Canada has seen a rising trend in HIV diagnoses over the last few years.
In 2021, there was a 5.2% increase in HIV cases compared to 2020. The rate of new HIV diagnoses was higher in men, 6.5 per 100,000, compared to that in women, 2.5 per 100,000. HIV disproportionately affects men and it’s important to how you can stay protected from the virus while having a healthy sex life.
What is HIV?
The HIV Virus
HIV stands for Human Immunodeficiency Virus. It is an RNA retrovirus which means that it multiplies using RNA, not DNA like human cells. Retroviruses have an enzyme called reverse transcriptase which converts their genetic information into DNA after they infect human host cells. There are two types of HIV virus: HIV-type 1 (HIV-1) and HIV-type 2 (HIV-2). The one that causes AIDS globally is HIV-1, whereas HIV-2 is only found in some regions of Western and Central Africa.
HIV Infection
HIV infection is caused when the virus attacks a person’s cells, starts replicating, and establishes a permanent base. The infection progresses in three stages.
- Acute stage: A variety of symptoms, known as acute retroviral syndrome, can appear after infection. None of these symptoms, however, are specific to HIV. The time from exposure to onset of symptoms is 2 to 4 weeks, although, it can be as long as 10 months. An infected person can experience the following:
- Fatigue
- Muscle pain
- Skin rash
- Headache
- Sore throat
- Swollen lymph nodes
- Joint pain
- Night sweats
- Diarrhea
Some people might experience no symptoms at all and the only way to know for sure is to get an HIV test. During this time a person has high levels of the virus in their body, known as a high viral load, and they will be contagious.
- Clinical latency: The next stage of HIV infection is asymptomatic. The virus remains in the body and continues to multiply If the infected person is put on antiretroviral therapy (ART), the virus stops multiplying and the viral load becomes negligible. The person will not proceed to the third stage and will never experience HIV symptoms for the rest of their life.
- AIDS: In the third stage, someone who is infected develops acquired immune deficiency syndrome (AIDS), a severe and usually fatal condition. The viral load in the body is extremely high, as a result of which the patient’s immune system becomes weak and can no longer fight opportunistic infections such as:
- Recurrent bacterial infections
- Thrush
- Recurrent pneumonia
- Candidiasis
- Cervical cancer
- Oral hairy leukoplakia
- Coccidioidomycosis
- Cryptococcosis
- Cytomegalovirus disease
- HIV-related encephalopathy
- Herpes
- Kaposi sarcoma
- Lymphoma
- Tuberculosis
If left untreated, this is followed by advanced HIV infection within 3 years and eventually death.
How is HIV Transmitted?
HIV is unable to survive outside living cells and is transmitted via infected bodily fluids such as blood, semen, vaginal fluids, rectal fluids, and breast milk. The virus, however, is NOT transmitted through saliva, tears, or sweat.
In order for transmission to occur the virus has to get through a mucous membrane (the opening of the penis, the foreskin, the vagina, or the rectum) or a break in the skin (needle use). HIV can also be passed from an infected mother to the child at birth.
High-risk activities for HIV include:
- Unprotected sex: any type of sexual intercourse without using condoms
- Unsafe medical procedures: receiving unsafe injections, blood transfusions, and tissue transplantation, needlestick injuries, unsterile surgery
- Sharing or reusing needles: sharing contaminated needles and injections, reusing syringes to inject drugs or medicine
Who is at Risk for HIV?
If you belong to any of the following groups, you have a higher risk of acquiring HIV:
- individuals taking part in condomless sex
- people with an HIV-positive partner who is not on treatment
- people with a partner whose HIV status is unknown
- men who have sex with men
- anyone with multiple sexual partners
- transgender women
- sex workers
- drug-injecting users
- prisoners
HIV Prevention
Understanding the risk factors that lead to the spread of HIV is the first step in prevention. You can stay protected for the rest of your life if you engage in safe sex and safe needle use.
Safe Sex Practices
Practicing safe sex is an integral part of a healthy lifestyle. It can range from open communication with sexual partners to using contraception correctly and getting regularly tested for STIs.
