How is HIV transmitted – and how is it not?
Undetectable = Untransmittable (U=U)
What are HIV and AIDS?
HIV is a long-term infectious disease, the advanced stage of which is called AIDS. Before effective medication, AIDS was called the final stage of HIV infection. Medication also helps to boost the immune system of a person living with HIV in the AIDS stage so that they can continue a healthy life as a person living with HIV.
HIV stands for Human Immunodeficiency Virus. HIV causes a persistent infection, resulting in damage to the body’s defence system. The virus weakens the immune system by destroying helper cells called CD4 lymphocytes. The progression of HIV infection is very individual. Without medical treatment, the average time to progress to the AIDS stage is 10 years.
AIDS stands for Acquired Immune Deficiency Syndrome. “Acquired” in this context means the opposite of congenital or accidental. A person is considered to be in the AIDS stage when they are HIV-positive and have at least one comorbidity typically associated with AIDS. By the time AIDS progresses, the immune system has already suffered significant damage and resistance to illnesses is severely compromised.
What are the symptoms of HIV?
HIV infection can be asymptomatic for several years, sometimes even more than a decade. Some people develop early symptoms within 1–6 weeks of infection, similar to normal flu symptoms.
The most typical symptoms are sore throat, swelling of the glands of the neck, fever, rash, muscle pain and headache. All of these are also typical of many common viral infections, and symptoms alone are not enough for an HIV diagnosis. HIV infection can only be detected by an HIV test.
- HIV can be completely asymptomatic for several years.
- Only some people infected with HIV develop early symptoms, which means that symptoms cannot be used as a basis for diagnosing HIV infection.
- It is estimated that there are around 600 HIV-positive people in Finland who do not know about their positive HIV status.
- The only way to be sure of your HIV status is to take an HIV test.
How is HIV transmitted – and how is it not?
HIV is not transmitted through everyday interactions. HIV is not transmitted through droplet transmission, such as by coughing, or hugs, kisses, dishes, or shared toilets or showers. Effective HIV treatment stops the transmission of HIV.
- HIV can only be transmitted through unprotected sex, blood or from mother to child.
- HIV does not remain infectious outside the human body.
- Oxygen quickly destroys the virus.
In Finland, the vast majority of new HIV infections are caused by unprotected sex with a partner who did not know they were living with HIV.
HIV can be transmitted through unprotected sexual contact
The possibility of infection exists if the mucous membranes or broken skin are exposed to a high level of virus-containing body fluid, such as blood, semen, pre-ejaculatory fluid released from the male urethra or vaginal discharge. The risk of transmission during vaginal intercourse is higher for women than for men. In anal intercourse, the risk of infection is higher for the receptive partner because the rectal surface is easily damaged and has many blood vessels. Using a condom correctly during intercourse protects against infection. There is a theoretical risk of infection from unprotected oral sex, where semen, pre-ejaculatory fluid released from the male urethra or vaginal discharge enters the mouth. Other body secretions, such as saliva, tear fluid, urine, and faeces, contain so few viruses that there is no risk of infection.
Many factors influence the possibility of infection. For example, other coexisting sexually transmitted diseases such as chlamydia, gonorrhoea and syphilis can cause ulcers on the mucous membranes, making it easier for the virus to enter the body.
HIV can be transmitted through contact with blood
HIV can be transmitted through the use of shared needles, syringes or other equipment associated with the use of injected drugs. This type of transmission mainly concerns people who use injected drugs. Health counselling and the use of clean syringes and needles helps prevent infections. In Finland, only a few HIV infections are detected among injecting drug users each year.
HIV can be transmitted through contact with blood, such as organ and blood transplants or other blood products containing the virus. Today, however, blood products are tested almost everywhere in the world. In Finland, testing of donated blood started as early as 1985. Since then, there have been no cases of HIV infection through blood products in Finland.
HIV can be transmitted vertically
HIV can also be transmitted vertically, from mother to child during pregnancy, childbirth, or breastfeeding. If the mother is living with HIV, the transmission can be prevented by medication. In Finland, HIV testing is offered to everyone at the child health clinic, and almost all pregnant women now participate in this screening. By 2021, approximately 500 HIV-negative babies have been born to HIV-positive mothers in Finland.
Undetectable = Untransmittable (U=U)
HIV can not be transmitted through unprotected sex with a person living with HIV who is on effective HIV medication. People living with HIV who take HIV treatment and have what’s known as an undetectable viral load do not pass on HIV, even when other prevention methods aren’t used. This is what is meant by undetectable = untransmittable (U=U). There is also no risk of HIV infection when using PrEP medication.
HIV infection does not have any outward symptoms. Even a person who looks perfectly healthy can be living with HIV. People living with HIV do not pose a risk to their environment and can function in society in almost any role in a completely normal way.
The PARTNER1 (2016) and PARTNER2 (2019) studies are large international research projects that have been able to show that the chance of any person living with HIV and having an undetectable viral load transmitting the virus to a sexual partner is scientifically equivalent to zero. The studies followed gay and straight couples in which the person living with HIV was taking HIV medication, had undetectable viral load, and had sex without a condom with an HIV-negative spouse.
