HIV/AIDS

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HIV/AIDS

HIV/AIDS is not the most common sexually transmitted infection (STI) in Canada, [see our FAQ on STIs] but it is likely the most feared and the most stigmatized. Although the stigma of having HIV may be decreasing over time, there are still people who are afraid to get tested, even though anonymous testing is increasingly available.

What is the difference between HIV and AIDS?

Human Immunodeficiency Virus (HIV) is a virus that attacks a person’s immune system. Once infected, if you do not take medication to help maintain your immune system, you may get other illnesses called “opportunistic infections.” The appearance of these opportunistic infections (such as Pneumocystis pneumonia [PCP], Mycobacterium avium complex [MAC], Toxoplasmosis gondii, tuberculosis, cytomegalovirus [CMV] and certain types of cancer, such as lymphoma) marks the beginning of AIDS: Acquired Immunodeficiency Syndrome. AIDS can be fatal.

With treatment, the number of new cases has been decreasing in Canada since 2008 (For more information see the Public Health Agency of Canada: At a Glance - HIV and AIDS in Canada: Surveillance Report to December 31st, 2012), but some people are over- represented in the statistics. In particular, Aboriginal people as well as people who are socially or economically marginalized are at higher risk—those who suffer from racism, who are poor, have inadequate housing or are homeless.

Sadly, the rate of infection is increasing amongst women (For more information see the BC Centre of Excellence in HIV/AIDS: New Canadian Study of Women Living with HIV). Women accounted for 23% of the Canadian total of HIV-positive test results in 2011, nearly double the proportion in 1999 (12%). Women, including older women, also have a greater biological susceptibility to HIV (For more information see the Canadian AIDS Society: Women’s Biological Susceptibility to HIV (PDF)). And women are more vulnerable due to the social factors stated above, and due to gender-based violence.

How do you get HIV?

There are four ways you can get HIV:

  • unprotected vaginal or anal sex with a person who is infected (see “Can you get HIV from oral sex?” below);
  • receiving infected blood or blood products;
  • sharing infected needles or drug paraphernalia; or,
  • transmission from an infected mother to the fetus in the uterus, to the baby during delivery, or while breastfeeding.

 Women who have sex with women, bisexual women and trans women are also at risk for HIV (for more information see ACT Toronto: Women Lovin’: A Sexual Health Guide for Queer Women (PDF)). People who practise sexual bondage and sadomasochism (BDSM) should also seek correct information about transmission (such as ACT Toronto: BDSM: Safer Kinky Sex).

There is little risk if infected blood comes in contact with skin that is intact; that is, where there are no tiny cuts or wounds in the skin’s protective barrier. Health care workers are rarely infected because of a needle stick injury. However, tattooing, piercing and other body modifications where skin can be pierced must be done in a reputable establishment to avoid the risk of infection. This also applies to acupuncture.

Someone who already has an untreated STI is at greater risk for HIV if they have unprotected sexual activity with a person who is HIV-positive [see our FAQ on STIs]. The body produces antibodies at the site of the infection in order to fight it. HIV attacks these cells, which then carry HIV into the bloodstream.

Can you get HIV from oral sex?

Oral sex is considered a low-risk activity for HIV transmission. However, if there is already a sore on or in the mouth, this increases the risk of getting HIV from someone who is HIV-positive.

Men who have unprotected oral sex with multiple male partners (MSM) are particularly at risk for HIV. Syphilis is increasingly common in this community, spreading through unprotected oral and anal sex. If a man is unaware of his syphilis infection, an undetected syphilis sore on or inside his mouth will increase his risk of getting HIV through oral sex from some who has it. MSM with multiple partners should be tested regularly for syphilis.

How can you protect yourself from getting HIV?

  • Use a barrier method of protection (male or female condom) for vaginal or anal sex, especially before getting tested.
  • Use barrier protection for oral sex (a sex dam for oral sex on the vulva or anus; a condom on the penis) if a partner has HIV. While it is less common for people to use a barrier for oral sex this practice reduces risk.
  • Get tested for STIs after unprotected sexual activity with someone. Testing – and treatment of STIs if necessary – is an important way to reduce the risk of getting HIV.
  • Check with your local health unit regarding safety standards for tattoos and other body modification.
  • Get tested for HIV three months after possible exposure.
  • If you are HIV-positive, take medication to further reduce the risk to your partner(s) (this is called treatment as prevention).
  • Do not share needles or drug paraphernalia.
    • Many communities have needle exchange programs.
  • If you are pregnant and you know you are HIV-positive, taking medication can dramatically reduce the risk to your fetus.
    • Caesarean section is not necessarily recommended.
    • Newborns receive medication for a short period after birth before they are tested for HIV.
    • HIV-positive mothers should neither breastfeed nor practise “mixed” feeding; i.e., bottle and breast.

For more information about HIV and pregnancy, see: CATIE: You Can Have a Healthy Pregnancy if You are HIV Positive.

