All your questions about safe sex, HIV and testing have been answered here.
All About Safe SexHow to be safe
while having masti
All About HIVUnderstanding HIV, its
causes and symptoms
HIV TestingEverything you need to know
about HIV tests
HIV treatmentLearn about treatment methods
available, and their effects
Emergency HIV treatmentLearn about PEP
and how it can help you
Living with HIVIt’s possible to live a full life
even when HIV positive
What is safe sex?
Safe sex is the use of condoms and water based lubricant during anal or vaginal intercourse.
- Safe sex can prevent HIV transmission.
- Safe sex can prevent pregnancy.
- Safe sex can help prevent most STIs.
The most common way to transmit HIV is through vaginal or anal intercourse without a condom. Safe sex prevents HIV being passed on through sexual intercourse. Safe sex also protects you against unintended pregnancy and against some common STIs that can be transmitted during intercourse, for example chlamydia and gonorrhoea. Not all STIs are transmitted in the same way and so using condoms doesn’t provide one hundred per cent protection against all sexually transmitted infections.
Why play safe?
Safe sex is the best way of protecting yourself and partner’s from STIs, including HIV. There are very good reasons why sexually active people need to practise safe sex including the following:
- Condoms stop HIV transmission.
- You can’t judge whether someone has an STI based on how they look, dress, behave, who they have slept with, etc. Anyone can get HIV or another STI.
- Practising safe sex provides you with peace of mind.
- Thinking ‘HIV won’t happen to me’ provides no protection.
- Some STIs are quite common and using condoms reduces the risk of infection.
- People with HIV or STIs don’t always know that they are infected.
- Safe sex protects against unintended pregnancies.
- HIV can affect anyone.
What happens if you don’t play safe? – Methods of contraction
HIV is spread when infected blood, semen, vaginal fluids, or breast milk enters the bloodstream of another person through:
- Direct entry into a blood vessel
- Mucous linings, such as the rectum, penis, vagina, mouth, eyes, or nose; or
- A break in the skin.
It is important to state that HIV is not spread through saliva (spit), and neither can it be caused by casual contact like sneezing, coughing, eating or drinking from common utensils, shaking hands, hugging, or using restrooms, drinking fountains, swimming pools, or hot tubs.
How to play safe?
The HIV prevention landscape has changed considerably in recent years. Condoms, used together with lubricant, remain the most effective barrier against the transmission of HIV, though they are no longer the only option. Additional biomedical technologies and new understandings of existing technologies have created a promising new landscape for HIV prevention.
In regard to HIV, ‘safe sex’ refers to sex with a very low likelihood of transmission. There are now at least five strategies that reasonably constitute ‘safe sex’, provided that certain parameters are met. They are:
- The use of Condoms during casual encounters between men of unknown or discordant serostatus.
- HIV negative men taking effective pre-exposure prophylaxis (PrEP).
- Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence of sexually transmissible infections (STIs).
- Effective use of serosorting between HIV positive men.
- Effective negotiated safety agreements.
When to play safe?
Unless sex is between two long term monogamous partners who are both HIV-free and have been recently tested for STIs, it is recommended that some form of protection (condoms, pre exposure prophylaxis etc) be always used when indulging in sexual intercourse.
When it comes to oral sex, there have been some cases of HIV being transmitted through oral sex. In most of these cases the person had sores, wounds, gum disease, ulcers, cuts, herpes or infections in the mouth. Without these factors it isn’t easy for HIV to enter the bloodstream via the mouth or throat. While research has indicated HIV transmission can occur through oral sex, it is viewed as a rare occurrence. However, to reduce this small risk make sure your mouth and gums are in good condition before engaging in oral sex. Not allowing your partner to ejaculate into your mouth will also reduce the risk.
While oral sex is not a risky activity in regards to passing HIV, other STDs can be easily passed through oral sex, for example gonorrhoea. Therefore, it is advised to go in for regular STD testing.
With whom to play safe?
Unless it is sexual activity with a long-term monogamous partner, with both having been recently tested for any possible STI/HIV, it is always recommended that condoms be used. Even with a partner, regular STI/HIV testing should be done as part of routine health checkup.
What happens in case you forget to play safe?
