What is HIV in 2023?
HIV stands for Human Immunodeficiency Virus. It is a virus that damages the immune system, which impacts the body’s ability to recover from infection and disease.
The landscape of HIV has changed drastically in the last 40+ years. We have come a long way with HIV medication, education, and research, making prevention, treatment and testing now widely available.
While there is no cure for HIV yet, it is now a manageable chronic condition with medication. That means that, in Australia, when managed correctly with medication, HIV is not a life-threatening illness.
So, is AIDS still a concern?
Whilst AIDS still exists, it does not look like it used to.
AIDS stands for Acquired Immune Deficiency Syndrome.
HIV is not AIDS. Without treatment, HIV may develop into AIDS over a course of several years. If timely treatment is accessed and maintained, AIDS can be prevented.
Western Australia has a goal of virtually eliminating HIV transmission. The goal is to achieve the 95-95-95 global targets, that is:
- 95% of PLHIV will know their HIV status (through testing)
- 95% of PLHIV who know their status receive sustained ART
- 95% of PLHIV on sustained ART have an undetectable viral load
Western Australia has made amazing progress towards reaching these targets; however, these can only be achieved once there is progress towards zero forms of HIV-related stigma and discrimination.
Is there still stigma towards HIV?
There is no place for stigma towards HIV in 2023
Unfortunately, stigma around HIV still exists. The landscape of HIV has changed greatly since the AIDS epidemic, and it’s time our attitudes changed too.
Everyone can challenge HIV stigma. Here are suggestions:
- Share the progress that has been made towards HIV with others
- Learn about the history of HIV and the resilience of people it has impacted
- Understand how HIV transmission works – it is not as transmissible as you might think!
- Find out how to support a loved one living with HIV
- Educate others who use AIDS as an insult or the punchline of a joke
- Use language with intention, instead of using stigmatising language
- Encourage others to get tested for HIV, no matter their behaviour or sexual activity
- Normalise getting tested! Opt-in to have HIV included on your routine blood tests.
Living with HIV in 2023
When someone tests positive for HIV, we refer to them as a person living with HIV (PLHIV). People are not defined by their HIV status, so using person first language is recommended.
People living with HIV can live long, happy, healthy lives. In Australia, it is possible to receive treatment and stop the progression of HIV into AIDS. This is called antiretroviral treatment (ART).
In Australia, approximately 29,000 people are currently living with HIV. Over 90% of people with a diagnosis are receiving HIV treatment.
What is ART?
ART stands for antiretroviral treatment.
ART reduces the amount of HIV in the body (“the viral load”), preventing further harm to the immune system.
Oral medication is highly effective and PLHIV have used it as treatment for many years.
A heavy regimen of medication is no longer required. In 2023, most ART involves taking a combination oral medication. This means only taking 1 tablet, once a day.
An exciting innovation in HIV treatment is the Cabenuva injection. This is a long-acting, complete HIV regiment administered every 2 months. With these injections, a PLHIV does not need to take daily medication!
In WA, HIV treatment is free to everyone through the public healthcare system, regardless of if you have a Medicare card or not.
Like any medication, ART may lead to side effects, but these are very rare and often are very manageable. If symptoms persist, it is recommended to speak to your doctor.
Testing for HIV in 2023
There are multiple ways to test for HIV in 2023. HIV is a blood borne virus, so a blood test or finger prick is required. Testing is easy to access through a doctor or can be done via self-test.
So, who should get tested?
It is important for all people to get tested for HIV in 2023.
Everyone should get tested, even if they are asymptomatic or don’t believe they are part of a high-risk population.
- HIV is a blood-borne virus, as well as an STI. People who are not sexually active should still be getting tested for HIV, as it can be transmitted through blood that contains the virus.
- Talk to your doctor or a sexual health nurse to find out how often you should get tested.
- Testing is recommended but can only be done with a patient’s informed consent.
- The bottom line is – everyone should be getting tested for HIV!
Does HIV have any symptoms?
It is possible to have HIV with or without symptoms.
- In the process of becoming HIV positive, some people may have signs and symptoms known as “seroconversion Illness”. These are flu-like symptoms, such as a fever, rash, aches, or fatigue (not including a running nose or sore throat). Symptoms do not present shortly after exposure to HIV.
- It is also common to have no symptoms at all! Not every PLHIV gets symptoms – like many other STIs and BBVs, it is possible to be asymptomatic.
- The only way of knowing your HIV status is through testing. Testing is recommended no more than every 3 months unless there has been a potential exposure to HIV.
Where can you get a HIV test?
You can get a HIV test at a GP or sexual health clinics.
- Any general practitioner (GP) can provide you with HIV testing.
- However, many doctors don’t have much experience with sexual health, so we recommend accessing a sexual health clinic. Doctors with an interest in sexual health and sexual health clinics are able to provide safe, confidential and judgement-free support.
- Testing is confidential. A doctor will never share your status to others.
- Getting tested never needs to be embarrassing or shameful. Getting tested not only looks after your sexual health, but also that of your partners.
- Visit the WAAC website for sexual health clinic locations. https://www.waac.com.au/learn/getting-tested/
Can you test yourself for HIV?
You can self-test for HIV using the ATOMO HIV self-test.
- The ATOMO HIV self-testing (also known as home-based testing) can be self-administered at home or in any environment that you feel comfortable in.
- The HIV self-test involves pricking your finger to draw blood and mixing with the test fluid.
