HIV/AIDS

Overview

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS). AIDS is a disease in which there is a severe loss of the body's immune system. The immune system is our body's natural defense and allows us to fight off viruses, bacteria and other disease-causing infections.

HIV was first reported as a threat by the U.S. Centers for Disease Control and Prevention (CDC) in June 1981 and has been a global problem for more than 30 years.

When HIV was discovered, it was diagnosed almost entirely in men. Soon after the first cases were reported, HIV was also being found in women and children, including newborn infants. Now, about one in four people living with HIV are women, and in some parts of the world this number is even greater.

The good news is that in recent year the overall rate of HIV infections has decreased in the United States and in many parts of the world. The rate of new infections in the U.S. fell by about 19 percent between 2005 and 2014, and diagnosis among women declined by 40 percent. However, on a negative note there are still about 40,000 new infections reported each year.

HIV disease is also much more manageable than in the past. Originally, HIV was a fatal disease for persons infected with the virus. Until 1995, few drugs were available to treat the virus. This progressive attack on the immune system resulted in serious infections and ultimately led to AIDS then death.

Since then, many new drugs have been developed and approved to treat both HIV and its related infections. As of 2016, there are more than 25 antiviral drugs approved by the FDA.

These medications have greatly extended the lives of many people living with the disease. Current estimates are that a person infected with HIV at age 20 may live until their 70s provided they receive effective treatment. Many people infected with HIV have been living with the infection for more than 20 years due to very effective medications.

Although the drugs to treat HIV are highly effective and generally well-tolerated, they are expensive, usually costing about $3,000 per month. They also have potential side effects that range from headache, nausea and vomiting to kidney or liver damage and (rarely) life-threatening reactions.

Therefore, all people—men, women, teenagers and even people over 50—need to be careful about protecting themselves from being infected with HIV.

The Virus

The human immunodeficiency virus differs from most other viruses because antibodies produced by our immune system cannot control or kill HIV. Once a person is infected, HIV remains in body tissues forever. This is true even for people taking antiretroviral therapy (also called ART).

In a person who isn't treated, the virus eventually breaks down the immune system to where it can no longer protect the body from infections. This "internal battle" or disease process can last 10 years or more.

Serious and often fatal infections such as Pneumocystis carinii pneumonia, Mycobacterium avium complex and cytomegalovirus can take over in the late stages of AIDS. In addition, patients with HIV face an increased risk of developing certain cancers such as lymphomas and neurological disorders.

Since the beginning of the AIDS epidemic in the early 1980s, the total number of HIV infections among U.S. women have progressively increased, especially in women of color. In 1985, only a small percentage of people living with AIDS were female. Today, women make up 19 percent of those infected and about 65 percent are African-American women. Fortunately, the overall rate of new infections among U.S. women has been decreasing over the past 10 years.

Even though the rate of HIV diagnosis for African-American women has decreased, it remains four times the rate for Caucasian women. Hispanic women, who represent about 17 percent of U.S. women, make up16 percent of women with AIDS. Caucasian women, who represent about 80 percent of the U.S. female population women, account for only 18 percent of women living with HIV.

According to the CDC, which extensively tracks HIV data in the United States, the higher infection rate for women of color may be due to multiple factors including: lack of HIV knowledge, lower perception of risk, drug or alcohol use and different interpretations of safer sex.

The death rate due to HIV/AIDS is also higher in women of color. Deaths due to HIV infection were among the top 10 leading causes of death for African-American females aged 20 to 54, according to the CDC. This is at least in part due to a lack of access to adequate health care and HIV treatment for these women.

Although the number of new AIDS cases in this country has fallen significantly, there are more people living with HIV than ever before. In 2014, the most recent year for which data are available, there were about 1.2 million U.S. adults and adolescents living with HIV infection, but about one in eight has never been tested and is unaware of their infection. This undiagnosed group is responsible for the majority of new HIV infections.

At the same time, relaxed attitudes about using barrier protection has health officials worried. New studies have identified disturbing increases in HIV infection among some groups, particularly African-American and Latino/Hispanic gay and bisexual men. Health officials believe this may be in part because of over-optimism about HIV treatments.

