HIV is a reportable disease in British Columbia, just like other sexually transmitted diseases (STDs) like Syphilis and Gonorrhoea. This means that if you test positive for HIV, the clinic or doctor's office where you had the test done must send some information about you to the public health office. The public health office will then check with the clinic or doctor to see if you need help talking to any people that may have been at risk of catching HIV from you.

At the end of 2006, it was estimated that between 12,200 to 13,000 people in British Columbia are living with HIV/AIDS.

More HIV statistics can be found here.

At the end of 2006, it was estimated that between 60,000 and 62,000 people in Canada were living with HIV/AIDS. It is also estimated that 27% of HIV positive Canadians are unaware of their infection.

More HIV statistics can be found here.

As of December of 2007, it was estimated that 33.2 million people are living with HIV/AIDS. (UNAIDS)

More HIV statistics can be found here.

Window Period

The window period is the time between when you are exposed to HIV and when a blood test will be able to measure the antibodies your immune system creates to fight HIV. It can take anywhere from four weeks to three months after HIV enters your body to develop enough antibodies to be measured on an HIV test. Most people will develop enough antibodies to test accurately for HIV from four to six weeks.

There may be some short term symptoms of infection, but without an HIV test you won't know for sure if you have the virus.

Asymptomatic Period

The asymptomatic period is the time when HIV is in your body but your immune system is strong so there may be no symptoms of infection. The virus may be active and harming your immune system but you can feel as healthy as ever.

Symptomatic Period

The symptomatic period is when HIV becomes more active in your body. The virus has weakened your immune system after living in your body for a while. Symptoms of HIV infection may begin to appear, or re-appear.

AIDS Diagnosis

A person is diagnosed with AIDS when he/she has HIV plus one or moreof the illnesses specific to the syndrome. At this stage a person has generally been living with HIV for many years and the immune system is severely damaged.

In most cases one of the "opportunistic infections" will eventually cause the death of the person living with AIDS.

While AIDS can still be a fatal illness, some drugs are now being used that can reduce HIV's damage to the immune system, delay symptoms, prevent opportunistic infections, and prolong life.

Some people with HIV develop symptoms which can be like those of many other conditions:

• Chronic yeast infections in the vagina, in the ears, on the tongue
• Frequently tired
• Diarrhea
• Dramatic weight loss
• Swollen lymph glands on the neck and in the armpits
• Sweating a lot while you sleep
• Fever that won't go away

Such symptoms are often caused by common illnesses and not by HIV infection. If you have concerns about these symptoms, you should check with a doctor or health care practitioner.

AIDS stands for Acquired Immunodeficiency Syndrome. AIDS is caused by prolonged infection with HIV. Once HIV infection has significantly weakened an individual’s immune system to the point where they are unable to fight off opportunistic infections, that person is diagnosed as having AIDS.

HIV or the Human Immunodeficiency Virus is a virus that only infects humans.
A person diagnosed with HIV infection is referred to as being HIV positive.

Once HIV enters the bloodstream, it inserts itself into the cells that make up the immune system and then begins to multiply. The HIV virus attacks the immune system slowly making it easier for a person to get a variety of illnesses known as opportunistic infections. In some cases it may take years for a person to start feeling and looking ill as a result of being HIV positive. During this symptom-less or ‘asymptomatic period’, an HIV positive person can still infect others with the disease.

In the human body there are many germs such as bacteria, protozoa, fungi and viruses. When the human immune system is working well, it is able to control these germs. However, when the immune system is weakened or compromised, these germs may get out of control and cause health problems.

Opportunistic infections are mild to severe infections caused by microorganisms (pathogens), which can include bacteria (such as staph), viruses (such as HIV), and fungi (such as yeast). While these microorganisms usually do not cause serious disease in healthy individuals, individuals with compromised immune systems (such as individuals infected with HIV) will be less likely to resist such opportunistic infections.

