It’s now 2021; for almost four decades our communities have been living with the HIV epidemic. During this time we’ve learnt so much. Particularly in the last few years, there have been some remarkable leaps and bounds in how much we understand about HIV and what we can do to treat and prevent it more effectively than ever. Welcome to HIV in the 21st century.
There’s a long legacy of gay and bisexual men educating each other and taking action around HIV. At the start of the epidemic, there was little known about it and little to be done besides worry. But thanks to incredible medical advances, we’ve progressed a long way. Now in 2021, it’s time to keep up the education, continue taking action and commit the anxiety to history.
After decades of research and development, there are now more ways to detect HIV, treat it and protect against it. These advances mean improved quality of life for people living with HIV, including better health outcomes and reduced stigma attached to having the virus. But as there is no known cure, a major part of managing the HIV epidemic focuses on preventing it. In recent years, the HIV prevention landscape has shifted rapidly — sometimes even faster than cultural attitudes towards HIV. Even though the worry of HIV is still real for some of us, that’s changing too.
In this article:
About HIV: What is it?
HIV stands for human immunodeficiency virus. It’s a virus that targets the immune system — the very system in our bodies that’s there to protect against infections and diseases. HIV works by hijacking the immune system to spread itself throughout the body. If left untreated, it can seriously damage or destroy the immune system over time, leaving the body vulnerable to other infections that might otherwise be avoided, potentially proving fatal in the long term. This stage of HIV is known as acquired immune deficiency syndrome or AIDS.
Although there’s currently no cure, there are many medicines available to treat HIV and preserve someone’s health. Unlike early therapies from the mid-1980s, modern treatments are well tolerated; they’re also highly effective at stopping the virus from damaging the immune system, meaning someone using treatment can typically live a long, healthy life. Remarkably, effective treatment is also able to control the virus so that HIV cannot be passed on through sex — even when condoms aren’t being used.
“Remarkably, effective treatment is also able to control the virus so that HIV cannot be passed on through sex — even when condoms aren’t being used.”
Transmission: How do you get HIV?
HIV isn’t fussy about whom it can infect — any body will do. In Australia, most new HIV transmissions occur during unprotected sex. That doesn’t just mean not using a condom — it means not using any form of HIV prevention, including biomedical options.
HIV is present in body fluids of people who have HIV. Blood, semen (cum and pre-cum), anal mucus, vaginal fluids and breast milk can carry the virus. However, for people living with HIV, using treatment greatly reduces the amount of HIV present in body fluids.
Once a person using HIV treatment is sustaining an undetectable viral load (which can take a few months after starting treatment and is monitored by viral load testing), there is effectively zero risk of onward HIV transmission during sex. Although, without treatment much larger amounts of the virus may be present in body fluids, increasing the risk of onward transmission.
“Having unprotected penetrative sex — either vaginal, though particularly anal — doesn’t guarantee someone will get HIV, but doing it without any form of protection is considered high risk for HIV transmission.”
You can’t get HIV from contact with saliva (spit), tears, sweat or urine (piss). So that means HIV isn’t transmitted when kissing, touching, sharing cutlery or anything else that doesn’t involve transfer of body fluids containing the virus. Having unprotected penetrative sex — either vaginal, though particularly anal — doesn’t guarantee someone will get HIV, but doing it without any form of protection is considered high risk for HIV transmission.
Having oral sex without any form of protection is considered very low risk for getting HIV.
Testing: How can you tell if you’ve got HIV?
The only way to be sure if you have or haven’t got HIV is to go for an HIV test. That’s because it’s possible to have HIV without knowing — even for years. You can get a rapid HIV test at some walk-in centres, otherwise you can get comprehensive testing for HIV and other sexually transmitted infections (STIs) by a doctor or at a sexual health centre. You can find testing services nearby and across Australia using Emen8’s interactive map.
Not everyone who gets HIV will experience symptoms. For some people, symptoms can be easily mistaken for a bad cold or flu. You can discover more in Could it be HIV? Recognising the signs and symptoms of HIV seroconversion illness.
Prevention: How can you prevent HIV?
Condoms have been a standard for helping to prevent HIV and other STIs for at least 35 years. Despite not everyone using them every time, condoms are the most popular choice for the majority of guys having casual sex. But in 2021, condoms are not the only option to prevent HIV — thanks to science and modern medicine, we’ve advanced much further than wearing physical barriers as the only means of HIV prevention available.
In recent years, biomedical options have emerged to offer highly effective HIV prevention alongside condoms. Biomedical options involve using prescription medicines in consultation with a doctor. Many people find them highly convenient and desirable — whether always, sometimes or never used with condoms.
Remember that using condoms achieves more than just preventing HIV — using one also helps prevent against other STIs. Even so, it’s possible that when using condoms some STIs can still be transmitted or acquired. That’s why regular testing is important for everyone.
“… in 2021, condoms are not the only option to prevent HIV — thanks to science and modern medicine, we’ve advanced much further than wearing physical barriers as the only means of HIV prevention available.”
No matter your HIV status, it’s useful to know about other HIV prevention options in addition to condoms.
PEP stands for post-exposure prophylaxis. It’s useful for HIV-negative people in an emergency — such as if a condom breaks or isn’t used. A short course of often easily tolerated, modern anti-HIV medicine can help prevent someone from getting HIV after a possible exposure. Check out PEP: Protecting you against HIV when you need it for more details and how you can access it if necessary.
Undetectable viral load (UVL)
Undetectable viral load is a big deal. It’s all about how in 2021 we know that people living with HIV who use treatment to achieve and maintain an undetectable viral load cannot pass the virus on through sex — even if condoms aren’t being used. Using HIV treatment medicine as advised suppresses the virus in the body, preserving someone’s health as well as eliminating the possibility of HIV transmission. It may take a few months after someone starts treatment to sustain an undetectable viral load, which is confirmed by testing. Simply put, undetectable HIV means untransmittable HIV. Check out HIV now — all about U=U: Undetectable = Untransmittable for more details.
PrEP is perhaps one of the more innovative ways to prevent HIV available for use by people who are HIV-negative. It stands for pre-exposure prophylaxis and involves regular use of easily tolerated, modern anti-HIV medicine that provides cellular level protection from the virus. As well as being highly effective, it’s also easy to access — in 2018 PrEP became a government subsidised medicine on the Pharmaceutical Benefits Scheme (PBS) available from any doctor. Check out Introducing PrEP – the little blue pill making a big impact for more details.
For a guide to comparing and combining HIV prevention options check out Wanna compare tools? Here’s how safe sex choices measure up down under.
Support: Where can you talk to someone?
Sometimes it’s just good to chat with someone about HIV. Whether that’s due to concerns about getting it, how you can avoid it or about an HIV diagnosis. Whatever you’d like to talk about, there are organisations and community groups available to advise you on HIV prevention and other sexual health matters.
Speaking with a doctor or sexual health centre is a great start. You can also reach out to us at Emen8 by sending a message from our Facebook page or contact form. Alternatively, get in touch with your local HIV/AIDS organisation in your state or territory. There are national online communities for people using PrEP and people living with HIV who can help too.
For support with PrEP, check out our guide: Got a PrEP question? Here’s where to find support.
For support for people living with HIV, check out the TIM (The Institute of Many) website or Facebook page.