- The result is provided within 15 minutes after performing the test.
- There is currently only one HIV self-test approved for sale in Australia. It is important to only use devices approved for sale, so that you can be sure the result is accurate, and that the device is safe to use.
- ATOMO HIV Self tests are available for purchase from WAAC, M Clinic and a number of Pharmacy 777 locations that can be found here: https://www.mclinic.org.au/atomo-self-test
- If you test positive on a self-test kit, book an appointment with a GP to confirm your diagnosis and commence treatment.
What is a HIV window period?
The HIV window period is different for blood test and self-testing kits.
All viruses have what is known as a window period. This is the time between the first exposure to the virus and when the test can reliably detect it. For HIV, the window period depends on the type of test used.
Blood tests are the most accurate and have a window period of up to 6 weeks after exposure. Self-testing kits have a window period of up to 3 months after exposure.
Preventing HIV in 2023
The first step of preventing HIV is becoming aware of how HIV can be transmitted. HIV is both a blood-borne virus and a sexually transmitted infection.
In order for transmission to occur:
- The virus needs to be present in one person’s body
- HIV can only be transmitted when the PLHIV has a high viral load, meaning there is a high presence of the virus in the bloodstream.
- There needs to be a bodily fluid present that contains the virus
- Not all bodily fluids contain the virus – there are only six fluids that can contain HIV (blood, menstrual blood, semen, vaginal fluids, anal fluids, breastmilk)
- There needs to be a mode of transmission, such as:
- Sexual or non-sexual activity that will transmit certain fluids from one person’s body to another’s. This could be through sharing razors and toothbrushes, sharing injecting equipment, blood rituals, childbirth or breastfeeding.
- There needs to be a point of entry on the body, such as
- Vagina or anus
- Cut or lesion
- Injection point
HIV cannot be transmitted via saliva. You can do everyday activities like share a drink, share a meal, kiss a PLHIV, and there will not be a risk of contracting the virus.
So, how can HIV be prevented?
HIV transmission can be prevented a number of ways.
There are a number of ways to prevent the transmission of HIV. It is everyone’s responsibility to actively prevent HIV transmission, regardless of your HIV status.
Some ways to prevent HIV include:
- Using barrier methods during sexual activity, such as
- Dental dams
- Using lubricant to prevent tears in the skin
- Using sterile injecting equipment, avoiding sharing equipment
- Taking treatment as prevention (TasP) if you are a PLHIV
- Taking PrEP or PeP medications if you are not living with HIV/are HIV negative
- Testing regularly to know your status
Undetectable = Untransmissible (U=U)
U=U means treatment can be used as prevention
HIV transmission can be prevented if a PLHIV is taking their medication as prescribed. This is known as treatment as prevention (TasP)!
If your blood tests show you have no detectable HIV (undetectable viral load), then the virus cannot be passed on to anyone else. This means that someone with an undetectable viral load can have sex with no risk of passing on HIV.
It is important to remember that U=U is only in relation to HIV and does not prevent the transmission of other STIs, so we recommend regular testing and the use of barrier methods.
Under WA law, if a PLHIV is taking preventative measures to stop transmission (i.e., undetectable viral load), then they do not need to disclose their status to sexual partner/s. Visit the HIV/AIDS Legal Centre for more guidance: halc.org.au.
Pre-Exposure Prophylaxis (PrEP)
PrEP is a prevention option for anyone who is HIV-negative and who may be at risk of getting HIV. It is a medication containing a dose of ART that is taken prior to potential exposure to HIV. When PrEP is taken as prescribed, it can reduce the risk of getting HIV by almost 100%.
There are a few different ways that PrEP can be taken. The most effective form is daily PrEP. A doctor can provide guidance on the best PrEP schedule for you.
- Daily PrEP
- Involves taking one pill every day to keep a sufficient level of ART in your body 24/7
- Involves less planning
- Approved for a broad range of populations but how PrEP is taken will vary on how you identify.
- Also called ‘event-based’ or ‘2-1-1’ PrEP
- Involves taking PrEP around the times you are having sex and requires planning in advance
- Is less effective than Daily PrEP
- Can only be used for cisgender men having anal sex (due to a lack of evidence for other groups).
Where can you get PrEP?
You can get PrEP from GPs or PrEP prescribers.
Any doctor or GP can prescribe PrEP but you may be more comfortable discussing your needs with a practitioner who is experienced in prescribing PrEP.
- Prior to starting PrEP, the GP will test you for you HIV status, other STIs and your kidney function
- Visit the M Clinic website to see a list of PrEP prescribers in Perth https://www.mclinic.org.au/prep/prescribers
How much does PrEP cost?
The cost of PrEP differs.
|Closing the Gap scheme||Free|
Post-Exposure Prophylaxis (PEP)
Post-Exposure Prophylaxis (PEP)
PEP is a 4-week course of treatment for people who have been potentially exposed to HIV. It is most effective when taken within a few hours of the risk event happening but can be started up to 72 hours (3 days) after.
Where can you get PEP?
- Emergency departments in many public hospitals (free of cost!)
- Sexual health clinics
- Doctors that can prescribe HIV medication (these are called S100 providers, and you can find a list of WA providers here: https://www.health.wa.gov.au/Articles/F_I/Information-for-pharmacists-HIV-s100-community-prescribers)
For more information about PEP and assistance finding a prescriber call PEP Line 1300 767 161
PEP Line is 24 hours a day, 7 days a week.