Symptoms of opportunistic infections will vary according to the microorganism that caused the infection and by the individual infected. Treatment or medical management of opportunistic infections may be difficult because some of these microorganisms may be resistant to standard antibiotic therapy. For example, since antibiotics target bacterial structure and function, and since viruses and bacteria are structurally different, antibiotics will have no effect on viruses.

There are many different kinds of opportunistic infections. The following is a list of some common opportunistic infections:

Bacterial Infections:
Bacterial Diarrhea
Tuberculosis (TB)
Syphilis & Neurosyphilis
Bacterial Pneumonia

Malignancies:
Anal Dysplasia/Cancer
Cervical Dysplasia
Kaposi’s Sarcoma (KS)
Lymphomas

Viral Infections:
Hepatitis C
Herpes Virus (Shingles)
Herpes Simplex Virus (Oral and genital)
Human Papiloma Virus (HPV, genital warts and anal and cervical cancer)

Fungal Infections:
Aspergilosis
Candidiasis (Thrush, yeast infection)
Coccidioidomycosis
Histoplasmosis

Protozoal Infections:
Cryptosporidiosis
Psoriasis
Pneumocystis Pneumonia (PCP)
Taxoplasmosis

Neurological Conditions:
AIDS Dementia Complex (ADC)
Peripheral Neuropathy

Sexual activity:

• Abstaining from sexual intercourse
• Having sex with only one partner and you and your partner are monogamous (only participating in sex or sexual activities with each other)
• Having protected sex using condoms (male or female) correctly and consistently. Reminder: While spermicides may prevent pregnancy, they do not protect against HIV
• Engaging in activities that are safe such as kissing, masturbation, mutual masturbation and massage

Drug use:

• Do not share equipment (needles, syringes, cookers, cotton or rinse water)
• Always use new equipment for each injection
• If you share equipment, clean syringes with bleach and water several times
• Use community resources such as needle exchange programs

Mother to child transmission:

• Being aware of one’s HIV status
• Consider taking antiretroviral drugs during pregnancy and labour
• Reduce the baby’s exposure to mother’s bodily fluids: consider the best course of delivery (i.e. caesarean section)
• Mothers with HIV are advised not to breastfeed: breast milk may be available from a milk bank

Blood transfusions and medical procedures:

• All blood supplies are screened in British Columbia and therefore carry no risk of HIV transmission
• When travelling, it is advisable to know the medical procedures of the country you are visiting
• Ensure a new or sterilized needle is used for each injection

Tattooing and piercing:

• When getting tattoos or piercing, ensure that the shop is reputable and uses only new or sterilized equipment
• Artists should take care not to dip into a large quantity of ink. Instead each individual should have their own small pot of ink as to avoid contamination

Health care workers:

• Most effective way to limit the risk of infection is to practice universal precautions
• Wash hands thoroughly; use protective gloves, eyewear, etc.

 

Microbicides are currently unavailable for use as clinical research is still taking place to ensure the safety and efficacy of these substances. To date, there are at least eleven product leads that have been proven effective and safe on animals and are presently being tested on humans. If one of these leads proves successful, it is possible that microbicides may be available in five to seven years time.

Microbicides are substances that would be able to prevent the transmission of HIV and other STI’s. These substances can take many forms including creams, films, gels, suppositories, or as a sponge or ring that releases the active ingredients over time.

To help prevent the transmission of the HIV (Human Immunodeficiency Virus), individuals should be aware of their own HIV status. In an ideal world, individuals would be aware of their partners’ status. However this is not always the case due to the following reasons:

• Difficulty and/or discomfort when discussing previous sexual or drug related history.
• Difficulty and/or discomfort when discussing sex or sexual issues.
• Fear of being stigmatized or discriminated against.
• Difficulty disclosing HIV status for fear of violence, rejection, abandonment, or of their status becoming public knowledge.
• Does not consider themselves or their partner(s) to be at risk for HIV.

