Get Real! Positively Informed on HIV/AIDS

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Get Real! Positively Informed on HIV/AIDS

Heather Corinna

What do you really know about HIV and AIDS? How sure are you that what you know is correct or complete, and how much do you think it matters that you know about HIV and AIDS at all?

What do you really know about HIV and AIDS? How sure are you that
what you know is correct or complete, and how much do you think it
matters that you know about HIV and AIDS at all?

This article isn’t here to scare you: after all, most of you who have
been sexually active are much more likely to end up with HPV, Herpes or
Chlamydia than you are with HIV. But that doesn’t mean it’s smart to
forget about HIV, or figure it’s nothing you’ve got to know about,
especially since unlike other, more common STIs, HIV/AIDS is one of the
rare few that has the capacity to cause very serious long-term health
problems and can kill you.

While it’s less common for western teens than other sexually
transmitted infections, it also isn’t anything close to rare: a few
million teens and young adults worldwide acquire HIV every single year.
Every hour of every day, one young American between the ages of 13 and 21 is infected with the HIV virus.

In the United States alone, 25% of all new HIV infections are in
people of all sexes and orientations between the ages of 13 and 21, and
a majority of those young adults don’t even know they have it: in a
Kaiser Foundation survey of youth about HIV, less than 30% of
respondents have ever even been tested, and less than 50% reported they
even knew where to go to get testing in the first place.

Roe is gone. The chaos is just beginning.

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Among gay youth, awareness about HIV and the real risks posed has
also been decreasing, and concerns about safer sex have decreased. That
may well be in part because the overwhelming bias about gay men and
HIV/AIDS was so extreme it had gay men of all ages in a very real state
of panic for a long time, or because more focus — as it should be —
has been put on other populations when it comes to HIV and AIDS, not
just on gay men. But it’s likely also in part because so many people
with HIV seem to be doing just fine thanks to advanced drugs, and more
dangerously, because in some gay populations, risking HIV is sometimes
seen as a rite of passage, much like risking pregnancy is sometimes
viewed among young straight women. But the risks to gay men — the
risks to anyone — remain very real: around 50% of all new AIDS cases
in young men are from men sleeping with men. (The same risks do not
exist with young gay women: female-to-female HIV transmission is very
rare.)

According to the Centers for Disease Control, at the end of 2003, an
estimated 1,039,000 to 1,185,000 persons in the United States were
living with HIV and/or AIDS. The CDC has estimated that approximately
40,000 persons in the United States become infected with HIV each year.
The vast majority of HIV infections arise from sexual contact, for both
men and women alike. AIDS is currently the fifth leading cause of death
among all adults aged 25 to 44 in the United States. So, no matter who
we are, who we sleep with, or how safe we think we are, we can say
pretty clearly that being ignorant about HIV and AIDS is a clear danger
to our health and the health of those around us.

Because for so many years, information about HIV and AIDS was so
biased, an unfortunate result of those biases has been that lots of
folks have outdated or incorrect information about HIV. Let’s debunk
some myths and look at the facts.

You can spread AIDS through–

Might as well stop right there: you can’t spread AIDS to someone else at all. You can only spread HIV person-to-person.

So, what IS HIV? And what is AIDS? Both are acronyms: HIV
stands for Human Immunodeficiency Virus; AIDS for Acquired Immune
Deficiency Syndrome. HIV is a virus people can and do spread around,
and AIDS is a syndrome which people with HIV often eventually develop:
HIV often progresses to AIDS, and you can’t wind up with AIDS without
having contracted HIV first. AIDS is not contagious: HIV is. Neither
are currently curable: once you’ve got HIV or AIDS, you’ve got them for
life.

The HIV virus attacks cells in your body called CD4 cells — also
called T4 or T-helper cells — which are essential in helping your body
fight off infection and disease. As HIV destroys your immune system,
that’s where and how AIDS — severe immunodeficiency — can develop. An
HIV-positive (someone diagnosed with the HIV virus) person is diagnosed
with AIDS when their immune system becomes seriously compromised —
because those CD4 cells have been killed by HIV — and manifestations
of HIV infection are severe. Then the body becomes incapable of
fighting off infections that normally we can handle, and aren’t of real
danger to us — things like colds or yeast infections – but which
aren’t harmless once we’ve got AIDS: every infection (same goes with
cancers) becomes a major threat to our health because our body is no
longer capable of the normal processes that fight off and help us heal
from those infections.