This relaxed attitude toward prevention has led to an upswing in new HIV infections in the younger age group over the past few years. According to the CDC, there was a 21 percent increase in HIV incidence from 2006 through 2009 in people aged 13 to 29. This was driven in part by a 34 percent increase in HIV infection in young men having sex with men. More recent CDC data from 2014 found that young people aged 13 to 29 made up about 40 percent of all new HIV infections, which totaled more than 44,000.

HIV Transmission

HIV can be transmitted through blood, semen and vaginal secretions of an infected person. Here are some important facts about how HIV is transmitted:

• The virus is mainly spread by unprotected sex (no condom used) and sharing needles with an HIV-infected person.
• Babies born to HIV-infected women may become infected before or during birth or after birth through breastfeeding if the pregnant mother does not take antiviral medications and other preventive measures aren't taken.
• You cannot become infected with HIV through casual contact like hugging or shaking hands or through insect bites or stings.
• Very few cases of HIV have been transmitted in household settings. They are believed to have occurred when infected blood or other body fluids came in contact with broken skin or mucous membranes of household members.
• Casual contact through closed-mouth or "social" kissing is NOT a risk factor for transmission of HIV. However, experts recommend against "French" or open-mouthed kissing with an infected person because of the increased possibility of contact with blood-contaminated secretions. Plain saliva is not contagious.
• The presence of oral or genital sores from other sexually transmitted diseases (such as herpes or syphilis) increases the risk of sexual transmission of HIV.
• The risk of acquiring HIV from an infected health care professional is extremely low.
• Female-to-female transmission of HIV is very rare However, case reports of female-to-female transmission of HIV indicate that vaginal secretions and menstrual blood are potentially infectious and that mucous membrane (e.g., oral, vaginal) exposure to these secretions has the potential to cause HIV infection.
• HIV is at least four times more transmissible to women than to men through sexual intercourse. Anal intercourse presents a greater risk.

People infected with HIV who regularly take antiretroviral medications are much less contagious. A recent, large international study found that they are 93 percent less likely to infect sexual partners with the virus.

Diagnosis

Many people report no symptoms when they are first infected with HIV. Even those who do have symptoms often do not see a health care provider, and the symptoms do away without any treatment.

That is why it is important to ask your health care provider about testing if you have any risk factors, such as:

• Having unprotected sex with more than one partner, especially if you do not know their HIV status
• Sharing needles with an HIV-infected person
• Having unprotected sex with bisexual men or men who inject drugs
• Having other sexually transmitted diseases, such as herpes, chlamydia, syphilis or gonorrhea

Some people do have initial symptoms within two to three weeks after being infected with HIV. This is called "acute retroviral syndrome," or primary HIV infection. The symptoms are similar to those of mononucleosis—such as fevers, rash, sore throat, fatigue, joint ache and headache. Symptoms can last from one to three weeks.

When acute HIV infection is diagnosed, several studies have found that starting treatment immediately with antiretroviral therapy (ART) may help control progression of the infection and limit its damage to the immune system. It does not provide a cure.

There are several types of tests available that can detect HIV antibodies. The first HIV tests were introduced in 1985 to screen donated blood when it was learned that people were getting HIV from blood transfusions and blood products. Testing was controversial because there were no effective HIV treatments.

The tests to diagnose HIV have greatly improved through the years and are highly accurate. The chance of having a false positive or false negative test is probably less than 1 percent. The newest test is called a fourth-generation HIV chemiluminescent assay. It has replaced older tests such as the enzyme immunoassay and Western blot. The newer test can diagnose infection within about two weeks after exposure to the virus and can distinguish between HIV-1 and HIV-2. Results are usually available within 24 hours.

The U.S. Food and Drug Administration (FDA) also has approved six rapid HIV tests, some of which can give results within 20 minutes. These tests can usually be done on blood, plasma or saliva to check for the presence of HIV antibodies. Although highly accurate (97 percent to 99 percent), the Centers for Disease Control and Prevention (CDC) recommends that ALL positive rapid tests be confirmed with a follow-up blood test before a final HIV diagnosis is made.

The FDA has approved several over-the-counter HIV tests that are available in drugstores or can be purchased online. Some can be performed in your home. One of these tests, OraQuick, uses saliva to detect HIV antibody. Many out-patient clinics and emergency departments offer this test.

