HIV & AIDS, its testing and treatment

HIV and AIDS basics

People may talk about HIV & AIDS like they are exactly the same thing, but they are not. HIV is the virus that infects a person. With treatment, women with HIV can live long lives and be otherwise healthy. AIDS is the later stage of HIV infection when the body's immune system is damaged.

What is HIV?

HIV is the name of a virus that attacks the body's immune (defense) system.

H — Human: This particular virus is found only in humans.
I — Immunodeficiency: This virus weakens the immune system and makes it harder to do its job of protecting the body against bacteria, viruses, or other germs.
V — Virus: This is a tiny, infection-causing particle that takes over other cells to grow and spread.

The body's immune system cannot fight off HIV by itself. It needs help from medicine to fight HIV. Without medicine, HIV damages and eventually causes serious damage to the immune system. At this point, HIV progresses to AIDS.

What is AIDS?

AIDS is the advanced stage of HIV infection when the body's immune system is damaged. The immune cells (white blood cells) are so few that they can no longer fight off severe infections and some types of cancer. People with AIDS are often critically ill and need medical treatment to prevent death.

A — Acquired: The infection comes after being exposed to HIV from someone else's bodily fluids, usually blood or sexual fluids such as semen. HIV can also be passed from mother to baby during pregnancy, labor and delivery, and breastfeeding. But it is not a genetic disease (passed down among families).

I — Immuno: It affects the cells and organs of the immune system (the body's system that fights infections).

D — Deficiency: The body's immune system does not work properly, putting it at risk for other infections and some cancers.

S — Syndrome: Many symptoms common to a specific illness

How does HIV affect women differently than men?

HIV is different in women compared to men in several ways:

• A woman has a higher risk of getting HIV when having vaginal sex than a man has.


• Some health problems, such as sexually transmitted infections (STIs) and vaginal yeast infections are more common, more serious, or harder to treat in women with HIV.


• Women with HIV can pass HIV to their babies during pregnancy and birth and through breastfeeding. But with treatment, the risk of passing HIV to your baby is less than 1 in 100.

How do I know if I have an HIV infection?

You cannot rely on symptoms to know if you have HIV. The only way to know for sure is to be tested. Some people develop flu-like symptoms within two to four weeks of exposure, but many people with HIV do not. If you think you have been exposed to HIV, get tested. Testing is the only way to know for sure if you have HIV.

How long will I have HIV before it becomes AIDS?

Without treatment, women with HIV will usually show signs of AIDS within five to 10 years of first getting infected with HIV. Women who get treatment and keep HIV under control can delay the development of AIDS for decades.

How long you have HIV before you develop AIDS depends on factors you can control and some things you can't control:

• What you can control: taking your HIV medicine (antiretrovirals, or ARVs) prescribed by your doctor on time and every day, seeing your doctor as often as recommended, managing stress, and choosing healthy foods. These actions can help you live a longer life with HIV.


• What you can't control: the kind (the "strain") of HIV that you have. Some strains of HIV progress to AIDS more quickly than others, despite treatment. You also may not be able to control what resources are available to you (such as adequate housing, a steady income, social support, and access to good health care).

How do I know if I have AIDS?

Only a doctor can diagnose AIDS. You have developed AIDS if you already have HIV and one or more of the following happens:

• Your "viral load" (amount of HIV that can be measured in your blood) stays high and causes your immune cells' CD4+ count to go down.


• Your CD4+ count drops below 200 cells per cubic millimeter (normal is 500 to 1,200). CD4 cells (sometimes called T cells or T lymphocytes) are important for fighting infection. Your doctor will monitor your CD4+ count.


• You have an AIDS-defining opportunistic infection or cancer.

Does an HIV diagnosis mean I will die?

No. Today, new and effective drugs make it possible for people with HIV to live longer and healthier lives.

If you have HIV, you can have a near-normal lifespan if you get regular medical care and treatment for HIV, take your medicine as your doctor tells you to, and have your viral load under control.

How early you begin treatment has a direct effect on your life expectancy. So, for example, a 35-year-old woman diagnosed with HIV early in the infection could expect to live to be 80 or even older if she takes her medicines daily, maintains levels of HIV (viral load) too low to be detected in the blood, and gets regular medical care.

People who have HIV, are on treatment, and have an undetectable viral load also have a much lower risk of passing HIV to their partners.

How HIV is spread

• Through vaginal or anal sex. Anal sex is riskier than vaginal sex.