HIV isn’t as big of a deal as it used to be, because there are good drugs for it now. In fact, isn’t there a cure for AIDS now?

Neither HIV or AIDS are currently curable. However, both are
treatable. Advances in medicines to manage HIV through antiretroviral
therapy and other alternative therapies — as well as increases in
screenings to diagnose HIV earlier and earlier — have made a very
real, positive difference when it comes to those living with HIV. HIV
is no longer an absolute death sentence.

However, managing HIV also relies on two very important factors:
finding HIV early, and having the resources to access and afford the
medications for management. One big reason why people of color
worldwide are harder hit by HIV and AIDS has to do with class
differences — who has more money and agency — between the races when
it comes to healthcare. And for younger people, many of whom don’t have
their own healthcare, especially when they’re first starting out in
their adult lives, and many of whom don’t get regular STI/HIV testing,
having good drugs and management tools is sometimes of limited use.

Even when good healthcare and treatment for HIV can be accessed,
living with HIV is hardly a walk in the park. The medications for HIV
patients do a real number on a lot of people in terms of side effects,
they can be incredibly expensive, and a lot of other lifestyle changes
usually need to be made by those living with HIV to feel okay. In
addition, treatment for HIV does not do anything to protect sexual
partners from getting HIV from a partner who is HIV-positive: it
remains highly contagious and dangerous.

Because of earlier detection and advances in medicines, fewer young
people with HIV right now will progress to quickly AIDS, and younger
people nowadays with AIDS have been living longer than ever before. But
it’s important to remember that AIDS is a terminal condition, one that,
on average — when antiretroviral therapies are not used — develops
within about ten years from acquiring HIV on average. On average, once
HIV has progressed to AIDS, people with AIDS die within one year. No
one who has contracted full-blown AIDS has lived through it. Preventing
HIV is still the very best thing we can do.

You have to have anal sex or do drugs to get HIV.

Unprotected anal intercourse (particularly for the receptive
partner: the person in whose bottom a penis is entering) and
needle-sharing drug use are absolutely the two most prevalent risks of
HIV for young people (and most people, period). But not only do those
risks exist for people of all sexes and gender equally — especially as
anal sex becomes more common among heterosexual teens — heterosexual
vaginal intercourse is a very close second when it comes to HIV risks.

Understand that why anal sex presents an increased risk is because
anal and rectal tissue is more delicate than vaginal tissue, and more
likely to have microtears (incredibly small tears) or abrasions from
sex, which present sites for infection. But the same can often be true
with vaginal tissue, especially when we consider how many young people
are having sex without lubricant, without responsive and gentle
partners, and how common date and stranger rapes are for young women
(forced or even consensual "rough" sex increases risks of HIV and other
STI transmission: sexual violence plays a very big part in the HIV/AIDS
pandemic).

HIV is spread through four routes, and most prevalently in this order: male sexual fluids, blood, female vaginal fluids or breastmilk.
If you are directly exposed to any of those things or expose others to
them — genitally, orally, or intravenously (in your veins) — then you
could get or spread HIV.

You’d have to have sex with a lot of people to get HIV.

Not at all: all you’d have to do is have unprotected sex with one
person who has HIV. By all means, the greater number of sexual partners
you have, the greater chance you’ve got of winding up with a partner
with HIV, so limiting partners is a big help is reducing the risk of
HIV. But if you’re having unsafe sex with even one partner, you’re at
risk, so it’s a very big deal to never make exceptions when it comes to
safe sex, not even just "that once."

Only gay men get AIDS.

