It’s now 2023; for four decades, our communities have been living with the HIV epidemic. During this time, we’ve learnt so much. In the last few years, there have been remarkable leaps and bounds in our understanding of 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 legacy of gay and bisexual men educating each other and taking action around HIV. At the start of the epidemic, little was known about it, and there was little to do besides worry. But thanks to incredible medical advances, we’ve progressed a long way. Now in 2023, 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 the virus. But as there is no accessible cure, a major part of managing the HIV epidemic focuses on preventing it. In recent years, the HIV prevention landscape has shifted rapidly — even faster than cultural attitudes towards HIV have. Though the worry of HIV remains 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 same 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. 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. These can potentially be fatal. This stage of HIV is known as acquired immune deficiency syndrome or AIDS.
Although there’s currently no cure, many medicines are available to treat HIV and preserve someone’s health. Unlike early therapies from the mid-1980s, modern treatments are well tolerated; they also stop the virus from damaging the immune system, meaning someone using HIV treatment can typically live a long, healthy life. Remarkably, effective treatment can also control the virus so that HIV cannot be passed on through sex — even when condoms aren’t being used.
“Remarkably, effective treatment can also 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 of a number of choices available in the HIV prevention toolkit.
HIV is present in the 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 dramatically reduces the amount of HIV present in these body fluids.
Once a person using HIV treatment sustains an undetectable viral load (which can take a few months after starting treatment and monitored by viral load testing), there is effectively zero risk of onward HIV transmission during sex. However, without treatment, much larger amounts of the virus may be present in body fluids, risking 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 the transfer of body fluids that contain 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 a 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, or buy HIV self-testing kits online and from some pharmacies. Otherwise you can get comprehensive testing for HIV and other sexually transmitted infections (STIs) by a regular doctor or at a sexual health centre. Find sexual health testing services near you 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. Learn 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 preventing HIV for at least 35 years. Despite not everyone using them every time, condoms are a popular choice for many guys having casual sex. But today, 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 HIV prevention option available.
In recent years, biomedical solutions 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 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.
“… 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 HIV prevention option available.”
No matter your HIV status, it’s helpful 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 easily tolerated, modern 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 when you need it.
Undetectable viral load (UVL)
Undetectable viral load is a big deal. It’s all about how in 2023, we know that people living with HIV who use treatment to 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 using 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 Same PrEP, new choices: on-demand, periodic or daily for different ways to use PrEP that can suit your needs.
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, organisations and community groups are available to advise you on HIV prevention and other sexual health matters.
Speaking with a friendly doctor or sexual health centre is a great start. You can also reach out to us at Emen8 on Messenger or thruogh our contact form. Alternatively, get in touch with the 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.