• By sharing needles or syringes, such as when using drugs


• From a mother to her baby during pregnancy, childbirth, or breastfeeding


• Through oral sex, but getting HIV from oral sex is very rare. You can get HIV from giving oral sex if infected sexual fluids get into your mouth and you have bleeding gums or mouth sores, or from receiving oral sex if your partner has bleeding gums or a mouth sore.

What types of fluids carry HIV?

You can get infected with HIV if one of the following fluids from an infected person enters your body:

• Blood, including menstrual blood


• Semen(cum), including pre-semen (pre-cum)


• Vaginal fluids


• Anal mucus (fluids from the anus)


• Breastmilk

Can I get HIV from sharing needles?

Yes. Sharing needles or syringes and other injection drug equipment is very risky. Sharing needles is the second most common way that HIV is spread to women in the United States (sex is the most common way). Any woman who shares needles with someone is at risk for HIV infection, because the needles may have someone else's blood in them.

Can I get HIV from a piercing or tattoo?

Getting HIV from a piercing or tattoo is rare. But it is possible to get HIV from tattoo and piercing tools that are not sterilized correctly between clients. Tools that cut the skin should be used once, then thrown away or sterilized between uses.

Before you get a tattoo or have your body pierced, ask the right questions. Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C. A new, the sterilized needle should be used for each person.

Can I pass HIV to my partner?

Many HIV-positive women with HIV-negative partners (also known as serodiscordant or mixed-status couples) worry about passing HIV. Research shows that it is easier for an HIV-positive man to spread HIV to an uninfected woman than for an HIV-positive woman to spread HIV to an uninfected partner. But it is possible for women to spread HIV to their uninfected partners through vaginal, oral, or anal sex. While very rare, it is possible for HIV-positive women to spread HIV to their female sex partner. This is because HIV is in the blood (including menstrual blood), vaginal fluids, and cells in the vaginal and anal walls.

If you are HIV-positive, you can pass the virus at any time, even if you are getting treatment. But getting treated with antiretroviral medicine can lower the risk of passing HIV to your partner by 96%.

How can I prevent passing HIV from my partner?

If you take HIV medicine and your viral load is not detectable in your blood, your chances of passing HIV to your sexual partner is lower. You should always use a latex condom or dental dam with sex. Your HIV-negative partner also can take medicine (called pre-exposure prophylaxis or PrEP) to keep from getting HIV.

How can I prevent passing HIV to my unborn baby?

Today, new medicines mean you can lower your chance of passing HIV to your unborn baby during pregnancy, labor, and childbirth to less than 1%. Taking medicine to treat HIV (antiretrovirals, or ARVs) is recommended for everyone who is HIV-positive to lower their viral load and help protect their immune system. Having a viral load that cannot be detected can keep you healthy and also prevent you from passing the virus to your unborn baby. Because HIV can spread in breastmilk, in the United States, you should not breastfeed if you have HIV, even if your viral load cannot be detected.

HIV testing

Getting tested is the only way to find out if you have HIV. Early testing is important. If you have HIV, starting treatment early with today’s antiviral drugs may help you live decades longer and lower the risk of passing HIV to your partners.

Should I get tested for HIV?

• Older than 15. All women and girls older than 15 need to be tested at least once.


• Every pregnant woman should have an HIV test as early as possible in the pregnancy. You need to get tested even if you have been tested before. Also, consider getting tested for HIV if you plan to get pregnant.

Some women with HIV don't know they have it, because HIV may not cause symptoms for several years.
Even if HIV causes no symptoms, it is still causing problems with your body's immune system that need to be treated as soon as possible.

Some women who test negative assume their partners must be HIV-negative too. But your HIV test reveals only your status, not your partner's.

When should I get tested for HIV?

If you think you might have been exposed to HIV, get tested. But testing right away may not pick up early HIV infection. The first HIV test taken soon after infection may say that you do not have HIV even if you do. That is because some HIV tests look for antibodies (the body's natural immune response to a foreign invader) that your body may not have developed yet.

If you get HIV, your body will usually begin to develop antibodies within three to 12 weeks (21 to 84 days).  The time between being exposed and developing antibodies is called the "window period."

There are newer HIV tests available that can tell whether you are HIV-positive early after exposure to the virus. One of the newer tests looks for the virus itself, by testing for viral load (the amount of HIV in your blood) and a marker on the virus called p24 antigen. This test is much more sensitive. It can detect HIV within nine to 11 days after exposure. This type of test may be more expensive. Ask your doctor if this test is available when you get tested for HIV.