In the early 80’s, when HIV and AIDS were first discovered, a
majority of those diagnosed with AIDS were gay men. Diagnosed: that
means who were found to have it, that doesn’t speak for all the folks
who had it without being diagnosed. But at this point, we know that
EVERYONE can get HIV and AIDS: in 2004, AIDS was a leading cause of
death for black women between the ages of 25 and 34, for instance.
Worldwide, more than 90% of HIV infections are due to unprotected
heterosexual intercourse (consensual and through rapes), and around
half of those living with HIV today worldwide are women.

Most sexual HIV transmission in the western world is indeed
male-to-male, and secondarily male-to-female, and women are twice as
likely to contract HIV from men than men are from women worldwide. One
troubling thing the Kaiser study showed was that overall, young men
expressed less concern and interest in finding out about all aspects of
HIV and AIDS, even though men are the most common transmissors of the
virus, no matter who they’re giving it to.

Additional things that can put you at a higher risk for acquiring
HIV are having another existing sexually transmitted infection (such as
one of the more common ones: one reason teen girls are at an increased
risk of HIV is because so many have Chlamydia without knowing it or
treating it), getting wasted and having sex (primarily since that
increases the risk of having unsafe sex), and much more rarely now,
blood transfusions and having had a mother who was HIV-positive at the
time of your birth. We can also safely say that homophobia increases
the risk of HIV and AIDS, because in cultures and communities where men
who sleep with men — exclusively, or as well as with women — have to
be (or feel they have to be) on the down low, HIV rates are higher.
Likewise, we can say that racism and xenophobia have increased the risk
of HIV and AIDS given how much harder hit people and communities of
color have been by HIV and AIDS. And by all means, ignorance, denial
and silence increases all of our risks.

Just to give you an idea, here are some scenarios by which you and your friends could wind up transmitting or contracting HIV:

  • Your current boyfriend had sex with an ex-girlfriend who was raped
    by someone HIV-positive, and who was too scared to tell anyone –
    including her doctor — she got raped. Until she had sex with your
    now-boyfriend, she didn’t choose to be sexually active, so she never
    got tested. She didn’t tell your boyfriend about her rape, so since he
    thought she didn’t have a partner before him, he never got tested
    either and told you it’s okay because his previous partner was a
    virgin. That’s the same reason you thought it was okay to go without
    condoms, because you’re on the pill so figured your biggest risk was
    covered, but as it turned out, that ex was HIV-positive.
  • Your ex-boyfriend was an older guy. His partners before you were
    also younger women, and he doesn’t consider them as STI-risks (or care
    about putting them at risk), so he’s never been tested, and also took
    advantage of you and them in terms of persuading you to have anal sex
    without a condom, because he said you couldn’t get pregnant that way,
    so there was nothing to worry about. You didn’t insist on condom use
    because you felt like he’d think you were being a baby. But he’d
    contracted HIV a few partners before you from another young woman who
    got it from another equally careless guy.
  • On vacation, you and your friends got a tattoo from a shabby
    roadside parlour where they just don’t pay a lot of attention to using
    new needles for each customer. One of your friends is now HIV-positive,
    but because she isn’t even thinking of that as a risk, she’s walking
    around without HIV treatment and without practicing safer sex, possibly
    transmitting HIV to other people you know.
  • You started seeing someone a few months back, and things were great
    at first, but after a couple months — before you had time to really
    get to know their whole history — and after once or twice with
    unprotected sex, you found out that they had some serious drug
    problems. They told you it was mostly weed, booze and some X, but
    didn’t mention that they’d also shot heroin once at a party just to try
    it. Because they thought of themselves as safe since they weren’t a
    regular intravenous user, they’d never even been tested to know they
    had HIV, which they exposed you to.
  • You were at a party once and hooked up with a friend of a friend.
    You were wasted, and just didn’t have it together enough to ask about
    condoms: in fact, you couldn’t even remember the next morning if one
    was used or not. But that person you slept with (unbenownst to you),
    contracted HIV from another person at a party last year. You just
    hooked up with someone at a party recently again, and transmitted HIV
    to them, too.