Another over-the-counter test uses blood obtained with a lancet and placed on a filter strip. The sample is mailed in a protected envelope using an anonymous code. You receive test results by making a toll-free call. If the result is negative, you will hear a prerecorded message; if it is positive, you will receive counseling and be referred to a health care professional.

Highly technical and expensive tests are also available that look for genetic material of HIV. These viral RNA tests are used to screen the blood supply and can be used to diagnose early or acute HIV infection before HIV antibodies are detected. They are usually referred to as "viral load" tests.

Regardless of how you are tested for HIV, if your test is negative you can generally be reassured that you do not have the virus. However, if you have think you may be at risk for HIV, it is strongly advised to get retested in about four to six weeks.

The CDC recommends a final HIV test at four months if there has been a "high-risk" exposure to the virus. This would be an adequate time for development of HIV antibodies to occur.

Treatment

When the human immunodeficiency virus (HIV) emerged in the early 1980s, it was considered a death sentence. There were few drugs to treat the virus. Resulting opportunistic infections or other AIDS-related conditions led to death. Since then, many drugs have been developed and approved to treat both HIV and its opportunistic infections.

These antiretroviral medications, also known as antiretroviral therapy or ART,
have greatly extended the lives of many people living with HIV, including children. However, none of the medications cures HIV disease. The drugs are also expensive, costing $3,000 or more per month. They must be taken every day indefinitely and may cause side-effects and toxic effects to the body.

If people frequently miss or skip doses of ART, the virus will become "resistant" to the medications and will no longer be effective.

HIV treatment continues to change rapidly. New therapies, different combinations of drugs and improved methods for monitoring infection make treatment increasingly effective but also complex.

Here are three important facts about ART for HIV:

• It is now recommended that everyone with HIV take ART, regardless of their CD4/T-cell counts and even if they are not having any symptoms or complications related to the virus.
• ART will stop or greatly delay progression to AIDS and prolong life.
• ART has changed over the past several years and will continue to change, so if you have HIV, it is important that you and your health care providers stay up to date about the most effective and least toxic medications.

It is very important that you find an HIV specialist to care for you. Given the speed with which the field changes, many primary care physicians and other providers, such as nurse practitioners and physician assistants, cannot keep up with the latest treatment advances.

Being HIV-positive, you may also face unique psychological and social challenges, such as whom to notify, how to handle your feelings, when to start treatment and where to find financial assistance. These are issues that HIV specialists and their staff and medical practices are most familiar with.

An HIV specialist, whether he or she is a primary care or infectious disease doctor, should know the unique ways in which HIV infection affects a woman's health. For example, HIV-infected women are more likely to experience certain gynecological disorders than HIV-negative women and are much more likely to have abnormal Pap tests. HIV-positive women should have a Pap test twice within the first year after their initial HIV diagnosis. If both Pap tests are normal, they can then usually resume getting annual Pap tests.

The overall goal of HIV treatment is to reduce the amount of virus in the bloodstream to a level so low it cannot be detected. Indeed, having "undetectable" virus is the benchmark for measuring a successful therapy regimen. It is important to know that an "undetectable" virus does not mean that you're cured or that the virus is completely out of your body.

Another benefit from HIV treatment is its potential to prevent the serious opportunistic infections that make AIDS a debilitating condition.

With the advent of a class of drugs called protease inhibitors in the mid-1990s, a new model was introduced for treating HIV infection. Drug therapy with protease inhibitors works to interrupt HIV replication by interfering with an enzyme known as HIV protease. By keeping the virus in check, the drugs can delay the gradual weakening of the immune system.

These powerful drugs used in different combinations have allowed people once disabled by AIDS to return to work and remain free from serious symptoms. This model uses a combination of at least three drugs from two or more classes. It was originally referred to as highly active antiretroviral therapy, or HAART, but is now simply called ART.

Before the development of new HIV drugs, the only treatment was zidovudine, usually known as AZT. Patients typically responded to AZT for several month but became sick again once the virus mutated and could overcome survive the drug's effects. These viral mutations also occur with other drugs used to treat HIV but less often with the new, more potent drugs.

