What is it?

HIV (human immunodeficiency virus) is an infection that weakens your immune system, meaning you’re more likely to catch other harmful infections.

Anyone can get HIV if they are sexually active, regardless of whether they are gay or straight or where they come from—but HIV rates are higher among gay, bisexual men or men who have sex with men (MSM) and people from sub-Saharan Africa living in the UK.

Up to six weeks after getting HIV many people experience a short one or two week illness called a seroconversion illness. It’s a sign that their immune system is reacting to the presence of the virus in their body. Seroconversion is also the point at which the body produces antibodies to HIV. Once seroconversion has happened, an HIV test will detect antibodies and give a positive result.

The most common symptoms of seroconversion are:

  • sore throat
  • fever
  • rash over the body

Some people with HIV never get a seroconversion illness and will only notice further symptoms of HIV after a few years. So whether you notice symptoms or not, if you’ve had a risk you should get tested and use condoms.

Transmission

HIV is a blood borne virus (BBV) and a sexually transmitted infection (STI).

The most common way HIV is transmitted in the UK is through sex without a condom but it can also be transmitted through sharing drug injecting equipment.

If you have a STI such as Chlamydia, syphilis or gonorrhoea, this can increase the risk of acquiring HIV.

 

There are lots of myths and misconceptions about how people get HIV. Here we debunk those myths and give you the facts.


HIV and AIDS are the same thing

No – When someone is described as living with HIV, they have the HIV virus in their body. A person is considered to have developed AIDS when the immune system is so weak it can no longer fight off a range of diseases with which it would normally cope.

You can get HIV by touching someone who has the virus

Nope – HIV can’t survive outside of the body so you won’t get HIV from touching someone, hugging them or shaking their hand.

HIV can only be passed on from person to person if the virus from infected body fluids (such as blood, semen, vaginal or anal secretions and breast milk) gets into your bloodstream by having unprotected sex, sharing injecting equipment or more rarely from mother to child during pregnancy.

 

Myths about HIV prevention and cure

There are lots of urban rumours about ways that you can protect yourself from HIV – from showering after sex or taking the contraceptive pill to having sex with a virgin. In reality, if you are having sex the only methods of HIV prevention which will protect you from HIV are condoms or pre-exposure prophylaxis (PrEP).

 

If I get infected fluid from an HIV-positive person into my body will I definitely get HIV?

No – HIV is not always passed on from an infected person. There are lots of reasons why this is the case. For example, if the HIV-positive person is on treatment it will reduce the amount of HIV in their body meaning it is unlikely to be passed on.

HIV is only a risk for certain groups of people

Like most illnesses, HIV doesn’t discriminate between types of people and the infection can be passed on to anyone via one of the ways mentioned above.

Some people are more vulnerable to HIV infection if they engage regularly in certain activities (e.g. injecting drugs) that are more likely to transmit the virus. However, it’s a common misunderstanding that HIV only affects certain groups.

It’s easy to tell the symptoms of HIV…

The symptoms of HIV can differ from person-to-person and some people may not get any symptoms at all. Without treatment, the virus will get worse over time and damage your immune system. You cannot tell by looking at someone if they have HIV. Many people don’t show any signs or symptoms. And, for people living with HIV who are on effective treatment, they are just as likely to be as healthy as everyone else.

Prevention

At least half of all transmissions occur within a few months of a person becoming infected because their body fluids (blood, semen and vaginal or anal secretions) are highly infectious.

The best way to prevent HIV infection is to always use condoms and lubricant, never share injecting equipment and get tested for HIV regularly. Early diagnosis and treatment can help prevent serious, and possibly life-threatening, illnesses.  Treatment also significantly reduces the likelihood of transmitting the virus to sexual partners as once you’re on effective treatment and your viral load becomes undetectable you cannot pass on HIV. It can take up to six months on treatment to become undetectable.

Don’t stop using condoms in a regular relationship unless you are sure that you have both had a negative test and are not having other casual sexual partners.

In addition to condom use, there are a couple of treatment options that can prevent HIV infection. Post Exposure Prophylaxis (PEP) and Pre Exposure Prophylaxis (PrEP) involve the use of existing HIV medicines (anti-retroviral therapy ART), to reduce the likelihood of HIV transmission.

PrEP is medication for people who are HIV negative, but at high risk of becoming infected, to take before sex to reduce the chance of becoming infected with HIV. PrEP is a combination of two different drugs Tenofovoir and Emtricitabine which have been used for many years as treatment for people who are living with HIV.

PrEP if taken consistently can significantly lower the risk of becoming infected with HIV (studies have shown up to a 92 percent reduction in risk). Once PrEP reaches protective levels in the body, it prevents HIV from staying in the body.  It takes between 2 and 24 hours following a double dose, to reach protective levels in rectal tissue and 7 days of daily tablet, to reach protective levels in vaginal tissue.