In any of those scenarios, you can see how easy it can be — in
certain conditions — to acquire HIV. You can likely also see how easy
it is for it to spread among many people: add just a partner or two to
those situations, and you’ve possibly got one or two more people with
HIV from the same person. Add a partner or two to those people, and
then a partner or two to all of those people…well, you can see how
much easier it can be for an awful lot of people to get sick from what
originally might have seemed like a safe situation to any given person.

HIV/AIDS is only a real problem in Africa.

HIV and AIDS are a real problem all over the map. Certainly, Africa
has been hit very hard by HIV and AIDS, largely because of a lack of
education about them both (which is also a problem in other continents,
including this one), as well as because of cultural issues and lack of
good healthcare and treatment. But the World Health Organization has
made clear that rates are also strongly rising in China, India,
Indonesia and Russia, and rates of HIV have not been decreasing here in
the western world. Some of why is because HIV information and treatment
is not reaching critical populations at risk, and teens and young
adults worldwide are one of those critical populations.

You can tell who has HIV and AIDS: it makes you look really scary, right?

Most people with HIV look just like most people without HIV. HIV
positive people usually look no different than anyone else: not
facially, not genitally. A whole lot of people with HIV, including
people who don’t know they have it and aren’t being treated for it —
feel and look just fine most of the time. HIV is often asymptomatic (it
shows no symptoms), and when symptoms are present, they’re a whole lot
like just having the flu. Those who have symptoms from HIV experience
things like fevers, chronic yeast infections, easy bruising, body
rashes, chronic fatigue, diarrhea or weight loss: it’s really easy to
think you’ve got something else — or nothing at all — when you
acquire HIV, especially at first.

When HIV progresses to AIDS, we’d be lyin’ if we said that AIDS
patients looked picture perfect: people with AIDS are very seriously
ill, and often look just as seriously ill as they are. Regardless, just
like with any other STI, thinking you can know if and when someone has
an STI just by looking is a really stupid thing to think: you can’t
know a person’s STI status based on how they look.

But you don’t even have to ask for HIV tests anymore: your doctor usually does them at regular checkups.

While many general practitioners and clinics have upped their
efforts to make HIV screenings more routine, it’s never smart to assume
you’ve been tested without finding out for sure. Too, a lot of doctors
report that because of the cultural climate in terms of teens and sex,
they are nervous to ask teens about their sexual activity and STI
testing. It’s often estimated that less than 20% of of teens and young
adults in the U.S. with HIV have been tested and are aware that they
have it.

There’s no reason not to be proactive and double check with your
healthcare provider that you have been tested for HIV. If you have been
sexually active and don’t want to tell your doctor (something we
wouldn’t advise keeping to yourself from healthcare pros, but still),
you don’t have to disclose that: you can ask for a test without
discussing your sexual history at all. If your doctor asks why you’re
asking for testing, all you need to say is because you want to be sure
you don’t have HIV.

I can’t get tested, because when you do, the doctor or clinic has to notify everyone you know.

That’s a reasonable fear — there’s so much stigma around HIV, and
with young people who usually acquire HIV through drug use or sex,
people knowing you’ve got HIV often also means people knowing (or
guessing about) you did whatever it was to wind up with HIV. But that’s
a fear which isn’t grounded in the reality of HIV testing right now.

You can get a test for HIV — an oral swab and/or a blood test — at
your regular, general doctor’s office or general health clinic, at a
hospital, via student health services or through your gynecologist,
urologist or sexual health/family planning clinic. There are also
clinics which specifically deal with HIV testing and treatment, too.
But ALL of those places are legally obligated to protect your privacy.

If you’re a minor, you can get HIV testing in most locations
worldwide without parental permission or notification. If you choose to
use a doctor where your family insurance will cover your visit, then
your test may show up on the statement sent to your family, but with so
many options for HIV testing in most places — many of which are
low-cost or even free — there’s no need to go through that channel
unless you want to. Most HIV results are not sent in the mail, or given
to someone else, but given to you, one-on-one, by the person who tested
you.