Studies also show that HIV treatments reduce the chance that an infected person will transmit the virus. The combination HIV drugs not only reduce the amount of virus in the blood but in other body fluids as well, including semen and vaginal secretions.

Finally, people who start early treatment with powerful drug combinations can delay symptoms of infection longer than those not receiving treatment. This is why it is recommended that everyone infected with HIV start treatment as soon as possible.

There may be reasons you consider delaying treatment, such as lack of health insurance, difficulty accepting the HIV diagnosis, depression or substance abuse, but these should be worked through with your HIV specialists and their care team with the goal of starting ART soon as possible.

If you have HIV/AIDS, you should be active in your treatment—discuss the risks and benefits of all therapy options with your health care professional so you can make the most informed decision. There are several options for treatment available, so your HIV specialist should help determine which combination of ART may be best for you. Factors to consider will include your age, what other medications you may be taking or if you are considering pregnancy.

Types of Drugs

Today, there are six main classes of antiretroviral drugs approved for HIV therapy. They include the following:

• Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) were the first antiretrovirals developed for treatment of HIV. These drugs interfere with an enzyme that enables the virus to replicate. There are eight NRTIs that have been approved for HIV treatment. These include AZT, lamivudine (Epivir), abacavir (Ziagen), didanosine (Videx) and tenofovir (Viread). Several of these, including tenofovir, lamivudine and emtricitabine, are also active against hepatitis B virus. These medications must always be used with one or two drugs from one of the other classes listed below.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to the enzyme reverse transcriptase to prevent the virus from copying itself. They include efavirenz (Sustiva), rilpivirine (Edurant), nevirapine (Viramune) and etravirine (Intelence).
• Protease inhibitors (PIs), work by interfering with an enzyme called HIV protease, they prevent the virus from replicating at a later stage in its life cycle. There have been eight PIs developed, though currently only darunavir (Prezista) and atazanavir (Reyataz) are recommended for use in the United States. These drugs are almost always prescribed with two of the NRTI medications noted above.
• Fusion inhibitors block HIV from entering the CD4 cells of the immune system. There is one drug in this class, called enfuvirtide (Fuzeon). This drug must be given as an injection and is generally no longer recommended for use in the United States due to better and safer therapies.
• CCR5 antagonists (also called entry inhibitors) block the virus from replicating by preventing its membrane from fusing with healthy white blood cells. They appear to suppress the most drug-resistant strains of HIV. There is only one FDA-approved entry inhibitor, called maraviroc (Selzentry). This drug, which is prescribed with other HIV drugs, is used for people who have developed resistance to other HIV drugs or who have an advanced HIV infection.
• Integrase inhibitors, are the newest class of antiviral medications and are highly effective at shutting down the virus. They work by preventing HIV DNA from integrating into human DNA. There are three drugs in this class: raltegravir (Isentress), elvitegravir (Vitekta) and dolutegravir (Tivicay). The integrase inhibitors have become the most commonly recommended drugs for HIV treatment and are included in five of the six regimens recommended in the United States for first-line treatment. They are also prescribed in combination with two NRTIs.

In the past, people infected with HIV patients had to take eight to 15 pills a day for their treatment. Many of the newer drugs are combined into one or two pills that can be taken just once a day, which makes it much easier for people who need ART. There are now six single-tablet-regimens approved by the FDA for use in the United States. These include:

• Odefsey (emtricitabine, rilpivirine and tenofovir alafenamide)
• Genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide fumarate)
• Triumeq (dolutegravir, lamivudine, abacavir)
• Stribild (elvitegravir/cobicistat/FTC/tenofovir)
• Complera (rilpivirine/tenofovir/FTC)
• Atripla (efavirenz/tenofovir/FTC)

These multiclass, one-dose medications combine two or more of the six classes of HIV drugs described above.

Medication Side Effects

All HIV medications carry the potential for toxicity or side effects. These are often referred to as adverse drug reactions. For example, protease inhibitors can redistribute fat cells in some patients. This condition, called lipodystrophy, causes paunches or humps to form in the abdomen or back. Some side effects are life threatening, such as the hypersensitivity reaction associated with abacavir.

More common side effects from antiviral drugs are headache, rash, nausea and vomiting. In most cases, these side effects are mild and will go away within one to two weeks. Your HIV specialist or one of their team should always discuss possible medication side effects with you before starting therapy.