Open communication involves an honest discussion about contraceptives, HIV status, history of STIs, previous or current sexual partners, and tests for STIs.
Contraception, when used correctly, is extremely effective in reducing the spread of STIs.
Barrier Contraception
Barrier contraception refers to physical materials used during sex to ensure that you don’t come in contact with a potentially infected partner’s body fluids.
One of the most common uses of barrier contraceptives is to block the sperm from reaching the egg and thus prevent fertilization. Some examples are:
- external condoms
- internal condoms
- spermicide (a chemical that destroys sperm cells)
Condoms can prevent the spread of HIV and other STIs when used during PIV and anal intercourse. Always use a clean, new condom when having sexual intercourse, ideally one that contains a water-based or silicone-based lubricant, which is more protective as it’s less likely to break during sex. Spermicides are less effective than condoms in preventing HIV transmission; they are used mostly to prevent pregnancy.
It’s important to note that barrier contraceptives such as the sponge, diaphragm, and cervical cap do not protect against HIV.
PrEP for HIV
PrEP, or pre-exposure prophylaxis, involves taking medicine before sex to keep you safe from HIV. The most widely preferred form of PrEP is a pill that you can take orally once a day. The other method is a long-acting shot given to you monthly by a healthcare provider. Only the pill is approved for PrEP in Canada, and it is also preferable as you can take it on your own and there are fewer chances of allergic reactions compared to the shot.
Truvada is the World Health Organization-prescribed medicine for PrEP. It contains emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF), which are combination antiretroviral drugs (as HIV is a retrovirus) that reduce the risk of acquiring HIV infection.
PEP for HIV
PEP, post-exposure prophylaxis, involves taking medicine after any risk of exposure to HIV. Pep needs to be taken immediately within 72 hours (3 days) of exposure in order to be effective.
A combination of three antiretroviral drugs, tenofovir disoproxil fumarate, emtricitabine, and raltegravir/ dolutegravir, is taken within 72 hours every day for a total of 28 days. When taken as prescribed, PEP is 81% effective in preventing the development of HIV infection.
However, PEP is not suitable for someone after 72 hours of exposure or anyone who faces repeated risks of HIV exposure due to the chances of drug resistance. PEP should be used for emergencies only, not as an ongoing HIV prevention strategy.
Limiting Sexual Partners
One way to prevent any chances of spreading HIV and other STIs is to limit the number of sexual partners, thus reducing exposure. Limit sexual partners to a small social circle of people that you are certain are also practicing safe sex and getting tested regularly for STIs.
Safe Needle Use
The chance of contracting HIV is high if an HIV-negative person uses injection equipment that belonged to someone with HIV. This is because the needles, syringes, or other equipment for injections may contain infected blood. HIV can live for up to 42 days in an already-used syringe, depending on temperature and other factors.
People Who Inject Drugs
If you take drugs, you can decrease your risk of contracting or transmitting HIV by following safe injection procedures. Don’t share medication-injecting equipment, such as water bottles, filters, spoons, pots, needles, and syringes. Use fresh, sterile equipment every time you inject.
If you believe you have a substance use disorder, enroll in a program that decreases substance dependence and the frequency of injections, and other risky behaviors.
Medical Syringes
For medical procedures, make sure that any syringes and needles are only used once and disposed of safely afterward. When receiving an injection or blood transfusion, it’s important that the facility adheres to proper infection-control practices and that blood and blood products are screened for HIV.
Don’t know how you can get PEP in Toronto? Then sign up with us to get started. You’ll speak to a physician who will then assess your situation and prescribe what you need.
Disclaimer:
The opinions shared in this article belong to the author and, like all content on Gambit’s Health Hub, should not be considered a replacement for professional medical advice, diagnosis, or treatment. If you have any health-related inquiries, consult with your preferred healthcare professional or visit a licensed, Canadian physician through Get Gambit for a supported condition.
This article has been medically reviewed by:
Dr. Taneer Ahmed, MBBS, MS
