HIV
HIV (Human Immunodeficiency Virus) is a virus that weakens the body's immune system and was discovered around 1980. Today, most of the people who are HIV positive in Sweden have access to good and effective treatment, but HIV still cannot be cured. Despite improved treatment options, there are many medical and personal consequences of living with HIV. If you do not know your HIV status, it is a good idea to get regularly tested, get treatment, if needed, and stop the risk of you transmitting the virus to someone else.
Transmission
HIV is most commonly transmitted through unprotected anal and vaginal intercourse with a penis, and through sharing needles. Pregnant and breastfeeding people living with HIV who are not being treated can transmit the infection to the child.
Compared to many other diseases, HIV is not easily transmitted as the virus cannot survive in the air. In order for HIV to be transmitted between people, it requires a certain level of the virus to be present.
If you’re on HIV treatment and have undetectable virus load HIV can not be transmitted via sex.
Most people that get HIV in Sweden today are infected by someone who does not know that they have HIV and is not treated for it.
The best way to avoid HIV being transmitted is to use PrEP or use condoms when having anal and vaginal intercourse, and not share needles. Everyone shares the responsibility to protect oneself and others, regardless of whether we are living with HIV or not.
Testing
If you have sex in ways that HIV can be transmitted, it is a good idea to get tested regularly, at least once a year. If you are having sex with multiple partners, you should get tested at least every six months. A positive test result means that you have HIV, and a negative means that you do not. A traditional blood test can give a reliable result six weeks after the time of possible transmission, and a quick test can give a reliable result after eight weeks. You can get tested earlier, and most of the time results are reliable two weeks after possible infection.
Traditional HIV test
Most commonly, HIV is diagnosed through a blood test taken in the arm fold in a healthcare facility. The blood is sent for analysis, and the results are usually back after a couple of days. The benefit of getting tested at a health clinic is that there are nurses and counsellors available to talk to, if you want. If the test is positive, you are referred to a physician that specialises in HIV and you will visit them regularly for follow up and treatment.
Rapid HIV test
Rapid HIV tests are relatively new in Sweden, and are not yet available within the general healthcare. A rapid test is taken through pricking a finger and testing a few drops of blood. Results are usually ready within 15 minutes. Just like with traditional testing, you are referred to an HIV specialist if you test positive.
You can get a rapid test at RFSL or some of the other independent clinics in Sweden.
If you test positive at RFSL, you will get assistance in contacting healthcare, but if you test positive abroad then will have to contact an HIV specialist yourself.
If you test positive in a rapid test, an additional traditional blood test is taken to be 100% sure it is positive before you get on treatment.
The virus
HIV is a virus that weakens the body’s immune system. It attacks the T helper cells (cd4+) that are one of the types of cells that regulate the body’s defence against different diseases, like viruses, bacteria and fungi. The HIV virus needs living cells in order to multiply. In the cell, the virus blends with the cell’s genetic material and can be dormant for a long time. If the cell is activated, it starts producing the virus again. When the cell multiplies through mitosis, HIV is embedded in the new cells and will destroy them over time.
The level of virus in the blood can vary, and it is usually measured when you visit a doctor. Most people that receive HIV treatment have a viral load that is so low, it cannot be detected – this is a good thing, but the virus is still embedded in the cells and can be activated if you discontinue treatment.
What happens in the body when you contract HIV?
When HIV enters the body, it starts multiplying and the level of virus increases quickly. The risk of transmitting HIV to someone else is greatest at the beginning, when the viral load is high and you are unaware that you are living with HIV.
About half of everyone who contracts HIV will develop a primary infection between one to four weeks after being infected. A primary infection means that you get sick – some people do not get very sick while others have more intense symptoms, like a bad flu, and need to seek healthcare. After a couple of weeks, the primary infection subsides, but the lymph nodes are usually still swollen. Often, you can get tested for HIV during the primary infection. After the primary infection, it can take years until the HIV is noticed again.
However, it is good to get tested and start treatment as soon as possible so that you do not get sick or transmit the virus to someone else.
Treatment
There are very effective treatments that prevent the HIV positive person from getting sick, but unfortunately the disease cannot be cured. Many who test positive start treatment quickly, often within a couple of weeks. The medications have improved and the adverse effects have been reduced dramatically. It is still common to experience side effects in the beginning of treatment, but they usually subside.
It is important to be careful with the medication and follow the doctor’s instructions for it to work optimally and avoid negative side effects.
If you discontinue taking your medication or do not follow instructions, the virus can become treatment resistant, making it more difficult to develop effective drugs.
Most people who have HIV can live long and feel well. Most have undetectable viral loads, making it impossible to transmit HIV to someone else.
What does legal obligation to disclose your HIV status mean?
Duty to inform is part of the Communicable Disease Act, which means that people living with HIV need to inform their sex partners about their HIV status before sex. The law places all responsibility on people who know they are living with HIV. In the report “HIV, crime and punishment” (RFSU, RFSL and Hiv-Sverige, 2011) you can read in more detail what the duty of information meant for people living with HIV.
The obligation to provide information as it stands today contributes to stigmatizing people living with HIV.
If the information obligation for HIV is removed, it would mean that people living with HIV no longer would be criminalized if they do not inform their sex partners about their HIV status. The legal obligation has meant that people living with HIV have had to tell them something that doesn’t matter – that they live with a virus that cannot be transmitted. RFSL is working for a change in the law. It’s good that treatment and testing for HIV is free, so we don’t want to remove HIV completely from the law, but the law should be designed in a way that HIV is excluded from the rules that are counterproductive and that stigmatize people living with HIV.
PrEP
PrEP, pre-exposure prophylaxis, are medications that an HIV-negative person can take to avoid getting HIV. PrEP provides a high protection against HIV, if you take your medications properly. PrEP is available in Sweden for certain target groups. You can read more about PrEP and how and where to get it by clicking here.
AIDS
If you do not get treatment for HIV, you will develop a very weak immune system and become sick. When the immune system cannot fight infections like a cold or flu, these infections can make you really sick. When you are very sick as a result of HIV having weakened your immune system, this is called AIDS, and if you do not get treatment, this is a deadly disease. Today, there are very few people in Sweden who die from AIDS as our HIV treatment works effectively.