If you are taking other medications, including prescription or over-the-counter (such as alternative medicines, supplements, vitamins and minerals), it is important to let your HIV specialist know this. There may be drug interactions or restrictions on what medications can be taken together.

Your HIV specialist will monitor your HIV treatment response with a blood test called a viral load test. This test measures the amount of HIV in your blood—in medical terms, "plasma HIV RNA"—and is quantified as "copies per milliliter." This test will be done one or two times before you start HIV medications and then usually about once a month after ART is started.

Before treatment, the viral load can be in the thousands or even millions. The goal with ART is to get the viral load below 20 copies per milliliter of blood. It may take about four to six months of ART to get the virus load to an undetectable level. Once the viral load is undetectable, the test only has to be done every three to six months.

The CD4+/T-cell count is another test your HIV specialist will monitor during treatment. A normal T-cell count is about 500 and, depending on how long someone has been infected with the virus, it may be much lower, sometimes even under 50. Historically, if T-cell count fell below 200, the person was given a diagnosis of AIDS. Effective ART will usually return the T-cell count to normal, although this can take one to two years of treatment or longer depending on how low the number is when ART is first started. This process is often called immune recovery.

Prevention

Preventing Mother-to-Child Transmission of HIV

Many studies have shown that HIV treatment can dramatically reduce the risk of a mother transmitting the virus to her baby. Without preventive therapy, about 25 percent to 30 percent of all HIV-positive pregnant women will pass the virus on to their babies. If a woman takes ART during her pregnancy and her infant receives AZT after birth, the risk of HIV transmission drops to less than 2 percent.

The medical and research communities continue to make advancements in the treatment of HIV-positive women. Most recently, the FDA approved the use of the drug darunavir (Prezista) in combination with ritonavir in pregnant and postpartum women with HIV. Several other HIV medications have also been found to be safe when taken by women during pregnancy.

With the availability of an effective means of preventing perinatal infection, health care providers are urged to screen all pregnant women for HIV, regardless of individual risk factors. The CDC also recommends postnatal screening for infants born to mothers who were not tested for HIV during pregnancy or at time of delivery.

Prevention

In the United States, HIV is most commonly acquired by men who have sex with other men. Among women, it is most commonly acquired through heterosexual sex and less commonly through injection drug use. The primary means of prevention and the primary focus of public health officials throughout the epidemic have been on the use of barrier contraceptives—condoms, male or female.

And although they provide protection against HIV infection, condoms are not foolproof—the only absolute way to prevent HIV is to abstain from having sex with anyone who is infected, even if they may not know they're infected.

One approach to HIV prevention that historically has been promoted is called the "ABC" approach, in which A stands for abstinence or delay of sexual activity, B for being faithful and C for condom use. This idea implies monogamy and reductions in casual sex and multiple sexual partnerships.

In other words, to reduce their risk of HIV, women would need to: stop having sex with multiple partners; stop having casual sex and engage in intercourse only as part of a committed, monogamous relationship; and consistently use condoms during sex.

Other preventive behaviors include:

• Always use a condom (male or female) from start to finish during any type of sex (vaginal, anal and oral). Use latex or polyurethane condoms, not "natural" condoms.
• Use only water-based lubricants with latex condoms. You can use non-water-based lubricants with polyurethane condoms. Do not use oil-based lubricants such as petroleum jelly or vegetable shortening because they can weaken the latex.
• If you use a spermicide with a condom, use the spermicide in the vagina according to the instructions. Spermicides have not been shown to protect against HIV or other sexually transmitted infections.
• Avoid contraceptives containing the spermicide nonoxynol-9. Over-the-counter contraceptives that contain the spermicide nonoxynol-9, such as foams, creams, and gels, do not protect against HIV infection or other STDs. In fact, vaginal contraceptives containing nonoxynol-9 can promote vaginal irritation, which may increase your risk for HIV and other sexually transmitted diseases and transmission of infections.
• Don't do anything that could tear the skin or moist lining of the genitals, anus or mouth and cause bleeding. For instance, trauma to the mouth caused by rough kissing could lead to an exchange of blood.
• Avoid alcohol and illicit drugs. Alcohol and drugs can impair your immune system and your judgment. If you use drugs, do not share needles, syringes or cookers.
• Do not share personal items such as toothbrushes, razors and devices used during sex that may be contaminated with blood, semen or vaginal fluids.
• Seek early diagnosis and treatment if you have any symptoms of sexually transmitted diseases. Other sexually transmitted infections may increase your risk of HIV infection. If you test positive for a sexually transmitted infection, your health care provider should test you for HIV as well.
• Realize that you cannot tell by looking who is HIV-infected. In fact, a person can be infected and go years without any symptoms. During this time, they are still infectious.