The PARTNER1 study involved slightly under 900 couples. In the first study, a total of 58 000 unprotected sex acts were reported. PARTNER2 was a follow-up study involving slightly under 800 gay couples. In the second study, more than 76 000 acts of unprotected anal intercourse were reported. In neither study were there any cases of HIV infection between couples from vaginal or anal intercourse. You can read more about the PARTNER studies here.
How to prevent an HIV infection?
In Finland, the vast majority of new HIV infections are caused by unprotected sex with a partner who did not know they were living with HIV. It is estimated that there are approximately 600 people in Finland who do not know they are living with HIV. Condom use during sex is an excellent way to prevent HIV if the HIV status of the sexual partner is unknown.
Using two condoms on top of each other does not increase safety. It instead creates more friction, which increases the chance of the condom tearing or slipping off the penis. Poor quality condoms, such as novelty condoms, do not protect against HIV. Condoms must be changed when moving from one orifice to another during intercourse.
The use of lubricants is recommended as it reduces the possibility of damage to the mucous membranes. Water-based lubricants are suitable for use with condoms. Oil-based lubricants such as Nivea, Vaseline or massage oil will corrode a latex condom and the condom may break. Polyurethane condoms, such as the Femidom, which is inserted into the vagina or rectum, and the Durex Avanti, which is worn over the penis, are stronger than the standard latex condom. These can be used with an oil-based lubricant and are also suitable for people with rubber allergies.
- One of the best ways to prevent HIV infection is to get tested for HIV.
- Once you know your HIV status, HIV can be treated with effective medication.
- Early detection of HIV infection also prevents further infections.
PrEP (Pre-Exposure Prophylaxis)
In the early 2010s, a new safe and effective way to prevent HIV emerged. This pre-exposure prophylactic drug treatment for HIV is known as PrEP. PrEP is for people who are not living with HIV but are at high risk of infection. The effectiveness of PrEP has been proven in several studies. In Finland, PrEP was introduced in 2019 and is now available free of charge.
PEP (Post-Exposure Prophylaxis)
PEP is a preventive treatment to be started after exposure to HIV. Preventive treatment should be started as soon as possible, but no later than 72 hours after the exposure event. Significant exposure includes exposure to HIV-positive blood, semen, breast milk or visibly bloody secretions on mucous membranes, broken skin or through the skin. If a person living with HIV is on effective HIV medication, there is no risk of HIV transmission (U=U). This also means that starting PEP medication is not necessary.
Advice on prevention
If PrEP medication is relevant for you, you can contact Positiiviset ry HivFinland or Hivpoint to discuss the matter with an expert. The Hivpoint website also has a comprehensive information package on PrEP in Finland, which is worth checking out. Read more here.
If you have been in a situation where you are at a clear risk of HIV infection and need PEP medication, contact your nearest emergency healthcare unit as soon as possible. Before contacting them, please read more about assessing the degree of risk on the Hivpoint website.
How is HIV diagnosed?
HIV infection can only be detected by an HIV test. The HIV test is carried out on a blood sample, either by a rapid test using a fingertip blood sample, or in a healthcare facility using a venous blood sample. The result of a positive rapid test is always confirmed by a sample of your blood in a healthcare facility.
The earliest time to seek an HIV test is 4–6 weeks after the exposure, but a negative test result is not certain until 3 months after the risk event.
Is it easy to get tested for HIV?
Everyone has the right to get tested for HIV without a doctor’s assessment. The test must also be available anonymously and outside of your municipality of residence. People who want an HIV test must also not be asked for reasons or questioned as to whether they actually need the test. The test is free of charge everywhere except in private health centres.
There are also home tests to detect HIV infection, which allow you to perform a test in the privacy of your own home. HIV home test kits are paid products. The result of a positive rapid test is always confirmed on a venous blood sample in a healthcare facility. If you are feeling anxious or afraid of the possibility of an HIV infection, consider taking the test with a professional instead of at home. In healthcare, the test result will be shared with you in person and, if necessary, support can be arranged in the event of a positive test result.
HIV tests are available at:
- health centres (also outside your own municipality of residence)
- venereal diseases outpatient clinics
- private clinics (the test is a paid service)
- student healthcare
- community based testing points, such as those offered by Positiiviset ry HivFinland or Hivpoint
Do I have to pay to take an HIV test?
In public health centres and health stations, the HIV test is free of charge on the basis of the Act on Client Charges in Healthcare and Social Welfare. You can also take the test anonymously. In private clinics, the HIV test is a paid service. HIV home test kits are paid products. The home test kits sold in Finland include the CE-certified HIV home tests Autotest VIH and Exacto. These are sold by online pharmacies and the Hivpoint online shop. HIV home test kits can also be ordered from abroad, but it is important to ensure that the test is reliable (CE-certified) and that the instructions accompanying the test are easy to understand. You should read the instructions carefully before taking the test.
What should I do if I test positive for HIV?
If you get an HIV test in a public health centre or private clinic, you will be referred to an infectious diseases outpatient clinic or similar service in your area. HIV is treated both in outpatient clinics at university hospitals and in regional hospitals. If your rapid HIV test at home gives a positive result, you should contact your local health centre and tell them about your rapid HIV test result. If you are feeling anxious or afraid of the possibility of an HIV infection, consider taking the test with a professional instead of at home. In healthcare, the test result will be shared with you in person and, if necessary, support can be arranged in the event of a positive test result.