There are a number of things individuals can do to protect themselves from HIV transmission. Awareness and education are paramount in the prevention of HIV transmission.

Some individuals falsely assume that they are not at risk for HIV because they are not from a group that is currently considered “high risk” in Canada such as gay men, intravenous drug users, or people of Aboriginal descent. However it is important to keep in mind that the face of HIV is complex and more importantly, that HIV does not discriminate and can infect anyone regardless of their age, social status, economic status, sexual orientation, ability and racial or ethnic origin.

STIs do not go away. If you suspect or know you have an infection, make an
appointment with your doctor or health clinic. Even though you may feel uncomfortable
or embarrassed, it is important to get tested and get treatment. This is the only way you
will get better, protect yourself and protect your partner(s). Your partner(s) should get
tested and treated as well. Many STIs can be cured with antibiotics but some are more
complicated and may require further treatment. Your doctor may do an internal
examination as well as blood tests and/or ultrasound. The doctor will discuss all your
treatment options with you.

STI information line: 604-872-6652 or www.optionsforsexualhealth.org

 

Bacterial vaginosis
Chlamydia
Cytomegalovirus (CMV)
Epididymitis
Gonorrhea (‘the drip’)
Hepatitis B and C
Herpes
Human Immunodeficiency virus (HIV)
Human papillomavirus (HPV; genital warts)
Non-gonococcal urethritis (LGV)
Pelvic inflammatory disease (PID)
Phthirus pubix (crabs; pubic lice)
Scabies
Shigella
Syphilis
Urinary tract infections (UTIs)
Vaginitis (vaginal yeast infections)

Practicing safer sex can reduce your chances of STI infection. Finding creative ways to make sex play as safe and satisfying as possible is also important.

Key ways to reduce risk include:

• Talking to your partner (s) about their sexual history and/or needle use
• Careful and consistent condom use when having sex
• Using new (unused/unshared) or clean (sterilized) needles at all times
• Keeping your partner (s) body fluids (blood, cum, pre-cum vaginal fluid and discharge from STIs) out of your body (vagina, anus, or mouth)
• Not touching sores or growths caused by sexually transmitted infections
• Go for an STI check up with your doctor or health clinic
• Check yourself and your partner(s) for infection before having sex
• Get treatment if you have an STI and do not have sex until your treatment is finished

Symptoms may vary from one person to another and in some cases people may have no symptoms at all which is why testing for STIs is often recommended. Some common signs of infection are:

• Itching in the genital area
• Abnormal fluid or discharge
• Burning sensation when urinating
• Sores or lesions around the vaginal, anal or penile area
• Pain during or after sex
• Pain in or around the genital area and/or pelvis
• Sores or blisters in the genital area or in and around the mouth
• Red or swollen throat
• Flu or fever symptoms

If you have signs of infection:

• Discontinue sex until you have been properly diagnosed and treated
• Go see a doctor or go to a health clinic for a check up. You may have to request for tests specifically

STIs are transmitted through sexual activities such as oral, vaginal or anal sex. Some STIs can also be spread through contact with infected blood. STIs are contagious which means you can contract them from your partner(s) if they are infected. STIs will stay with you if you do not receive treatment for them. STIs are most commonly found in the rectum (bum), in or around the vagina, in and around the penis and/or in the mouth.

The acronym “STI” stands for sexually transmitted infections while “STD” stands for sexually transmitted disease. STIs are infections that usually start in your sexual and reproductive organs. Some infections may also infect other parts of your body. STIs are very common: up to 75% of the sexually active population will get an STI of some kind in their lifetime. While some STIs may be painful, it is not unusual to have an STI without experiencing any symptoms for some time. Once symptoms do occur, an STI is considered an STD.

The medicines that make up antiretroviral therapy (ART) cause change within the body and often these changes come with side effects. Different people may have different reactions to the various drug cocktails. Some people experience mild side effects while others may experience more severe side effects. For some, combinations are easily tolerated and no negative side effects are experienced.