PEP stands for post-exposure prophylaxis. It prevents HIV transmission and involves taking antiretroviral (ARV) medicines as soon as you suspect a possible exposure to HIV. PEP is intended for emergency situations. It is not meant to be used regularly by people who may be exposed to HIV frequently. PEP might be prescribed for you if you are HIV negative or don’t know your HIV status, and in the last 72 hours you:
- Think you were exposed to HIV during your work, for example from a needlestick injury.
- Think you were exposed to HIV during sex.
- Shared needles or drug preparation equipment.
- Were sexually assaulted.
PEP is effective in preventing HIV infection when taken correctly. At the same time, it is not 100% effective. The sooner you start PEP after a possible HIV exposure, the better. While taking PEP, it’s important to keep using condoms with one’s sexual partners and to continue safe drug injection practices.
Playing safe is not an option for me. Is there any way I can limit my exposure to HIV?
PrEP stands for ‘pre-exposure prophylaxis’. PrEP helps prevent HIV infection in people who do not have HIV but are at high risk of becoming infected with it, through sex or injection drug use. PrEP involves taking a specific HIV medicine every day. If a person is exposed to HIV, having the HIV PrEP medicine in his bloodstream can help stop HIV from setting up a permanent infection in the body. You may want to consider taking PrEP if you are not infected with HIV and are in an ongoing sexual relationship with an HIV-positive partner.
Other people who may want to consider taking PrEP include:
- Gay or bisexual men who are not in a monogamous relationship with a recently tested, HIV-negative partner, who have either 1) had anal sex without a condom in the past 6 months, or 2) been diagnosed with a sexually transmitted disease (STD) in the past 6 months.
- People who, in the last 6 months, have injected drugs and have either 1) shared needles or injection equipment, or 2) been in a drug treatment program.
It has been found that PrEP is most effective when taken consistently each day. According to the Centers for Disease Control and Prevention (CDC) in the United States, by using PrEP every day, you can lower your risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%. Adding other strategies, such as condom usage, along with PrEP can reduce a person’s risk even further.
What is HIV/AIDS?
HIV (Human Immunodeficiency Virus) is the virus that causes AIDS, by infecting cells of the immune system, and destroying or impairing their function. Infection with the virus results in progressive deterioration of the immune system, leading to immune deficiency. The immune system is considered deficient when it can no longer fulfil its role of fighting infection and disease. Infections associated with severe immunodeficiency are known as ‘opportunistic infections’, because they take advantage of a weakened immune system.
Types of HIV Virus
There are two types of HIV virus:
- HIV 1 is most common sub-Saharan Africa and throughout the world. HIV 1 can be divided into the following groups: M, N, and O. The pandemic is dominated by Group M, which is composed of subtypes A – J.
- HIV 2 is most often found in West Central Africa, parts of Europe and India. Both produce the same patterns of illness. HIV 2 is associated with a slower progression of disease than HIV 1. It is important for tests to detect the HIV subtypes that are present in the region. Otherwise, testing may lead to false negative results.
How common is HIV among MSM?
Anybody can get HIV irrespective of age, sex, race, ethnic group, religion, economic background, or sexual orientation. However, people engaging in unprotected vaginal, anal or oral sex or people sharing needles with an HIV infected person are most at risk.
The HIV prevalence in MSM is disproportionately high compared to the heterosexual men of reproductive age in the same region. Globally, men who have sex with men are 19.3 times more likely to be living with HIV as compared to the general population. (International AIDS Society, 2014) Official NACO figures park the MSM HIV prevalence at around 4.3% (NACO, 2015), but this figure may be greater due to the illegality of same-sex encounters in the country, with the current actual estimated HIV prevalence among MSM ranging between 7 and 16.5%. This is in comparison with the overall adult HIV prevalence, which is estimated to be 0.31 per cent (0.25-0.39%) in 2009. (Thomas, Mimiaga, Kumar, Swaminathan, Safren & Mayer, 2011) Just under a third (30%) of those who reported having anal or oral sex with a man in the last 12 months were married to a women and were engaging in heterosexual sex. (Thomas, Mimiaga, Kumar, Swaminathan, Safren, & Mayer, 2011).
What kinds of HIV tests are there? How often should I get tested?