For those already infected, antiviral therapy (ART) will reduce the ability to transmit HIV to a partner by reducing the amount of virus in bodily secretions. Early ART treatment is important for preventing transmission of HIV to partners.

A new approach to HIV prevention involves giving antiviral drugs (usually two) to people who are HIV-negative as a way to prevent them from getting infected. This is known as pre-exposure HIV prophylaxis or "PrEP." Numerous studies show that PrEP is highly effective.

The U.S. Food and Drug Administration approved the PrEP combination of emtricitabine/tenofovir disoproxil fumarate (Truvada) in 2012. Since then, numerous studies have shown that this prevention approach works very well; it can reduce the risk of getting HIV by more than 90 percent if used properly. Consequently, more people, including health care professionals, are learning about PrEP.

In 2014, the Centers for Disease Control and Prevention issued guidelines for the use of PrEP in men and women to decrease their risk of getting infected with HIV. Usage since then has greatly increased.

It's important to note that for women who have sex with other women, the risk of HIV transmission is small. However, surveys of risk behaviors within some groups of such women indicate relatively high rates of high-risk behaviors, such as injection drug use and unprotected vaginal sex with gay/bisexual men and injection drug users. To minimize HIV risk, you should:

• Understand that exposure of a mucous membrane, such as the mouth (especially if there is a cut), to vaginal secretions and menstrual blood is potentially infectious, particularly during very early and late-stage HIV infection when the amount of virus in the blood tends to be highest.
• Use dental dams, cut-open condoms or plastic wrap to help protect from contact with body fluids during female-to-female oral sex.

The most effective way to prevent HIV would be a vaccine. Researchers have been working very hard in this area for almost 30 years but have not been successful. There are several clinical studies underway with the HIV Vaccine Trials Network. However, it remains unclear how long it will be until we have an effective vaccine against the virus.

Facts to Know

1. The Centers for Disease Control and Prevention reports that 673,538 people in the United States have died from AIDS between the start of the epidemic in 1981 and 2013 (the most recent year for which death data are available). In 2014, an estimated 1.2 million people were living with AIDS in this country.
2. Today, about a quarter of people living with HIV are women.
3. According to the World Health Organization, as of November 2015, 36.7 million people were estimated to be living with HIV/AIDS worldwide. Of these, 34.9 million were adults, 17.8 million were women and 1.8 million were children.
4. During 2013, AIDS directly caused the deaths of an estimated 6,955 people in the United States. Almost 7,000 additional deaths were AIDS-related.
5. The overwhelming majority of HIV infections occur in developing countries.
6. HIV infection can be passed from a mother to her baby before or during birth and through breastfeeding. In the United States, without antiretroviral drugs, 25 percent of women will transmit the virus to their children. When women and their infants receive antiretroviral drugs during pregnancy and delivery, the risk of transmission drops to 2 percent or less.
7. Many people report no symptoms when first infected. However, some people have initial symptoms, called acute retroviral syndrome or primary HIV infection. The symptoms are similar to those of mononucleosis—such as fever, fatigue, joint ache, headache and sore throat—and last for one to three weeks.
8. Improved drug treatment for HIV infection allows people to live many years and most likely will never develop AIDS. The antiretroviral therapy (ART) drugs have allowed many people to stop taking preventive therapy for AIDS-defining opportunistic infections such as Pneumocystis carinii pneumonia and Mycobacterium avium complex.
9. There are six main classes of drugs used to treat HIV infection. The drugs are used in combination with each other to fully shut down the virus at different stages of replication and to help prevent resistance. There are also now six FDA-approved medications that provide a combination of drugs in a single pill that can be taken just once a day.
10. The riskiest behavior when it comes to HIV transmission is sharing needles to inject drugs with someone who is HIV infected. The next riskiest behavior is anal sex, followed by vaginal sex. You should avoid having unprotected anal or vaginal sexual intercourse with anyone whose HIV status you are unsure of.