A word about PEP

Post Exposure Prophylaxis is a short course (usually one month) of antiretroviral (ARV) medication that can be made available in specific circumstances when a person might have been exposed to HIV through, for example, a needle stick injury or sexual assault by a person known to have HIV. However, because the side-effects are so difficult to deal with, most people do not complete the regimen of one full month.

There is also a treatment called pre-exposure prophylaxis (PrEP) medication taken by a person who is at high risk of HIV infection before sexual activity. As of 2014, this treatment has not been approved in Canada.

How do you know you or your partner(s) has HIV?

Most people have flu-like symptoms in the first two weeks after infection; but they are not necessarily likely to associate what looks like flu with HIV infection. Unfortunately, a person is most infectious in those first few months—when they are unaware they have been infected—because it is too early for an accurate test result (see below). This means that a new partner may be infected and unaware of it. If a person thinks they may have been exposed to HIV, they need to be tested.

Go for your test three months after you think you may have been exposed because it takes up to three months for antibodies to HIV to be detected in a blood sample. While you are waiting, use protection to avoid transmission to someone else during the “window period.” After that, blood can be drawn and sent to the laboratory for testing. Results may take two weeks. Some health care providers offer a rapid test. After pricking your finger with a lance and mixing the sample with fluids, the result appears in less than a minute. If the test is “reactive” blood must be drawn and sent to a laboratory. If the test is “non- reactive” you do not have HIV (you are HIV-negative).

Counselling is normally part of the testing to determine if you need any additional support. Trained professionals will ask questions about your sexual activities. If specialized STI, HIV/AIDS services are available, it is preferable to use them.

HIV is a “reportable infection.” Some people choose to be tested by their health care provider who then notifies the local public health unit if the result is HIV positive. There are also facilities that offer testing using a code or the person’s initials instead of their name or other identifiable information. Anonymous HIV blood testing is available in many communities. For information about testing near you, contact your local public health unit.

What can you do if you are infected?

The sooner you take antiretroviral medication (ARVs) the better. When HIV enters the bloodstream, it multiplies; the amount of the virus in the bloodstream is known as a person’s “viral load.” Taking medication reduces your viral load and in this way reduces the likelihood that you will get the opportunistic infections of AIDS.

As medication continues to improve, people with HIV are taking fewer pills with fewer side-effects. Many are able to live fairly normal lives and can expect to live out a normal lifespan, especially if they are able to pay attention to other aspects of their health. Some people with HIV use complementary therapies as well, such as vitamin and mineral supplements, acupuncture and herbal medicines. For information about treatment, see: CATIE: HIV Treatments.

Does HIV affect women differently?

For HIV-positive women, opportunistic infections that infect her sexual and reproductive system cause several illnesses, such as:

  • increased rates of vaginal infections;
  • pelvic inflammatory disease (PID);
  • genital warts (HPV); and
  • cervical cancer.

Since cervical cancer treatments weaken the immune system, this is an additional problem for a woman who is HIV-positive. If an HIV-positive woman develops cervical cancer, this is a sign that she has developed AIDS (For more information see Canadian AIDS Society: Women and HIV/AIDS: Treatment Issues). 

What does the law say about sexual activity for people with HIV/AIDS?

After the Cuerrier case (1998) (For more information see: Canadian HIV/AIDS Legal Network: After Cuerrier: Canadian Criminal Law and the Non-Disclosure of HIV-Positive Status (PDF)), the law required that if you had HIV/AIDS you had to disclose your status to sexual partners before engaging in behaviours that carried a risk of transmitting HIV. If you put that person at risk without disclosing your HIV status, you could be charged with sexual assault. The argument here is that your partner could not consent because they did not have all the information they needed to make their decision.

Since that time, criminalization of non-disclosure has resulted in a number of prosecutions and convictions. With the advent of improved medication, this legal decision has been challenged.

Medication reduces viral load. For a person with an undetectable viral load, having unprotected oral sex, for example, is unlikely to lead to transmission.

It has been argued that it serves no good purpose criminalizing STIs, including HIV, and that it is counterproductive to good public health policy. People should be encouraged and not discouraged from being tested. The risk with criminalizing HIV is that it may keep people away from testing, counselling and support, and partner notification. The law does not protect people against infection; we need to protect ourselves. There is concern that criminalization leads to ongoing stigma and discrimination faced by people living with HIV (For more information see: Canadian HIV/AIDS Legal Network: Criminal Law)

Where can I get more information?

Statistics: Public Health Agency of Canada: At a Glance - HIV and AIDS in Canada: Surveillance Report to December 31st, 2012

To locate AIDS Service Organizations (ASOs) in Canada: www.aso411.ca/

HIV and the law: Canadian HIV/AIDS Legal Network: Criminal Law

Women and HIV/AIDS: Canadian AIDS Society: Women

Treatment and women: Canadian AIDS Society: Women and HIV/AIDS: Treatment Issues

Public Health Agency of Canada: Section 5: Management and Treatment of Specific Infections: Human Immunodeficiency Virus Infections

 

This FAQ may provide medical information, but is not meant to be a substitute for medical advice. When you have questions about your health, it is always advisable to ask a health care practitioner.

Created February 2014