If a person is positive, then that new case will be reported to
public health agencies (that’s really important to help with prevention
efforts as well as with developing treatments), but not with a name
made public: a code is used instead. You may be asked, if you test
positive, to let the clinic know about your current and previous sexual
partners so that they can inform them a previous partner (again,
confidentially) has tested positive so they, too, can know to get
tested. Or, you may be strongly encouraged to self-report to current
and previous partners, something we, too, would strongly urge you to
do, even when it is difficult.

We all get that testing can be really scary. (Not to sound like your
granny, but back in the day when I first got screenings for HIV, we had
to wait weeks and weeks for results, and this is before we had
antiretrovirals, when being HIV-positive really was a real death
sentence, and we still weren’t sure, as we are now, about how it was
even transmitted. That wait was absolute torture.) But in so many ways,
putting off testing is like letting a pile of unopened bills sit on
your desk: the bills aren’t going to go away, and the longer you wait
to deal with them, the worse things are going to get if you owe.
Believe it or not, finally going and getting tested — and getting in
the habit of doing it — is much more of a relief than it is a burden.
If you’re feeling really messed up about getting tested, ask your
clinic for some extra emotional support before, during and after your
tests: they can help and they want to help.

For more on current HIV testing, click here.

I don’t want to even go INTO an HIV or AIDS clinic to get tested, because if I don’t have it already, I might get it there.

Not anything close to likely. Again, there are four major routes of
HIV transmission, and if you’re not having unprotected sex with anyone
in the clinic, sharing needles with anyone in the clinic (and
clinicians are beyond impeccable about using clean needles for
testing), or breastfeeding from someone in the clinic, you’re not going
to wind up with HIV. You can’t get HIV through casual contact — like
sitting on the same chair or sharing a toilet — and you also can’t get
it from even pretty close contact with someone who is HIV positive:
close contact like closed-mouth kissing, hugging, handshaking, even
sharing glasses or cups, don’t present HIV risks.

So, how can you protect yourself?

The most effective way to avoid acquiring HIV is to abstain from
vaginal and anal sex with partners (oral sex may present risks,
especially if and when blood is involved, but oral sex presents greater
STI risks with other STIs than it does with HIV), injection drug use,
and any exposure to other people’s blood in other contexts (such as in
unclean tattoo parlors or via self-done tats, by sharing razors or
toothbrushes, or via scenarios like biting or being bitten).

But if you’re not abstaining from sex, latex condoms have been
shown, time and time again, over a considerable amount of time, to
reduce the risk of HIV transmission by as much as 99%, and by 80% on
average, with typical (rather than perfect) condom use. To give you an
idea of what sort of risk protection 80 – 99% is, anyone with ears has
heard again and again how much seatbelts help save lives. Seatbelts
prevent death in car accidents by around 40% according to most sources.
In other words, using latex condoms for ALL the genital sex you have,
always, provides more than twice as much protection for you against HIV
than seatbelts provide protection against death in a car. That’s a
whole lot of protection for something so easy to afford, obtain and use.

If you’re going to be sexually active, it’s essential to use latex
barriers — male or female condoms — during sex, to prevent the spread
of HIV, as well as other infections and diseases, and it’s crucially
important that condoms are ALWAYS used, not just sometimes, not most of
the time, but every single time.

It’s also really important to use condoms correctly: if you or your
friends are having condoms break often, you can be sure you’re not
using them correctly, since rates of breakage shown with correct use
are usually less than 2%.

Correct condom use means:

  • having a condom on for ALL direct genital contact,
  • opening the package carefully to avoid tearing or puncturing the condom,
  • always leaving room in the tip of the condom for ejaculate,
  • using EXTRA latex-safe lubricant with your condoms, every time, and adding more as needed,
  • being sure to hold the base before withdrawing after sex,
  • and using condoms which are of good quality, and have been stored properly before use.

For more detailed instructions on proper condom use, click here.

While latex barrier use all by itself is really critical, getting
regularly tested isn’t a footnote, either. Regular HIV and STI
screenings for EVERYONE who is or has been sexually active (has had any
sort of oral or genital sex with another person) are hugely important.
Getting tests for ALL STIs, at least once every year, is critical to
protect yourself and others.

