-c). The sooner you start PEP, the better, and every hour counts.
- Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., et al. (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine, 4(151). doi: 10.1126/scitranslmed.3004006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22972843/
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