While there are a variety of HIV tests available, the three most popular ones are- Enzyme Immunoassays (EIAs) (ELISA), Western Blot / Line Immunoassays, Polymerase Chain Reaction (PCR) and the HIV Rapid Test. It is advisable to go in for an HIV test if one has engaged in unsafe sexual activity. HIV tests are highly sensitive and may even result in a false positive. A confirmatory test should ideally be taken, to determine whether you’re truly HIV-positive. If you receive a positive result from a second test, you’re considered to be HIV-positive. You could also receive a false-negative result, which means the result is negative when in reality you are infected. This generally happens if you’re newly infected and you get tested during the HIV window period. This is the time before your body has started producing HIV antibodies i.e. approximately four to six weeks after infection.
If you receive a negative result and are still doubtful that you’ve contracted HIV, it is advised to schedule a follow-up exam in four to six weeks.
(Angel, 2016; Centers for Disease Control and Prevention)
HIV Rapid Test
HIV Rapid Test helps detect HIV antibodies in your blood. A qualitative exam, it is as reliable as the ELISA test. This is a cost-effective test and it is advised that this test be made a part of one’s routine health checkup. The window period for the 3rd Generation Rapid Test is four to six weeks.
Enzyme Immunoassays (EIAs) (ELISA)
EIA or ELISA tests are quantitative tests that detect HIV antibodies in your blood, after 6-8 weeks of exposure to the virus.
Please note that even a borderline positive on ELISA has to be followed up with a Western Blot test to confirm your test results.
Western Blot / Line Immunoassays
The Western Blot is a supplemental test to confirm a positive test result for HIV. Please make sure you get a Western Blot test in case your EIA/ELISA test result is positive.
Polymerase Chain Reaction (PCR) Test
The PCR test is used to detect HIV’s genetic material, called RNA. This test can be used to diagnose very early infections and you can get a PCR-RNA test as soon as 14 days after exposure to HIV.
Although this test is the most accurate, it can be very expensive.
What kinds of treatment methods are available to me?
HIV medication is available to treat the infection. The therapy is called Antiretroviral therapy (ART) which is a combination of HIV medicines also known as an HIV regimen. Anyone infected with HIV can adopt this therapy. In fact, it is advised that the therapy be initiated as soon as one is detected with HIV. Though HIV cannot be cured through ART, people infected with HIV can lead longer and healthier lives if they adopt the therapy. The risk of transmission of HIV infection is also reduced. Potential risks include unwanted ART side effects from HIV medicines and drug interactions between HIV medicines, or between HIV medicines and other medicines a person is taking. It is important to take the HIV medicines every day, as prescribed, to avoid failure of the treatment. Poor adherence can lead to drug resistance.
WHO’s present policy does not recommend antiviral drugs but instead advocates strengthening of clinical management for HIV- associated opportunistic infections such as tuberculosis and diarrhoea. Better care programmes have been shown to prolong survival and improve the quality of life of people living with HIV/AIDS.
Will the treatment have any effect on how I feel?
HIV/AIDS and some HIV medication may have an impact on one’s brain. It can sometimes cause problems with movement, emotions and thinking. Symptoms of HIV-associated neurocognitive disorders (HAND) can include the following:
- Muscle weakness
- Difficulty paying attention
- Sudden shifts in mood and behaviour
It is advised to consult your doctor if you suspect that you have HAND. To be sure, keep a tab on your symptoms and note these down whenever they occur. Sharing this information with your doctor would help them give an accurate diagnosis. Build as much support as possible, including friends, family, and health care providers. Although it’s possible to treat HAND successfully, it may take a while for some symptoms to go away.
Emergency HIV treatment
Post-exposure Prophylaxis or PEP is useful in emergency situations where one might anticipate that they have been exposed to HIV infection. The treatment includes taking antiretroviral (ARV) medicines very soon after a possible exposure (the sooner the better). It is important to note that PEP cannot be taken regularly by people who may be exposed to HIV frequently. PEP can be taken in the following situations:
- If you think you were exposed to HIV during your work, for example from a needlestick injury.
- If you think you were exposed to HIV during sex.
- If you shared needles or drug preparation equipment.
- If you were sexually assaulted.
PEP is only effective when it is taken properly and is not 100% effective. While taking PEP, it’s important to keep using condoms with sex partners and to continue safe drug injection practices.
- So what’s the best time and how to test for HIV?
How soon can HIV be detected by a blood test?
It takes at least 4-6 weeks from the date of exposure for the antibodies to show up in the bloodstream. This is the HIV window period.
I just got my test result back, and I’m positive. What do I do?
Even before we answer that question, great job for having taken the initiative to get tested for HIV.
If you have been tested positive, please don’t panic. There are a lot of people who are living with HIV. With certain changes to their lifestyle, they are leading healthy lives. Consider the following to minimise the impact of HIV-
- See a healthcare professional for a complete medical check-up. Learn all about the infection and get advice on health maintenance.
- Ensure that you follow the treatment religiously and take the prescribed HIV medication.
- Get tested for TB and other STDs.
- Inform your sexual partner(s) about their possible risk for HIV. It can be a tricky thing to do, but an open and honest conversation is most advisable.
- Get networking and be part of support groups. People sharing similar experiences can teach you a lot on coping with the infection and life of an HIV patient.
- You can always fall back on trustworthy friends and family.
- For expert advice, speak to a trained counsellor. You can book a slot
- Have a balanced diet, limit alcohol and drug use and ensure physical activity including strength training.
- Always use a condom and never share syringes.
- Do not donate blood, plasma, semen, body organs or other tissues.
Is it possible that my tests results are inaccurate?
HIV Tests are highly sensitive and may result in a ‘false-positive’, implying that you are actually HIV negative but your test result shows positive. Similarly, there can be a ‘false-negative’ i.e. when results are negative in spite of contracting the virus. This ‘sensitivity’ is because the body takes time to produce antibodies in response to the virus and tests sometimes don’t detect them.
(Angel, 2016; Centers for Disease Control and Prevention)
Is being HIV positive a death sentence?
No, definitely not!
Advancement in technology and medical research has significantly improved the quality of life for people who are detected positive. Thirty years ago, when there was no HIV medication, people had a grim outlook and being HIV positive was treated as a death sentence. Today living with HIV has become easier. Though it demands significant lifestyle changes but with regular HIV tests and HIV treatment, HIV positive people can live long and healthy lives.
Do I have to tell everyone I sleep with about my HIV status?
Talking about your HIV status can be extremely personal, especially with someone who you meet for the first time. While it is intimidating, it is the best forward.
Do reach out to your exes and old flames and chat with them about it. Approaching the subject might be tricky. You can start by conveying that you care about their wellbeing. If you are comfortable narrating your experience when you first got to know that you are HIV positive, do so and then ask them to get tested.
Different people handle the situation differently. Some like to disclose their status in the beginning, even before the first date. Others might want to explore if a relationship is developing before they can trust the partner with such confidential information. When you do it and how is your call but we would suggest that you do have a discussion.
Do I have to tell my friends and family about my HIV status?
While there is no hard and fast rule to inform your friends and family, it’s good to have a support system. HIV tests are confidential. Only you would know your test result and unless you disclose it to your family, nobody would know.
We understand that all families might not be supportive. They might have basic questions like what is HIV and what is the impact of HIV. They may have no idea about what living with HIV is all about. You might have to visit the Safe Masti website to answer those questions. But studies have shown that people who disclose their HIV status respond better to treatment than those who don’t.
If however, you want to discuss these personal issues with a trained counsellor in a non-judgemental environment, do talk to us anonymously over call. Book a slot here.
Do I have to tell my employer about my HIV status?
Anyone infected, or thought to be infected, must be protected from discrimination by employers, co-workers, unions or clients. Employees should not be required to inform their employer about their HIV status. If the organisation takes proactive steps to sensitize employees about the impact of HIV, its risk factors along with details about HIV testing, a climate of understanding may develop in the workplace. Many times people are unaware about the myths around HIV, addressing which is quintessential for protecting the rights of people who have tested positive for HIV.
Testing for HIV should not be required of workers. Details about your status must be kept private unless the infection/illness makes you unfit for a particular job. In that case, you should be treated in the same way as any other employee with a chronic illness. A suitable alternative job can often be arranged by the employer.
Employers in different parts of the world are beginning to deal with these problems more humanely. We can learn from them and even take support from the concerned government department for assistance in employee sensitization. Most workers face no risk of getting the virus while doing their work. The virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people’s work, most workers are safe. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection.
Will me being positive affect my educational/career opportunities?
The HIV and AIDS (Prevention and Control) Bill, passed by the Indian parliament in 2017, prohibits discrimination in jobs and education for those living with HIV. It has provisions for improved healthcare access and privacy of the individual. Any denial/termination/discontinuation or unfair treatment of HIV positive people in jobs, education, healthcare is banned. Right against discrimination is a fundamental right enjoyed by all citizens of India. “No person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order,” the bill clarified.