Questions to Ask

If you are HIV positive or living with AIDS, review the following Questions to Ask and discuss them with your health care professional.

1. Do you have experience treating HIV/AIDS patients? About how many HIV patients have you treated? Are you an HIV specialist?
2. How soon should I begin treatment for my HIV infection? Are there any reasons why I should NOT start HIV antiretroviral therapy (ART)?
3. What are the main side effects of antiviral drugs you will prescribe for me?
4. Once I start treatment, do I have to continue taking the drugs for the rest of my life?
5. What is my viral load (the amount of virus in my blood) and my CD4 count? What do they tell me about my illness?
6. Are there alternative therapies I can consider that will help me stay healthy along with the ART you will prescribe for me?
7. If I get pregnant, can I still deliver a healthy baby? How can I protect my baby from getting infected with HIV?
8. Should I avoid breastfeeding my baby if I am HIV positive? Why?
9. What are the chances of my sexual partner becoming infected with HIV if we consistently use condoms?
10. How does HIV infection affect my risk for developing infections and other health-related complications?
11. What are some good resources such as magazines or websites to help me keep up with advances in fighting HIV/AIDS?

Key Q&A

Lifestyle Tips

1. Realize that HIV knows no age limits
   The rate of AIDS among those 50 and older is still increasing, both as a result of older people becoming infected with HIV and living longer with the virus. In 2014, an estimated 7,391 HIV diagnoses—16 percent of all diagnoses—occurred in people age 50 and older. So if you're newly divorced, still single or just between relationships, you should use condoms and take appropriate precautions, regardless of your age. Another very good idea is to make sure you and your partner have negative HIV tests (as well as tests for other STDs) before becoming intimate.roach should be discussed with your health care provider.
2. Take precautions for oral sex
   Although unprotected oral sex is safer than unprotected anal sex or vaginal intercourse, it is no guarantee of protection against sexually transmitted diseases. Most sexually transmitted diseases can be spread via oral sex. To protect yourself, make sure your partner uses a condom if you're performing oral sex; if he's performing oral sex on you, or if you're having oral sex with a woman, use a dental dam, a flat piece of latex used during dental procedures. You can get them in some medical supply stores. They provide a barrier between the mouth and the vagina or anus during oral sex. Household plastic wrap or a split and flattened unlubricated condom can also be used if you don't have dental dam. Also, don't brush or floss your teeth right before having oral sex. Either may tear the lining of your mouth, increasing your exposure to viruses.
3. Practice the best protection
   The best protection against any type of sexually transmitted disease is a latex condom. However, it doesn't provide 100 percent protection against STDs—only abstinence does. If you use a condom, make sure you use it properly. Human error causes more condom failures than manufacturing errors. Use a new condom with each sexual act (including oral sex). Carefully handle it so you don't damage it with your fingernails, teeth or other sharp objects. Put the condom on after the penis is erect and before any genital contact. Use only water-based lubricants with latex condoms. Ensure adequate lubrication during intercourse. Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage.
4. Get tested for STDs
   No one test screens for all STDs. Some require a rectal or vaginal exam and specimens obtained from these areas. Others require a blood or urine test. You can get tested at your health department, community clinic, private health care professional or Planned Parenthood. Or call the CDC at 1-800-CDC-INFO (800-232-4636) for free or low-cost clinics in your area.
5. Know whether you have an STD
   While some STDs may present with symptoms such as sores, ulcers or discharge, many have no symptoms. You usually cannot tell if you or a partner has an STD just by looking at him or her. Don't rely on a partner's self-reporting and assume that will prevent you from acquiring an STD. Many infected people do not know they have a problem. They may think symptoms are caused by something else, such as yeast infections, friction from sexual relations or allergies. Educate yourself about your own body and, in turn, learn about your own individual risk for contracting an STD. One way to do this is to schedule an examination with a health care professional who can sit down with you and help you learn the principles for staying safe and sexually healthy. Don't allow fear, embarrassment or ignorance to jeopardize your health and future.
6. Talk to your children about STDs
   Sexually transmitted diseases are particularly common among adolescents. Teens should be concerned about STDs and know how to protect themselves. As a parent, you can play a large role in your adolescent's behavior, both through the behavior you model and your communication with your teen. Make sure your daughter regularly visits a competent gynecologist or other female health provider and your son sees a medical professional who deals with adolescent health at least once a year, if for nothing else than some plain talk about STDs and pregnancy. And Talk to your kids. Study after study proves that when parents talk to their kids about sexual issues, their kids listen. Don't worry that talking about sex is the same as condoning it. Studies show that when parents talk about sex, children are more likely to talk about it themselves, to delay their first sexual experiences and to protect themselves against pregnancy and STDs including HIV when they do have sex.