Side effects tend to be most common among individuals recently after starting ART or following changes to a treatment regimen. Side effects may be manageable and may improve or disappear over time. They may also persist and impact a person’s quality of life. 

Common side effects may include but are not limited to:
Fatigue, headaches, anemia, digestive problems, aas and bloating, dry mouth, diarrhea, nausea.

It is always important to discuss side effects with your doctor. If side effects last longer than a few days or seem to be getting worse, a doctor should be contacted immediately rather than waiting until your next visit.

HIV testing is available for FREE at community health clinics, sexual health clinics and from your family doctor. Family planning centers or drug treatment facilities also offer testing. See also the list of testing sites in Vancouver and the Lower Mainland.

HIV is detectable by a blood test. The test tells you if you are infected with the Human Immunodeficiency Virus (HIV) by looking for antibodies. HIV antibodies are your immune systems response to HIV in your blood. Antibodies are proteins produced by the immune system to fight a specific germ.

Other tests are used when people already know they are infected with HIV. A viral load test is used to measure how many cells are being infected and killed by the HIV virus and is usually done when an individual is diagnosed with HIV infection and at regular intervals following diagnoses. A CD4 cell count measures the number of CD4 cells in a sample of blood. It is used by health care providers to determine when to begin, interrupt, or halt-anti-HIV therapy, when to give preventive treatment for opportunistic infections, and to measure an individual’s response to treatment. The lower the CD4 count, the higher the risk of an individual developing an opportunistic infection. The healthy range for a CD4 cell count is: 500-1500.

HIV is detectable by a blood test. Newer tests can detect HIV antibodies in mouth fluid (not the same as saliva), urine, or from a scraping sample taken from inside the cheek. "Rapid" HIV test results are available within ten to thirty minutes after a sample is taken. One of these tests has produced a high rate of false positives. A positive result on any HIV test should be confirmed with a second test.

Antibody test results for HIV are accurate more than 99.5% of the time. Once blood has been taken, an Elisa test is used to test for HIV antibodies. A positive test result is then confirmed with a Western blot test.
 
Two special cases have been known to give false results:

1. Children born to HIV-positive mothers may have false positive test results for several months because mothers pass infection-fighting antibodies to their newborn children. Even if the children are not infected, they have HIV antibodies and will test positive. Other tests, such as a viral load test, must be used to confirm results.
2. People recently infected with HIV may test negative if they get tested too soon after being infected with HIV.

All test results are confidential and must be delivered in person. You should not get your positive or negative result over the phone or by email. A positive test result means that you have HIV antibodies and are infected with HIV. A health care provider will give you information and options on what to do next and how to access services and support.

A negative test result means that you have not been exposed to HIV and you are not infected with HIV (provided you have not participated in a risk activity since testing). You now have the opportunity to learn and continue to practice HIV prevention, protecting yourself and others from STIs.

 

The result from an HIV test can either be positive or negative.

A positive test result tells you that you have been infected with HIV. Being HIV positive does not mean you have AIDS. By regularly monitoring your health and exploring your treatmentoptions, you can slow the progress of HIV and live a longer, healthier life. You can get support and information about living with HIV. Call your local AIDS Helpline for more information.

If the result is positive, you will be asked if you need help identifying people that might have been at risk of getting HIV from you. You have the right to say that you do not need this help. If youdo want help, public health staff will work with you and your doctor or clinic in order to identify people that may need to be warned that they have been at risk of HIV infection. If you have questions about this, call your local AIDS Helpline.

A negative test result can tell you one of two things:

1. Either you don't have HIV, or
2. You've been infected recently and your body hasn't produced enough HIV antibodies to be measured in a blood test.

A negative result doesn't mean you are immune to HIV. You might consider this a good opportunity to look at what you've been doing and what you can do to reduce your risk of infection.

Practice Safer Sex

• Use latex condoms, female condoms, and latex barriers with water-based lubricants during sex.
• Do not use oil-based lubricants, such as baby oil, hand lotion and petroleum jelly. They weaken the condom allowing HIV to pass through.

Safer Injection Drug Use

• The best way to reduce the risk of HIV infection is to use clean needles.
• Needles and syringes should never be shared.
• When new needles are not available, they should be thoroughly cleaned with bleach and water.

The following do not transmit the HIV virus:

• Saliva and tears (that are not mixed with blood)
• Urine (that is not mixed with blood)
• Utensils
• Towels
• Toilet seats
• Casual contact like kissing, hugging, and touching
• Caring for someone living with HIV/AIDS

The following body fluids can have high concentrations (i.e. a lot) of HIV:

• Blood (including menstrual blood)
• Semen, pre-cum
• Vaginal fluids
• Breast milk

The following are direct ways for these body fluids (carrying the virus) to enter the bloodstream:

• Vagina
• Anus
• Urethra
• Cuts and sores
• Points of needle injection

The most common ways HIV is spread are:

• Unprotected vaginal and anal intercourse
• Sharing needles for steroid or injection drug use
• During pregnancy or at birth an infected mother could transmit HIV to her child.
• A mother could also transmit HIV to her child through breast milk.

Since 1985 all blood products in Canada have been tested for HIV.

HIV drug resistance occurs when antiretroviral drugs lose their ability to block the reproduction of the HIV virus within the body. There are several factors which contribute to the accumulation of drug-resistance during antiretroviral therapy. They include:

• Poor treatment adherence (not taking medications as or when recommended).
• Poor absorption (this can happen as a result of not taking medication with food or when diarrhea and vomiting is experienced and drugs are expelled from the gut too quickly).

HIV is a retrovirus. Retroviruses use their RNA as a template for creating DNA when inside a human host cell. This is how retroviruses multiply.

Knowing that HIV is a retrovirus is important to understanding how HIV treatment works. HIV treatment works by preventing HIV from multiplying. It is able to block multiplication by interrupting different stages of the retrovirus multiplication process.

There are many different “classes” of antiretroviral therapy. Each “class” of HIV ART works to fight HIV infection by interrupting various stages of the HIV replication cycle. Some stop or slow down the process of HIV from replicating within the body, while other drugs work by helping the body to fix the damage HIV has done to the immune system. Other drugs work by helping the immune system to become stronger and more effective at warding off illness and infections.

Deciding on a combination of ART is something that an individual usually does in consultation with their doctor or other health care professionals. When deciding upon the most suitable combination for an individual, several factors are considered including but not limited to: viral load, CD4 count, previous treatments and experiences to those treatments, dosages and adherence particulars (how drugs should be taken).

Antiretroviral therapy (often called ‘ARV therapy’ or ‘ART’) is drug therapy that has been developed to disrupt the cycle of HIV replication. ARVs come in a variety of formulations designed to act at different stages of the HIV virus life-cycle. ART usually consists of a combination of three or four different drugs, which can delay HIV replication and immune system deterioration within the body. Administering ARVs in combination is called Highly Active Antiretroviral Therapy (HAART) which is often more casually referred to as a ‘drug cocktail’.

HIV treatment is the use of medications (antiretroviral therapies) which can help keep an HIV infected person healthy. Drug research and development is on-going. While current treatment can help people living with HIV at all stages of the disease, it cannot cure HIV infection. Individuals are unique, from their biology to their lifestyle, and therefore HIV treatment is complex and should be tailored to meet the needs of each individual.

Currently the global investment is approximately five hundred million US dollars per year. This cost includes industry and research agencies in industrialized countries. While this number may seem large, the investment must be increased to build capacity in “developing countries” in order to conduct trials.

Research for a vaccine has been and continues to be a long process that includes basic laboratory research, product development, and animal experiments. The next step is to test these products on healthy human volunteers through a number of phases. Since 1987, more than thirty HIV candidate vaccines have been tested in approximately sixty phase one and two trials involving more than ten thousand healthy volunteers. Presently, there are only two candidate vaccines being evaluated in phase three trials.

An ideal vaccine would be safe, accessible, inexpensive, easy to manufacture on a large scale, effective against multiple HIV clades/strains, have long lasting immunity, and be easy to ship and distribute globally.

Current HIV prevention technologies are limited in scope. Currently HIV prevention primarily focuses on either abstinence or condoms, which are effective when used correctly and consistently. Having an HIV vaccine would be an additional prevention tool providing it is safe, accessible and effective. Research has demonstrated that the use of vaccines as a therapeutic intervention tool when used in association with antiretroviral therapies could help to lower the cost of treatments and would increase long term efficacy.

No. Such a product is in various stages of clinical trials but presently it is not available for use.

An HIV vaccine would boost the human immune system so that it would not succumb to the virus that weakens the human immune system.

A vaccine is a substance used to improve the immunity to a particular disease or infection. An individual is injected with a killed microbe (bacteria or virus) which stimulates the immune system to fight against the microbe and therefore prevent the disease.

If you are HIV positive there are many things that can help to decrease the chance of infecting your baby with HIV such as early testing, have good prenatal care, talk to your health care professional about treatment, and have a delivery plan for the baby.

Testing babies for HIV is done after birth. Most babies born to infected mothers will initially test positive for HIV antibodies. Babies when they are first born take on their mother’s antibodies, which is why many babies when first tested after birth will test positive. This doesn’t necessarily mean your baby is positive. To determine your baby’s actual HIV status, doctors will recommend several tests. These HIV tests will look for the virus itself and not just the HIV antibodies. The first test will be administered at your baby’s birth. Follow up tests are  administered at two weeks, four to six weeks and after three months. If babies are infected with HIV, their own immune system will start to make antibodies. These babies will continue to test positive meaning they are HIV infected. If the baby receives at least two negative tests results after one month of age, your baby is not infected. If the baby is not infected, the mother’s antibodies will disappear and the baby will begin to create its own antibodies. Your baby will be tested again about twelve to eighteen months later to confirm all HIV antibodies have cleared.

Many HIV positive women give birth to healthy babies who are HIV negative. If you take HIV medication as prescribed by a doctor, your baby has less than a 2% (2 in 100) chance of becoming infected. Without medication this chance increases to about 25% (25 in100). 

There is no way to know for sure if your baby will be born with HIV. Women with higher viral loads are more likely to give birth to babies infected with HIV but no viral load is low enough to ensure a baby will not become HIV positive. Following prescribed drug therapy treatment may help prevent the spread of HIV to the fetus.

A vaginal birth is still recommended for mother and baby, but some doctors and health practitioners may recommend a woman deliver by caesarean section if her viral load puts the baby at greater risk. It is important to keep in mind however that having a caesarean section may not make a difference since in some cases the fetus may have already been infected with HIV before its birth.

Yes, it is your right and your choice to have a baby. Women living with HIV who are in relationship with an HIV positive partner have the right to become pregnant and bear children. There are some issues for consideration including preventing HIV transmission during conception and reducing the chances of mother-to-child transmission.

If a women is HIV positive and would like to become pregnant by her male partner who is HIV negative, this can be done without the risk of HIV transmission from the woman to the man through artificial insemination. If a woman who is HIV negative would like to conceive and her partner is HIV positive, sperm washing can be undertaken to make sure that HIV is not transmitted from the man to the woman.

Doctors will likely recommend an HIV test during prenatal screenings as a preventive measure to help reduce the number of babies born with HIV. While this is a strategy used in Canada, remember it is still your body and therefore you have the right to decide if you wish to be tested. You should also always be given the opportunity to talk about the test, how it is administered, what the results mean and how the results might affect you personally.