As you know by now, having other, more commonly transmitted STIs
left undiagnosed and untreated not only puts your general and
reproductive health in danger — and that of any sexual partners — it
also puts you at a higher risk of contracting more infections,
including HIV. And with HIV in particular, the earlier it is diagnosed,
the earlier you can take measures — such as lifestyle changes and
medications — to start taking care of yourself and to avoid developing
AIDS.

One other important way to protect yourself, while ALSO using latex
barriers for any partnered sex AND getting regular testing, is just to
alter some of your behavior, or live in a way that helps protect you
from the start. There’s a whole lot of reasons to avoid intravenous
drug use, obviously, but HIV prevention is one of those reasons. Too,
avoiding or seriously limiting drug and alcohol use is another big
help: it’s been shown time and time again that drugs and alcohol
influence people’s sexual behavior, and usually in ways that create
extra physical and emotional health risks, including STI risks.

Limiting sexual partners is another biggie. Sometimes, it can be
hard to imagine you even have to when you’re younger, because every
relationship feels like it’s going to last forever. But the reality is
that very few do, and for teens and young adults, most relationships
are really pretty short-lived. That doesn’t mean you have to pick one
person to date for all of high school and college if that doesn’t feel
right to you, nor does it mean you have to be celibate if you don’t
want to. What it does mean is that it’s smart and safer to give extra
thought to who you’ll take as a sexual partner, and to go slow with
sexual partnership. There are plenty of ways to test the waters that
don’t put you at big risks at all, even without use of latex barriers
— things like kissing, petting, frottage, manual sex (handjobs and
fingering, so long as hands are clean) and mutual masturbation are all
very safe sexual activities when it comes to HIV and other STI risks.
One other good rule of thumb is to forestall any sexual activity until
you’ve known someone long enough to feel comfortable talking very
openly about the parts of sex that are a drag, like how to have sex
safely and responsibly, like sexual history and STI testing history. If
you don’t feel okay asking for the last dates someone got screened and
their results, it’s a smart move to wait for any genital sex at all
until you do.

Remember, too: it can be easy to feel like we trust someone when
they’re new to us and we’ve got no sound reason not to. But not knowing
them well IS sound reason not to. To boot, trust doesn’t make anything
safer when it comes to STIs like HIV. Someone being trustworthy doesn’t
mean they haven’t been at risk, nor does it negate the need for safer
sex like latex barriers and STI testing. Want an example of very real
trust? Going to the clinic to get tested together and trusting that no
matter each of your results, the other person will be kind,
understanding and willing to work anything through that needs working
through.

Managing barriers, testing and lifestyle issues can seem daunting if
you’re not in the habit of doing it, but just like getting into any
other habit is — such as exercising daily, getting to work on time or
creating a study routine in college — once you get used to doing all
of these things, they really are a breeze.

What if I get a test and find out I’m positive?
No one is going to play Pollyanna and say that getting a positive
result is going to be your best day ever. That’s tremendously tough
news for anyone, and there’s little to soften that blow.

But the sooner you find out, the better off you are, and the sooner
you can get started on taking care of yourself as best you can. Again,
being positive really, truly, is not a death sentence anymore, nor does
it mean your whole life is over. People who are HIV-positive now and
who get good treatment and take good care of themselves and those
around them can have excellent relationships — including sexual
relationships — get pregnant and have kids, keep their jobs, and
achieve the goals they aspire to. That’s not to say all of that is
always easy as pie — it’s often not — but it is doable, and all the
more so when you face things head-on, and don’t delay in getting
diagnosed and treated.

There is also more and more support out there for HIV-positive
folks, so it’s not something most people will have to go alone. Having
HIV is in many ways no different than having any other sort of serious
disease: people with diabetes or cancers can find ways to survive and
manage their diseases, and the same is true for those who have HIV.

There’s just no good reason to avoid getting tested regularly. If
you find out you don’t have HIV, that’s one less thing for you to have
to worry about. If you find out you do, the sooner you know, the better
off you and everyone around you will be, and the better your chances
for getting through it and being able to continue the life you’re just
starting in the healthiest way possible.

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