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HIV - The Issues for Gay Men in Lothian
sexual health pages
Human Immuno-deficiency Virus (HIV)
HIV is a virus which affects the immune system, preventing it from working properly. It infects several primary cells in the immune system which co-ordinate the body’s fight against infection (CD4 and other lymphocyte cells) and uses these to make copies of HIV which go on to attack other cells.
Acquired Immune Deficiency Syndrome (AIDS)
When the immune system is weakened by HIV people are more likely to pick up opportunistic infections such as pneumonia or certain types of cancer, which would not normally affect someone with a healthy immune system. It used to be the case that people were considered to have developed AIDS when they became ill with these opportunistic infections. However, doctors now generally talk instead of the “advanced stage of HIV infection” and define this as a point when the immune system is damaged as a result of high levels of virus in the blood and a low number of CD4 cells available to fight infection. This is thought to be a better way of assessing the impact of the HIV virus than the presence or absence of opportunistic infections.
HIV is carried in body fluids and can be passed on through blood, semen, breast milk and vaginal secretions (including menstrual blood). HIV cannot be transmitted through other body fluids, such as saliva, urine, faeces (shit) and tears, as they do not carry enough of the active virus.
The main ways HIV is passed on from one person to another are:
For HIV to pass from one person to another there needs to be :
1. A route of transmission for the virus to pass from one person into
the bloodstream of another.
HIV transmission mainly happens through direct blood-to-blood contact (such as sharing unsterilised needles or other injecting equipment) and through unprotected anal or vaginal sex.
During unprotected penetrative sex, small amounts of infected blood or semen can pass into the bloodstream through the mucous membranes in the anus, penis or vagina. Oral sex carries a lower risk as the mucous membrane in the throat is thicker and better protected, and saliva itself carries substances which inhibit HIV. This is why only a very small number of people are known to have been infected with HIV through oral sex. Cuts, sores, sexually transmitted infections in the mouth and bleeding gums may increase the risk of HIV getting into the bloodstream.
Some sexually transmitted infections, such as gonorrhoea and syphilis, can weaken the body’s resistance to HIV, making it much easier to catch the virus if exposed.
Sex between men is the main route of HIV transmission in the UK, with Lothian being one of the worst affected areas. 42% of all known HIV-infected people in Scotland have been from Lothian, and sex between men was the route of transmission for one third of Lothian’s infected people. So sex between men in Lothian has been the route of transmission for 14% of all known HIV infections in Scotland.
Meanwhile, Scotland has some of the lowest figures for HIV testing in Europe and research is suggesting that unprotected sex between men is on the rise.
The main way to protect yourself and your partners from HIV is to use a condom for anal or vaginal sex. Oral sex carries a lower risk, with only a very small number of people thought to have been infected in this way, and all of them through receptive oral sex (sucking someone off). Things which may increase the risk of HIV being passed on during oral sex include : ejaculation in the mouth (although there is no difference between spitting or swallowing), bleeding gums, cuts, sores or other damage to the mouth or throat, and carrying other sexually transmitted infections.
Click here for information on HIV testing, including what to think about and where you can be tested.
Whether you are newly diagnosed with HIV or just looking for information on HIV and treatments, the following information aims to give you a basic start in understanding the complexities of being diagnosed with HIV.
Reaction to a positive result can be different for everyone; you may want to scream, shout, cry, hide, run away, feel numb, scared, lonely or relieved. Whatever your initial reaction, give yourself time to get used to the news and for it to soak in.
When you are ready you will have to decide what to do next: whether to start HAART (highly active anti-retroviral treatments, also called combination therapy), who to talk to and how to look after your health. A lot of people find it particularly helpful to speak to other people living with HIV to get support, share information and learn from one another’s experience. The organisations listed at the bottom of this page provide further support, information and counselling to people living with or affected by HIV, as well as opportunities to meet others in the same situation.
In Edinburgh the majority of treatments are provided by an HIV specialist clinic at the local GUM (Genito-Urinary Medicine) clinic, or at the HIV Counselling Clinic at the Western General Hospital. Both of these are specific HIV treatment centres and have specialist staff available to advise you on the best treatment options for your individual needs. The services operate under strict rules regarding confidentiality, and your status is not disclosed to anyone else without your permission.
You may want to let your GP know your HIV status. This has the advantage of making sure that your GP can respond to your specific health needs and does not prescribe any medication which could react badly with medication given to you by the HIV Counselling Clinic or GUM. GP’s are also generally nearer to your home, and responsible for providing 24-hour medical care, which will not be the case with the specialist clinics. However, GP’s can (with your permission) be approached by employers and insurance companies and asked for medical reports. In these situations your GP may have to disclose your HIV status to others.
You might find that you are encouraged to use specialist HIV clinics for specific check-ups such as viral load and CD4 tests (explained below) while your GP may respond to other medical/health needs. If you are unsure whether to go to the clinic or GP with some problems, you can call the HIV Clinic and a nurse will be able to advise you, based on the symptoms you describe.
There are two main diagnostic tools used to assess how much HIV is affecting your immune system : a CD4 count and viral load tests.
CD4 counts measure the number of CD4 T-cells in a sample of blood. As these cells are the main defence the immune system has against infections and viruses, they can give an idea of how your body is coping with the fight against HIV. A high count means the body is coping well and still able to fight infections. A low count means that HIV has damaged the immune system
Viral Load measures the quantity of virus particles present in the blood by detecting HIV genetic material. A high count means there is a lot of HIV present and the immune system may well be damaged. A low count means there is less HIV present and the body is still fighting infections well.
HIV counselling and testing is free and confidential at GUM and the HIV Counselling Clinic. The National AIDS Helpline is also an excellent source of information and support; they can be contacted free by dialling 0800-567-123 and operate 24 hours a day.
Images courtesy of the Steve Retson Project
Last updated 20th May 2004
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