The PrEP In Scotland leaflet provides more detailed information.

If you are HIV negative but have a high risk of being exposed, you should consider taking PrEP.  This includes men who have sex with men or transgender women who have had anal sex without a condom or have been diagnosed with a rectal sexually transmitted infection in the past twelve months. In addition, taking PrEP may be beneficial for heterosexual men or women who do not regularly use condoms during sex with a partner who is HIV positive and not on treatment.

PrEP is not suitable for everyone, and you should only take it if you feel it is right for you, and have discussed its suitability for you with a health professional.

In Scotland, the following criteria have been agreed by all the health boards for prescribing PrEP:

  • Aged 16 or over
  • Test HIV negative in a clinic
  • Able to attend for regular 3 month reviews
  • Willing to stop taking PrEP when no longer eligible
  • Resident in Scotland

Plus, one or more of the following criteria:

  • Current sexual partners, irrespective of gender, of people who are HIV positive and with a detectable viral load
  • Gay and bisexual men, other men who have sex with men*, and transgender women with a documented bacterial rectal STI in the last 12 months
  • Gay and bisexual men, other men who have sex with men*, and transgender women reporting condomless penetrative anal sex with two or more partners in the last 12 months and likely to do so again in the next three months
  • Individuals, irrespective of gender, at an equivalent highest risk of HIV acquisition, as agreed with another specialist clinician.

*This includes transgender men who have male sexual partners

PrEP does not prevent transmission of other sexually transmitted infections therefore it is important to continue using condoms. PrEP is not intended as a replacement for condoms

PrEP has been approved for use by the NHS for people who reside in Scotland and it is therefore free.

PrEP is only available from sexual health and MOT clinics in Tayside.  You must be seen by a nurse (at a walk-in or MOT clinic – click here for opening times) for a pre-PrEP consultation and then an appointment will be made for you at a PrEP clinic to see a consultant.  A decision and treatment plan will be discussed with you by the consultant

While PrEP is taken before possible exposure to HIV, PEP (post-exposure prophylaxis) is given to people in an emergency after someone has had a likely exposure to HIV. PEP requires individuals to access the drug within 72 hours of the exposure (ideally within the first 24 hours) and adhere to a regime for a month

If you don’t meet the criteria for PrEP on the NHS, then it might not be a good idea to take it The best thing to do is to discuss this with a sexual health clinician and keep them informed of any increase in HIV risk.

PrEP can be purchased online from generic suppliers. If you get, or intend to get your PrEP online, talk to your healthcare provider about it. Stay connected to your sexual health clinic as well, because you still need to be regularly monitored and tested.

PEP stands for Post Exposure Prophylaxis.  It is a 4-week course of pills you can take if you have been at serious risk of getting HIV. The medication can stop you becoming infected with HIV even after it has entered your body but it isn’t a guarantee.

PEP has the best chance of working within 24 hours but can be given up to 72 hours (3 days) from when you think you have been at risk of getting HIV. However, you shouldn’t wait for 72 hours before contacting the clinic as the longer you wait the less effective PEP is likely to be.

You can get PEP at:

  • Sexual Health or MOT clinics
  • Accident & Emergency departments in Ninewells Hospital and Perth Royal Infirmary (Evenings & Weekends)

The doctor will decide if you should have PEP depending on what kind of sex you have had.  The doctor will also want to ask you questions about who you have had sex with; if they are known to have HIV or not and what country they come from.  It would be very helpful if the person you had sex with could be seen too and have an HIV test.  This would help to clarify if you really need PEP or not.  We know this can be difficult though.

PEP is usually only recommended after anal sex without a condom or if a condom bursts but it may be prescribed in other situations too.  You can contact organisations like THT Scotland for advice if you are not sure whether the risk was enough to make PEP worth thinking about but if you are still unsure you should just come to the clinic to speak to someone whose job it is to help you in these situations.

It is still important to use condoms. The main reasons for this are:

  • Condoms, used correctly are better at stopping HIV than PEP
  • Condoms have no side effects
  • Condoms are cheap (often free) and easy to get
  • You can control the use of condoms
  • Condoms also prevent other serious STIs like syphilis and hepatitis B and C

Testing

In the UK, 1 in 8 people living with HIV don’t know they are infected and many people with HIV don’t have any symptoms so if you think you might have been at risk then get tested.

You can have a test for HIV at a Sexual Health Clinic, the MOT clinic or at your own GP. If you have been at risk through your drug use, you can also be tested at a number of addiction services such as Tayside Substance Misuse Service or The Cairn Centre in Dundee.

Alternatively you can now buy tests online to test your own blood for HIV. Tests cost around £30. You must make sure that any test you buy is licenced for use in the UK and have a “CE” mark. The test involves taking a drop of blood from your finger. The test will then check for antibodies in your blood. You must follow the instructions very carefully to ensure you get an accurate result.

 

The advantage of going to a sexual health clinic is that they have more in-depth knowledge and experience about HIV and other infections.  The MOT service can also offer a rapid HIV fingerprick test, where provisional results are available within 20 minutes.  The advantages of going to your GP are that it is usually a more familiar environment and you might feel more comfortable talking to your own doctor.  Wherever you go you should be able to ask questions about HIV testing.

Traditional testing for HIV is done by a taking blood from your arm.  Only 5ml of blood is needed.  Most test results take 7-14 days but some sexual health clinics are able to offer same day testing.  Depending on your risk they might give you the results over the phone or they might bring you back to discuss the results with you face-to-face.

The tests are very accurate but they will ask you for another blood sample to be sure.  You will be put in touch with the HIV specialists who will arrange to see you very quickly and the sexual health team can also provide advice and support.

If you’ve had unprotected sex in the last 4 weeks then we can’t be sure that you don’t have HIV.  You are in what is called the “window period”.  This is because it can take your body up to 4 weeks to make HIV antibodies which is what the test is looking for.  So a negative test doesn’t always mean you don’t have HIV.  You should have another test 4 weeks after the last time you had unprotected sex to be sure. A negative test at this time means you don’t have HIV.

Treatment

There is no cure for HIV, but once it is diagnosed you can start treatment that will help you live a longer, healthier life.  The earlier HIV is diagnosed, the better the treatment options. Treatment is now so effective that most people have an undetectable viral load within 6 months making the virus untransmissible, even if having sex without condoms. This is a large international campaign to highlight to all that U=U (undetectable= untransmissible).

It’s important to remember:

  • Successful HIV treatment means you can expect to live as long as anyone else
  • This treatment can be as simple as taking one or two pills, once a day
  • Once your treatment is working properly, you may only have to see a doctor once or twice a year
  • You can still have a great sex life– either with condoms, or even without once your treatment is working properly
  • HIV positive parents can have HIV negative children

You might not need to start treatment straight away but only an HIV doctor can work this out with you. If you were to wait until you were ill to seek medical advice it would be a lot more difficult to control your HIV and make you well.

Services & Team

HIV Specialist Service

East Block, Level 4, Ninewells Hospital, Dundee, DD2 1UB

For appointments call East Block: 01382 496 561

HIV Nurse Specialists: 01382 496 554

The HIV Specialist Service is made up of medical staff, nursing staff, pharmacists, a clinical psychologist and other specialties such as dietetics   The team provide both in-patient and out-patient care for all aspects of HIV management   The service is based at Ninewells Hospital in Dundee but clinics are held at locations throughout Tayside and the Specialist Nurses provide a community service if required.

Myths

There are lots of myths and misconceptions about HIV. Here we debunk those myths and give you the facts.

Most HIV testing in the UK is done in a sexual health or genitourinary medicine (GUM) clinic. These clinics are legally bound not to reveal personal details and test results. GPs and private doctors also perform HIV tests, which means your HIV test and results would appear on your medical records—but these would still not be discussed with anyone else unless relevant to your treatment. If you are concerned about who else your HIV test results will be shared with, speak to your doctor about this.

If someone living with HIV decides to have a baby, there are options available and steps they can take to ensure HIV is not passed on to their partner during conception (if the partner is HIV negative) or to their child. In the UK today there is less than a 1% chance of an HIV positive mother passing HIV on to her child if the right steps are taken.

There has never been a case of HIV infection from picking up or standing on a used needle in the UK. There have only ever been five cases of HIV infection from being pricked with a needle, and these all occurred in healthcare settings and there have been none since 1999. HIV is a very fragile virus that does not survive for long when exposed to the environment.

There is no risk of HIV infection from spitting and the risk of infection from biting is negligible. With over 60 million people infected with HIV worldwide over 25 years, there have only ever been four possible reports of HIV being transmitted through biting, all of which occurred in extremely specific and unusual circumstances.

Despite sometimes being talked about in the media, there is no evidence for this myth—commonly referred to as HIV-related ‘health-tourism’. In fact, the evidence shows that most migrants with HIV who come to the UK do not know they have it before they arrive (and are not diagnosed for a number of years) so are definitely not coming over here seeking treatment.

Effective HIV treatment means most people diagnosed nowadays with HIV are able to work just like everyone else and it is in fact illegal to discriminate against someone in recruitment or employment because they are living with HIV.

People living with HIV can do almost any job, though you cannot join the army, navy or airforce if you have HIV.