HIV and AIDS

Image colorisée du VIH - Centers for Disease Control and Prevention, USA.

The Human Immunodeficiency Virus (HIV) attacks the immune system. It thus gradually destroys the body’s defences. Serious diseases can then develop. When this happens, we enter the phase of Acquired Immunodeficiency Syndrome (AIDS).

How is the virus transmitted?

HIV lives in blood cells and sexual secretions (semen, cyprine). It is transmitted either through blood exchanges, from mother to child during pregnancy, childbirth or breastfeeding, or through unprotected sex.

HIV and sex

During sexual intercourse, the virus is mainly transmitted through vaginal or anal penetration. It is also considered that there is a risk during oral penetration (fellatio), even if this risk cannot be measured. The risk of transmission is increased in the presence of blood (periods, injuries…), semen or pre-ejaculatory fluid. Avoid brushing your teeth before and after oral sex, as brushing can weaken the gums and cause them to bleed slightly.

HIV is not transmitted through saliva because the possible presence of the virus is far too low. So kissing an HIV-positive person is not a risk of transmission (nor drinking from a glass, shaking hands, etc.).

Protecting Yourself

There is currently no vaccine against HIV. The most effective and safe means of protection against HIV transmission is the condom, which must be used correctly. A water-based lubricant should also be used to prevent condom rupture during vaginal or anal penetration. Once the man has ejaculated into the condom, he must immediately withdraw, holding the base of the condom between his fingers, to prevent it from remaining inside the vagina or anus.

Screening

In France, HIV testing (like other sexually transmitted infections and hepatitis) can be done free of charge and anonymously in a Centre Gratuit d’Information, de Dépistage et de Diagnostic (CeGIDD). It is done by a blood test.

Since 2015, self-tests can also be carried out. The result is known in less than 30 minutes. These self-tests are sold in pharmacies. They are reliable only for sexual intercourse going back more than 3 months. If the result is positive, it must be confirmed by screening.

Treatments

Although there is no vaccine against HIV nowadays, there are some treatments available to reduce the risk of infection.

PEP: in the event of suspicion of contamination during sexual intercourse lasting less than 48 hours (unprotected intercourse, defective condom…), you can go to an Infectious and Tropical Diseases Department (SMIT – specialized in HIV management), or, outside the opening hours of the SMIT, to hospital emergency rooms to assess this risk. You may be offered a one-month post-exposure prophylaxis (PEP). This reduces the risk of infection once you have been exposed to HIV. The faster you go to a SMIT or emergency room, the lower the risk of contamination.

PrEP: it is also possible to offer pre-exposure pre-exposure prophylaxis (PrEP) to people without HIV prior to sexual intercourse. It is an active treatment against HIV that reduces the risk of infection if you are exposed to the virus during sexual intercourse. From a public health perspective, the target audiences or situations are those statistically most at risk (men who have sex with men, trans people, prostitutes, multiple partners…). This treatment does not protect against other sexually transmitted infections.

TasP: Finally, HIV-positive people who are followed can also have their treatment considered in a prevention approach (treatment as prevention = TasP). Treatment reduces the viral load in the body, which reduces the risk of transmission. Today, antiretrovirals have achieved an efficacy that makes the virus undetectable in blood and sexual secretions. People who are HIV-positive and on treatment will no longer transmit the virus, even if they have unprotected sex.

Learn more: USA (CDC), UK (NHS)