Organisations keeping records of information must adopt data protection measures. It’s a matter of privacy for those who are HIV positive.
Workers with the infection must be treated at par with other workers. Testing positive for HIV cannot be the reason in itself for termination of employment.
HIV and mental health
People living with HIV are about twice more likely to experience mental health disorders especially CMDs (Common Mental Disorders) like depression and anxiety than the general population. This impairs their immune functions, reduces their adherence to treatment and significantly degrades their quality of life. There seem to be several reasons for this:
- The difficulty of living with HIV- a chronic, life-threatening and highly stigmatized illness.
- The direct effects of HIV and some opportunistic infections on the brain and central nervous system.
- The side effects of antiretroviral therapy can have mental, behavioral or neurological side-effects.
Common mental disorder (CMD) is a term used to describe a group of mental disorders that frequently occur in primary care patients. It includes symptoms of depression, anxiety and somatization, the latter often indicated by repeated visits to health care practitioners without resolution of the problem.
Many people with HIV experience a wide range of psychological and psychosocial issues throughout the experience of living with and adjusting to the disease. Difficulties may arise at every stage of infection including around the time of testing for HIV; when symptoms develop; receiving an AIDS diagnosis; beginning anti-HIV medication; and in terminal care. Mental or psychological disorders often seems to be related to various aspects of the disease:
- the severity of HIV/AIDS
- medication side effects
- younger age
- higher viral load
- the loss of health
- a decrease in functioning
- the deterioration of body integrity
- anticipatory loss of life, pain, poor family support and
- presence of AIDS in the spouse
- cultural factors like stigma
- relative lack of appropriate treatment facilities,
- poor access to the health care and
- low educational level
But help is always available if you want to talk to someone. Talk to our trained counsellors in an open, secure and judgement-free environment.
HIV and nutrition
Chronic infections like HIV and AIDS can lead to poor growth. You might experience a reduced appetite, lesser food intake and low nutrient absorption at a time when the body needs it the most. As a result, the weakened immune system is ill equipped to fight the virus. The body falls prey to opportunistic infections like tuberculosis.
People living with HIV should try and have a healthy balanced diet with limited salt, sugar and fats. ‘Foodies’ can experiment with cooking, to embrace a healthier lifestyle. Try having a balanced diet, which includes the following:-
- Plenty of fruits and vegetables rich in vitamins and minerals and fibre.
- Starchy carbohydrates that give you energy (eg. brown rice, potatoes, whole-wheat pasta and bread.)
- Proteins found in lean meat, fish and eggs. If you are vegetarian then beans and pulses.
- Dairy products like milk, yogurt and cheese.
- Small amounts of fats and sugars.
If you are underweight because you didn’t realise the virus was making you weak until you were tested positive for HIV, you should consult a dietician. Similarly, for dietary problems and/or side effects that make it hard to eat well and follow a balanced diet, take help from a health specialist.
And never forget your HIV medication. Taking extra care of your diet and nutrition definitely reduces the impact of HIV and improves life expectancy.
My partner has HIV. What precautions do I need to take?
If your partner has been tested positive for HIV, you need not stress out. With proper precautions, couples can reduce (but not completely eliminate) the risk of transmitting HIV to the healthier partner.
Ensure consistent condom use. (You can buy condoms here.)
For each act of intercourse, the odds for contracting the virus are 1 in 1,000. However, when you add that up over weeks, months, and years, a person in a relationship with an HIV-infected partner is at much higher risk. Therefore it is advisable to consult a doctor and get advice on other preventive measures like PrEP (Pre exposure prophylaxis) and PEP (Post exposure prophylaxis) that reduce the risk of HIV .
The risk of HIV depends on several factors, including how well the infected partner’s HIV is being managed. People who aren’t taking HIV medication will have higher concentration of the virus in their bodily fluids, making it more probable to pass it on to a sexual partner. People living with HIV taking proper medication, undergoing HIV treatment and Antiretroviral therapy (ART) will usually have less of the virus in their bloodstream and consequently reduced risk of transmission.
However, being on HIV medication does not eliminate the risk of transmission, so condoms must still be used. And one must get tested for HIV proactively. Click here to book a test.
Rather than avoiding intimacy, couples dealing with HIV should be aware of the risk of transmission, what activities involve risk, and what they can do to reduce it. Hugging, most kissing, and touching are all safe activities — so spread love not myths about HIV!