Organizations and Support

For information and support on coping with HIV/AIDS, please see the recommended organizations, books and Spanish-language resources listed below.

AIDSinfo
Website: https://hivinfo.nih.gov/
Address: P.O. Box 6303
Rockville, MD 20849
Hotline: 1-800-HIV-0440 (1-800-448-0440)
Phone: 301-519-0459
Email: contactus@aidsinfo.nih.gov

American Social Health Association (ASHA)
Website: https://www.ashasexualhealth.org/
Address: P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
Email: info@ashastd.org

amfAR, The Foundation for AIDS Research
Website: https://www.amfar.org
Address: 120 Wall Street, 13th Floor
New York, NY 10005
Hotline: 1-800-39-amfAR (1-800-392-6327)
Phone: 212-806-1600
Email: information@amfar.org

CDC National Prevention Information Network
Website: https://www.cdcnpin.org
Address: P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 404-679-3860
Email: info@cdcnpin.org

Elizabeth Glaser Pediatric AIDS Foundation
Website: https://www.pedaids.org
Address: 2950 31st Street, #125
Santa Monica, CA 90405
Hotline: 1-888-499-HOPE (1-888-499-4673)
Phone: 310-314-1459
Email: info@pedaids.org

Guttmacher Institute
Website: https://www.guttmacher.org
Address: 1301 Connecticut Avenue NW, Suite 700
Washington, DC 20036
Hotline: 1-877-823-0262
Phone: 202-296-4012
Email: info@guttmacher.org

Infectious Diseases Society of America
Website: https://www.idsociety.org
Address: 1300 Wilson Blvd., Suite 300
Arlington, VA 22209
Phone: 703-299-0200
Email: info@idsociety.org

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Website: https://www.cdc.gov/nchhstp
Address: Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov

National Institute of Drug Abuse: Drugs + HIV - Learn the Link
Website: https://www.drugabuse.gov/news-events/public-education-projects/learn-link-drugs-hiv

National Minority AIDS Council (NMAC)
Website: https://www.nmac.org
Address: 1931 13th St
Washington, DC 20009
Phone: 202-483-6622
Email: info@nmac.org

Sexuality Information and Education Council of the United States (SIECUS)
Website: https://www.siecus.org
Address: 90 John Street, Suite 704
New York, NY 10038
Phone: 212-819-9770

The Association of Asian Pacific Community Health Organizations (AAPCHO)
Web Site: https://www.aapcho.org/site/aapcho/
Address: 300 Frank H Ogawa Plaza, Suite 620
Oakland, CA 94612
Phone: 510-272-9536
Email: nagrewe@aapcho.og

Books

The AIDS Dictionary
by Sarah Barbara Watstein, Karen Chandler

AIDS (Preteen Pressures)
by Paula McGuire

Healing HIV: How to Rebuild Your Immune System
by Jon D. Kaiser

HIV Infection: The Facts You Need to Know
by Kenneth L. Packer

The HIV Wellness Sourcebook
by Misha Ruth Cohen, Kalia Doner

Sexual Health: Questions You Have...Answers You Need
by Michael V. Reitano, Charles Ebel

Sex: What You Don't Know Can Kill You
by Joe S. McIlhaney, Marion McIlhaney

Spanish-language resources

Medline Plus: Sexually Transmitted Diseases
Website: https://www.nlm.nih.gov/medlineplus/spanish/sexuallytransmitteddiseases.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov