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Basics of HIV (8)
Basics of HIV - Transmission of HIV (5)
Basics of HIV – Testing (10)
- How accurate are the tests?
- How do I know if I have an immunodeficiency disorder?
- Where can I get tested for HIV in Vancouver?
- What if someone tests negative during the window period?
- What is the "Window Period"?
- I haven't engaged in any activities that put me at risk for HIV. Should I get tested anyway?
- Why should I consider getting tested for HIV?
- What Will the Test Tell Me?
- How is HIV detected?
- What is an HIV test? What does it look for?
Living with HIV (12)
- What is HIV treatment?
- What is antiretroviral therapy?
- What does antiretroviral therapy do?
- What are some side effects of antiretroviral therapy?
- What is HIV drug resistance?
- What is "Viral Load"?
- What is a "CD4+ count"?
- What are T Cells?
- What are opportunistic infections?
- What are some of the most common opportunistic infections?
- I am HIV+ and returning to Canada, what do I need to know?
- What is an absolute CD4 count and how is that different from the % of CD4. What are they used to measure and what does it indicate? Is a drop in percentage worse than a drop in absolute or no?
Populations - Women (5)
Prevention - Vaccine (7)
Prevention of HIV (4)
Sexually transmitted infections (6)
Social issues - Disclosure (1)
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 eventually killing the cell and infecting other cells. 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.
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. Without treatment, it can take around ten years for HIV to weaken the immune system before an individual develops AIDS.
HIV does not discriminate; anyone who has engaged in a risky activity can be infected with HIV regardless of age, gender, economic back ground, sexual orientation, race, religion, ethnic origin, etc.
HIV attaches itself to a T cell and enters it. Once inside the T cell, HIV is able to multiply, which eventually leads to the destruction of the T cell. As more and more T cells become infected by HIV and destroyed, the immune system is weakened and becomes less able to fight off germs and bacteria.
There are no specific symptoms of an HIV infection. In fact, some people may never develop symptoms and for those that do, most of these symptoms will usually go away after a few days, or at most, a couple of weeks. Some people may develop flu-like symptoms 2-6 weeks after HIV infection. Those who do develop symptoms may experience the following: fever, swollen glands, muscle aches, diarrhea, fatigue, rashes. Often these symptoms of an initial HIV infection are hardly noticeable and since many illnesses have flu-like symptoms or cause swollen glands, many people living with HIV actually look and feel fine even though their immune systems are fighting the HIV virus. This stage of an HIV infection is typically called the “asymptomatic period.” This period usually lasts 5-7 years but could last as long as 10+ years.
This is why the only reliable way to diagnose an HIV infection is by getting tested- everything else is merely a guess and HIV is really too important an issue to simply guess about. 
Did you google HIV symptoms & diagnose yourself based on your internet findings? Often when a person does this, they find information about symptoms which are common among people who have been living with HIV for several years. After several years of living with the virus untreated, a person’s CD4+ cell count will eventually drop and will put you at an increased risk for developing symptoms of HIV infection. Sometimes called “ARS” symptoms, they may include swollen lymph nodes, night sweats, fever, diarrhea, weight loss and fatigue. At this point, a person may develop infections like thrush or persistent vaginal yeast infections. These are all signs that HIV infection is progressing but NOT a sign that you were infected with HIV a few weeks or months ago. Once again, all of these symptoms mirror many other viral infections and if you are unsure of your status, testing is the only way to know for sure.
As of December of 2009, it was estimated that 33.3 million people are living with HIV/AIDS. (UNAIDS)
The annual number of newly acquired HIV infections has been steadily declining since the late 1990s, as well as the number of AIDS related deaths. This decrease is thought to be due to the recent commercialization of antiretroviral therapy over the past few years.
More HIV statistics can be found here.
By the end of 2009, an estimated 69,844 people were living with HIV/AIDS. It is also estimated that approximately 26% of HIV positive Canadians are unaware of their status.
More HIV statistics can be found here.
At the end of 2010, an estimated 13,000 people in B.C. were living with HIV. Approximately one quarter of them are thought to be unaware of their status .
More HIV statistics can be found here.
HIV can be transmitted in two main ways:
Unprotected anal or vaginal sex
Injecting with shared needles
There are significant ways of preventing HIV transmission and reduce or eliminate risk. These include:
Practice Safer Sex
Use latex or polyurethane condoms, female condoms, and latex barriers with water-based lubricants when engaging in any form of sexual activity.
Do not use oil-based lubricants, such as baby oil, hand lotion and petroleum jelly. They weaken the condom, allowing HIV to pass through.
Schedule regular STI checkups (including HIV) in order to be aware of your status.
Safer Injection Drug Use
Use new/sterilized needles!
When new needles are not available, they should be thoroughly cleaned with bleach and water. Needles and syringes should never be shared.
If working in an environment where you may come in contact with blood, wear protective equipment (gloves, mask).
Chances of acquiring HIV are higher if you are infected with other STIs. Thus, if you are engaging in sexual activity, ensure you are regularly tested for STIs.
Some activities are considered higher risk than others such as unprotected sex or sharing needles, versus sex with a condom or using a new or sterilized needle. A good way to understand HIV risk is to consider the following transmission equation which helps to illustrate what three things are required to potentially transmit HIV.
|HIV TRANSMISSION EQUATION|
|BODY FLUID WITH HIGH LEVELS OF HIV||ACTIVITY||DIRECT ACCESS FOR THE VIRUS TO ENTER THE BLOODSTREAM|
|RISK OF HIV TRANSMISSION|
The following do not transmit the HIV virus:
- Saliva and tears (that are not mixed with blood)
- Urine (that is not mixed with blood)
- Toilet seats
- Casual contact like kissing, hugging, and touching
- non-insertive masturbation
- Injecting with unshared needles
- Tattooing/piercing with sterilized, new equipment
- Caring for someone living with HIV/AIDS
- Blood (including menstrual blood)
- Vaginal fluids
- Breast milk
- Rectal secretions
HIV cannot surive in air or water. The virus must reside in a human host in order to survive. It can only live in certain body fluids. These are:
- Blood (including menstrual blood)
- Semen (and pre-cum),
- Vaginal fluids,
- Anal fluids,
- Breast Milk.
For HIV to be passed between people, fluid must get from one person’s body directly into the other. This means there has to be an “entry point” for the fluid to enter the body. Our skin is a very strong barrier against the HIV virus. HIV can only enter the body:
- Directly into the blood stream (though broken skin, an open sore or a point of a needle injection)
- Through a mucus membrane (Vagina, anus and penis have mucus membranes which let HIV enter the body. Other mucus membranes include: the mouth, ears, eyes and nose.
The following “activities” are most common ways that fluid passes into these entry points:
- Unprotected vaginal/anal sex
- Sharing needles- (tattooing, piercing. Steroid or injection drug use
- During pregnancy-birth or breast-feeding from parent to child.
Some activities are considered higher risk than others such as, unprotected sex or sharing needles, versus lower risk activities like oral sex, sex with a condom or using a new or sterilized needle.
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:
- 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.
- People recently infected with HIV may test negative if they get tested too soon after being infected with HIV.
Your immune system is what protects you from bacterial and viral infections. It is made up of lymphoid tissue, circulating white blood cells, and proteins throughout the body. When your body is infected, the virus produced antigens (foreign toxins), and your immune system acts to counteract these by producing antibodies that destroy the harmful invaders.
An immune system disorder occurs when the immune system fails to recognize a harmful invader. This is known as an immunodeficiency, and can cause a heightened or lower immune response.
Those diagnosed as immunodeficient will likely have been diagnosed early (infancy, childhood), as common bacterial and viral pathogens (flu) would have taken advantage of their deficient immune systems. However, if you think you may be immunodeficient: special testing by a health care provider is required.
Those who are immunodeficient are said to be immunosuppressed as a side effect of being on medications including: chemotherapy, Hep C or PEP.
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.
If a person tests negative for HIV during the four week to three month window period, the negative result still cannot be considered confirmatory or accurate. During the window period, a negative test may result because the body has not produced enough HIV antibodies to be measured by a standard HIV blood test. Only after the window period of three months has passed, and providing the individual has not continued to engage in unprotected risk activities during the window period, should negative HIV test results be considered accurate.
From the moment HIV enters a person's body, it takes time for the body's immune system to develop enough HIV antibodies to be measurable by a standard HIV test. The period of time required for the body to produce enough HIV antibodies to become detectable by a standard HIV test is called the "window period". Tests currently administered in British Columbia have a "window period" which can last anywhere from four weeks to three months.
Even if a person has no risk factors for HIV infection they may still want to get tested. For many people, HIV testing is something that they choose to do regularly for their own personal reasons. Encouraging everyone to get tested is good practice and a great way to reduce HIV-related stigma. It also encourages responsibility and self-care around HIV prevention.
Some examples of why people choose to test for HIV:
- Some people make the personal choice to get tested because they feel anxious about HIV and want to know their status.
- Some people make the choice to add HIV-testing to their regular schedule or healthcare check-up.
- Some people choose “couples testing” whenever they begin a new relationship or it becomes a regular part of their relationship.
- Some people in ‘monogamous’ relationships make the personal choice to get tested (particularly if they are having unprotected sex) because they feel that their sexual partner may be engaging in risk behaviours (including unprotected sex and/or intravenous drug use) outside of the relationship.
- Some people make the choice to get tested because they are sexually active and have had or do have multiple sexual partners.
Remember that whatever your reasons are for testing, getting an HIV test is your choice and yours alone. No doctor or health care professional should ever carry out an HIV test without your consent.
If you think that you have been engaging in activities that put you at risk for HIV transmission, you may want to get tested. You may consider testing if:
- You have had vaginal, anal or oral sexual intercourse without a condom or without other barrier method protection.
- You have had a condom break during sex.
- You have had multiple sexual or drug equipment sharing partners.
- You have had a recent diagnosis of another sexually transmitted infection (STI).
- There is a chance that your sexual partner is not monogamous.
- You have been sexually assaulted.
- You have shared needles or syringes, or found out that a partner has shared needles.
- You have discovered that a partner has been exposed to HIV or learned that a past or current partner is HIV positive.
- You are pregnant.
- You have a child and do not know your child’s HIV status.
- You have had a needle-stick accident.
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.Your health care provider can also give you information and options on what to do next and how to access services and support.
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 you do 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:
- Either you don't have HIV, or
- 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.
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.
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, antigens or the genetic material of the virus. HIV antibodies are your immune system's response to HIV in your blood. Antibodies are proteins produced by the immune system to fight a specific germ.
For example, an EIA antibody 3rd generation (ELISA) is a blood test that looks for very small amounts of HIV-specific antibodies, and a NAAT (PCR RNA&DNA) is a test screens for the genetic material of HIV itself.
All HIV tests (except for home testing kits) are highly accurate after undergoing multiple trials and modifications before being available to the public. Their test results are highly accurate if tests are received after window periods. Window periods vary according to different kinds of HIV tests, some are from 10 to 12 days (Pooled RNA NAAT) and some are from 4 weeks to 3 months (ELISA and Rapid Test). The international guidance of window period for all HIV tests are up to 3 months. That is, any test comes conclusive at that point of time and no further retest is required.
The international guidance recommends healthcare providers to provide pre-test information an counseling and post-test counseling for all individuals, regardless of the status of their results.
HIV tests are available for FREE of charge at community health clinics, sexual health clinics and from your family doctor. Due to social stigma and decimation on HIV/AIDS, as well as personal assumption, a person often is discouraged to go for testing. However, it is always good to update your HIV status regularly after engaging in sexual activities to maintain your health and for further prevention.
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.
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 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).
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, gas 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 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).
Viral load refers to the amount of HIV in a person’s blood. It is very important that Persons living with HIV/AIDS (PWAs) monitor their viral load on a regular basis. Results of viral load testing can help indicate:
- When to start, stop, or adjust HIV treatment
- To what degree HIV is progressing within the body
- A higher ability to transmit HIV to another person
T cells can also be called CD4+ cells.
A CD4+ cell count measures the number of T cells in a cubic millilitre of blood. A measure of CD4+ cells indicates how healthy the immune system is and, in people who are HIV positive, can help to indicate how far the disease has progressed.
In a person with a healthy immune system, a CD4+ cell count generally falls between 500 and 1500. A CD4+ cell count of 200 or less in a person living with HIV may mean a higher susceptibility to opportunistic infections.
People who are HIV positive should monitor their CD4+ cell counts, and their viral load counts, regularly. Results are generally passed along and reviewed by health care professionals to support case-by-case, individualized planning in order to establish at what point an individual should consider starting or adjusting anti-HIV medications.
T cells play a very important role in the effective functioning of the human immune system.
T cells are important because they stimulate other immune cells to respond to infection. Without T cells, the immune system cannot protect the body against many types of germs.
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:
Syphilis & Neurosyphilis
Kaposi's Sarcoma (KS)
Herpes Virus (Shingles)
Herpes Simplex Virus (Oral and genital)
Human Papiloma Virus (HPV, genital warts and anal and cervical cancer)
Candidiasis (Thrush, yeast infection)
Pneumocystis Pneumonia (PCP)
AIDS Dementia Complex (ADC)
For Canadian Citizens/permanent residents moving between provinces or returning to Canada, we recommend that a person carry a 3 month supply of their medications. Although medical coverage varies between provinces, you are generally expected to use your existing medical coverage until you have met the 3 month residency requirement to be eligible for provincial medical coverage. While subsidy for HIV medications in BC is 100% (regardless of income level), this varies from province to province so please check with a local ASO or provincial health authority in the region you are moving to. To the best of our knowledge, there are no barriers to bringing personal medications into Canada, including HIV medications.
In returning to Canada or switching provinces, we also recommend keeping your bus/plane ticket to establish date of residency. Also, bring a copy of your medical records if at all possible.
Unfortunately, visitors to Canada are unable to access subsidized medications or free provincial medical coverage, and are only eligible for emergency medical services at hospitals. If you are visiting Canada and need HIV medications, these medications need to be shipped to you, from your home country and at your personal cost.
If you are thinking of immigrating to Canada please see the link from the Canadian Legal AIDS Network: http://www.aidslaw.ca/EN/issues/immigration_travel.htm to see how your HIV status may affect your ability to return to Canada.
Absolute CD4 Count: This is the number of total CD4 cells in your blood. It will read as a number such as “600” or “200.” This number fluctuates a lot (tired today? Battling a cold this week? Feeling really well rested?). This is a good reading in terms of initial assessments and a fall from 600 to 200 would be important and notable but absolute CD4 values are not as helpful in monitoring HIV progression because they change so much from day-to-day.
CD4 %: This is the percentage of CD4 in a person’s lymphocytes (White Blood cells). Typically, this percentage should be between 25-45% and in HIV+ people it is good to have this % in the 24-26% range. The percentage measurement is good for long-term assessment and pictures of a person’s health.
A falling absolute CD4 count is a sign that HIV is progressing and the immune system is becoming weaker but it is often difficult to judge someone’s health based on absolute CD4 count alone. CD4 count varies with age and these numbers are naturally less constant. Younger children usually have a much higher CD4 count than adults, for example. Percentage CD4 count on the other hand does not vary the same way as absolute CD4 count and is therefore often a better way of judging a person’s immune system. In terms of starting treatment, viral load testing is usually used alongside CD4 testing.
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.
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.
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.
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.
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.
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.
An HIV vaccine would boost the human immune system so that it would not succumb to the virus that weakens the human immune system.
No. Such a product is in various stages of clinical trials but presently it is not available for use.
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.
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.
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.
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.
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 partner's 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.
Microbicides are substances that can be applied inside the vagina or rectum to prevent transmission of HIV and other STIs during sex. These substances can be formulated as gels, creams, films, suppositories, or as a sponge or ring that release active ingredients over time. There are 23 Microbicides products undergoing clinical trials, yet more researches and developments on the effectiveness of Microbicides are needed before made available in the public. Currently, there are 3 phases of clinical trials that a microbicide product must pass through before it is being evaluated on effectiveness and safety.
- Phase I: to test the safety of various doses of a microbidcedes product, and involves a small number of volunteers;
- Phase II: to further test on the safety , and (or) positive responses, but involves hundreds of volunteers;
- Phase III: to test on the safety and effective on thousands of volunteers, can take up to three or four years.
Microbicides can prevent the sexual transmission of HIV in at least these four different ways:
- Provide a physical barrier to prevent HIV from entering into targeted human cells (E.g. Carraguard®, Cyanoviran®, cellulose sulphate, PRO 2000®);
- Strengthen the natural vaginal defence mechanisms by maintaining an ideal level of acidic pH, which protects the vagina and helps against HIV (E.g. Acidform®, BufferGel® and Lactobacillus crispatus);
- Kill or inactivate HIV (E.g. C31G and octoxynol-9);
- Stop the virus replicating once it has entered the cell; (E.g. tenofovir (PMPA))
Though Microbicides show effectiveness on HIV prevention, they should not been seen as an invention that ends the HIV epidemic. Rather, they should be seen as a new option to prevent HIV transmission, especially for women whose partners do not want to use condoms when engaging in sexual activities.
Are microbicides available now?
Microbicides are currently unavailable for the public, as clinical research into the safety and efficiency of these substances is still taking place. There are currently 23 microbicide products undergoing clinical trials, presently being tested on volunteers. Further investment into microbicide research and development should be undertaken to make the products available to the public.
- 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
- 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.
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.
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.
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
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, rectal secretions vaginal fluid and discharge from STIs) out of your body (vagina, anus, penis 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
Gonorrhea ("the drip")
Hepatitis B and C
Human Immunodeficiency virus (HIV)
Human papillomavirus (HPV; genital warts)
Non-gonococcal urethritis (LGV)
Pelvic inflammatory disease (PID)
Phthirus pubix (crabs; pubic lice)
Urinary tract infections (UTIs)
Vaginitis (vaginal yeast infections)
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
HIV is a reportable disease in British Columbia, just like other sexually transmitted infections (STIs) 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 aquiring HIV from you.