How can I get free HIV testing?

Many clinics and doctors' offices have free or low-cost HIV testing. Enter your ZIP code or address into the clinic finder on this page. If you have health insurance, you may be able to get free HIV testing under the Affordable Care Act (the health care law). HIV screening and counseling for women are covered without cost-sharing in most private health insurance plans. Medicaid also covers certain recommended preventive services, including HIV screening for women at higher risk for HIV, without cost-sharing or deductibles.

HIV testing for people with Medicare is usually covered once every 12 months. Pregnant women with Medicare can get up to three HIV tests for free during pregnancy.

Ask if the newer HIV test, which picks up infection earlier, is available when you get tested for HIV.

Facts about HIV and AIDS

The correct information is the key to understanding and preventing HIV and AIDS. Myths can be harmful. Getting the facts about HIV and AIDS can lead to better health and better living with HIV.

Fact: HIV and AIDS are problems in the United States.

HIV and AIDS are not problems that exist only in Africa or in other parts of the world. The Centers for Disease Control and Prevention estimates that more than 1.2 million Americans 13 years and older are living with HIV.

One in four people living with AIDS in the United States in 2014 was a woman. 

An estimated 128,778 women have died of AIDS since the beginning of the epidemic in 1981.

Fact: HIV is not the same as AIDS.

HIV is the virus that leads to AIDS. You have AIDS if your CD4 count drops below 200 or when you have certain infections or cancers. You can have HIV for years without having AIDS. Being infected with HIV does not mean you have developed AIDS.

Also, people with HIV who start treatment early in their infection, stay on treatment, and have an undetectable viral load can stay healthy and prevent the disease from progressing to AIDS.

Fact: HIV tests are reliable.

Newer HIV tests identify the virus itself and a marker on the virus called p24 antigen. These tests can detect HIV infection much earlier than previous tests. A follow-up test to confirm the results also can determine the strain of HIV infection you may have.

Fact: HIV cannot be cured.

There is no cure for HIV at this time. But with today's medicine, women can reduce their viral load (amount of HIV in the blood) to the point that it is undetectable. This means that your viral load is fewer than 40 to 75 copies in a sample of your blood.

An undetectable viral load does not mean that you no longer have HIV. It is still possible to pass HIV to others, although the risk is much lower. Having an undetectable viral load also helps prevent the progression to AIDS or getting other infections.

Research is being done that may lead to new treatments and new ways of preventing HIV infection. In the meantime, women with HIV are living full lives, including working, having children, and participating fully in their communities.

Fact: There is no vaccine to prevent HIV.

Right now we do not have a vaccine to prevent HIV. Vaccines are the best way to prevent diseases you can get from other people, like the measles, mumps, or polio. Researchers have been working for more than 20 years to develop a safe and effective vaccine against HIV.

HIV is a complicated virus that changes over time. This makes vaccine research difficult, and it takes a long time to do the research. Researchers are closer to developing a vaccine to prevent HIV and a vaccine to treat HIV and AIDS.

Fact: People with HIV should start HIV medicine right away.

Even if you're feeling great and have no symptoms, HIV is hurting your immune system. To protect your immune system, most experts recommend starting HIV medicines (called antiretroviral therapy or ART) as soon as you are diagnosed with HIV. Because these drugs reduce your "viral load," or the amount of HIV in your blood, they also reduce your chances of passing HIV to others.

Fact: You cannot know if your partner has HIV unless he or she is tested.

It can take years for you to see symptoms of HIV. This is called the latency period. The only way to fully protect yourself from sexually transmitted HIV is to not have sex of any kind. Using a condom correctly every time you have vaginal, oral, or anal sex can reduce the risk of passing HIV by 80%.6 Male latex condoms offer the best protection against HIV, but female condoms are also approved by the Food and Drug Administration to help lower your risk for HIV infection.

Use a condom every time you have sex for two reasons. First, your partner might be infected but not know it. Second, you cannot control your partner's risky behavior. You can know only your HIV status and control only your own risk-taking.

Fact: You (or your partner) need to wear a condom during sex, even if you are both HIV-positive.

If you and your partner have HIV, you still need to practice safer sex. Use a condom every time you have vaginal, oral, or anal sex. Condoms can protect you from other sexually transmitted infections (STIs).

Also, since there are different strains (types) of HIV, you can be infected a second time with a different type than what you already have. Some forms of HIV are also more virulent, meaning they progress to AIDS faster. You could become infected with a drug-resistant strain of HIV. This can make it very hard for treatment to work.

Fact: Women can give HIV to men.

It is much harder for men to get HIV from women, but it does happen. HIV can enter a man's body at the opening of the tip of the penis and through cuts or sores on the shaft that may not be visible.

Plus, if a partner has an untreated sexually transmitted infection (STI) like genital herpes, syphilis, gonorrhea, or chlamydia, the risk is even higher. These infections can bring more CD4 cells to the area of infection or cause breaks in the skin. These STIs also raise your risk of passing HIV to others.

Fact: A pregnant woman with HIV can lower the chance of passing HIV to her unborn baby to less than 1%.

A woman who knows about her HIV infection early in pregnancy and gets antiretroviral (ARV) medicine can lower the risk of passing HIV to her baby to less than 1%. Without treatment, the risk of a mother with HIV passing it to her baby is about 25% (in the United States).

If you are pregnant, get tested for HIV. Also, do not breastfeed your baby until you and your doctor are certain you don't have HIV.

Fact: Lesbians can get HIV.

It is rare for women who have only ever had sex with women to get or pass HIV. But HIV can be passed through vaginal fluids and menstrual blood.

Avoid sex if you (or your partner) have HIV and either a yeast infection or your period. Also, do not share sex toys, because microscopic particles in the fluids on sex toys can pass HIV. You can also get HIV from drugs and shared needles or syringes.

Fact: Women of all ages, races, and ethnicities, and sexual orientations can get HIV.

Any woman who has unprotected sex or shares needles or syringes with someone who is HIV-positive or whose HIV status is unknown is at risk for HIV.

HIV is not just a disease of gay men. In fact, worldwide, most people living with HIV are straight (heterosexual), and more than half of people living with HIV are women. In the United States, women make up about one in four people living with HIV.

Most women who are HIV-positive got HIV from unprotected sex with an HIV-positive male.

Fact: You can get HIV from sharing needles or getting tattoos or body piercings.

Sharing needles is the second most common way that HIV is spread to women in the United States (sex is the most common way). Any woman who shares needles with someone who is HIV-positive or whose HIV status is unknown is at risk for HIV.

It is also possible to get HIV from tattoo and piercing tools that are not sterilized correctly between clients. Tools that cut the skin should be used once and then thrown away or sterilized between uses.

Before you get a tattoo or have your body pierced, ask the right questions. Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C. You also can call your local health department to ask how tattoo shops should sterilize their tools. A new, sterilized needle should be used for each person.

Many, but not all, states regulate and issue permits for tattoo parlors. Before getting a tattoo, learn what regulations your tattoo parlor must follow and whether it has passed a health inspection.

Fact: HIV is not spread by mosquitoes, sweat, tears, pools, or casual contact.

Even if mosquitoes could carry the HIV virus, they do not inject blood into your skin. No transmission of this type has ever been reported around the world. Also, you cannot get HIV from shaking hands, using the toilet, or coming into contact with someone's sweat or tears from their eyes. The only bodily fluids that are known to transmit HIV are semen, vaginal fluids, anal fluids, breastmilk, and blood (including menstrual blood).

Women and HIV

One in four people living with HIV in the United States is a woman. Women of all ages, races, and ethnicities can get HIV, but some women are more at risk than others.

Who is at risk for HIV?

All women can get HIV, but your risk for getting HIV is higher if you:

• Have unprotected sex


• Have injected illegal drugs, either now or in the past


• Had sex with someone to get money or drugs in return or with someone who has traded sex for money or drugs


• Had sex with someone who
  
  
  • Has HIV
  
  
  • Has sex with both men and women
  
  
  • Injects drugs
  
  
• Have another sexually transmitted infection (STI)


• Had a blood transfusion between 1978 and 1985

Women who have sex with men

In the United States, most women get HIV from having sex with a man.³

Women are more likely than men to get HIV during vaginal sex because:

• The vagina has a larger surface area (compared with the penis) that can be exposed to HIV-infected semen.


• Semen can stay in your vagina for several days after sex. This means you are exposed to the virus longer.


• Having a vaginal yeast infection, bacterial vaginosis or an untreated sexually transmitted infection (STI)makes HIV transmission more likely. This is because the yeast or bacterial infection or STI brings white blood cells (and therefore CD4 cells that can be infected with HIV) into the vaginal area. Small cuts on the skin of your vagina (common with genital ulcers from herpes or syphilis) are hard to notice but may allow HIV to pass into your body.

As a woman, you are more likely to get HIV during vaginal sex when:

• You are unaware of your partner's risk factors for HIV. Some men, for example, have sex with men as well as women but do not tell their female partners.


• Male partner was recently infected. During this time, the amount of HIV in his semen is higher. Exposure during early infection may cause up to half of all HIV transmissions in the United States.


• Your partners do not use male latex condoms or you do not use female condoms correctly every time you have sex.


• Have a history of sexual abuse, which can lead to riskier future behavior.


• You have sex with multiple partners or have sex with someone who is having sex with multiple partners.


• Have sex in exchange for money or drugs.


• You misuse drugs or alcohol before or during sex.

Women who inject drugs or share needles

Women who use injection drugs or share needles or syringes and other injection equipment are at high risk for HIV. In fact, sharing needles is the second most common way that HIV is spread. (Sex is the most common way that HIV is spread.) Use of injected drugs also raises your risk for risky behaviors, such as not using a condom during sex. In a study of U.S. cities with high levels of HIV, 72% of women who injected drugs reported having sex without a condom in the past year.

If you use injection drugs, talk to your doctor about medicine, called pre-exposure prophylaxis (PrEP), to prevent getting HIV.

Women who have sex with women

Women who have sex only with women might think they are safe from HIV. This type of HIV transmission is rare. If you are a woman and your female partner has HIV, you can get it if you have cuts, bleeding gums, or sores in your mouth and you give oral sex. It is also possible to spread HIV through menstrual blood and shared sex toys.

As a woman who has sex with women, it is also possible to get HIV if:

• You inject or your partner injects drugs with someone who has HIV


• You have or your partner has sex with a man who has HIV


• Trying to get pregnant and use semen that has not been tested for HIV or sexually transmitted infections (STIs)

Lower your risk of getting HIV or passing it to your partner:

• Know your HIV status and your partner's HIV status.


• Take steps to protect yourself and others from HIV.


• Use latex condoms correctly and every time if you have sex with men.


• Use dental dams


• Never share sex toys.

Younger women

Young women are at risk for HIV:

• According to a 2013 survey, only half of the female high school students used a condom the last time they had sex. Only one in eight female high school students in the study had ever been tested for HIV.


• Younger women are more likely to have a sexually transmitted infection (STI). Having an untreated STI makes HIV transmission more likely. An untreated vaginal yeast or bacterial infection can also increase the risk of transmission. This is because the infection brings white blood cells (and therefore CD4 cells that can be infected with HIV) into the area. This is especially true for women because small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into your body.


• Teen girls and younger women are at higher risk for HIV infection than adult women because their reproductive tract is still developing.

Older women

Women over 50 are still at risk for HIV. Older women are more likely than younger women to be diagnosed with HIV much later after they are first infected.

This may be because older women may think they do not need condoms because they do not worry about getting pregnant. They may not talk about safe sex with their doctors or partner or get tested regularly for HIV and other sexually transmitted infections (STIs). Their doctors may also not suspect their symptoms could be caused by HIV. Later diagnosis can mean a later start to treatment and possibly more damage to your immune system. It can also raise the risk of spreading HIV to other people.

You can get HIV at any age. In fact, the decrease in hormone levels during and after menopause means your vagina will probably not be as lubricated (wet) as it used to be. This means that you have a greater risk for tiny cuts in your vagina during sex that can make it easier for HIV to get in.

Other health concerns

Older women with HIV also need to think about other health problems, such as heart disease and osteoporosis. If you have HIV, talk to your doctor about steps you can take to lower your risk of these problems. Ask about screening tests you might need as you age.

African-American and Hispanic women

Women of color, especially African-American and Hispanic women, are disproportionately affected by HIV.

• African-American women made up more than 61% of new HIV infections among women in 2015 but are only 14% of the female population in the United States. African-American women face the highest risk of HIV and other sexually transmitted infections (STIs) compared with women of other groups. However, many African-American women do not know their HIV status. Poverty, stigma, and fear of discrimination may prevent women from getting tested or seeking care if infected.

• Hispanic women made up 15% of new HIV infections among women in 2015. Cultural challenges may raise Hispanic women's risk for HIV. Hispanic women may avoid seeking testing, counseling, or treatment if infected because of their immigration status, stigma, or fear of discrimination. Poverty may also prevent Hispanic women.