HIV remains a major global public health issue, having claimed more than 33 million lives so far (WHO 2022).

While its severity cannot be overstated, HIV infection is now a manageable chronic health condition - people who have HIV are able to live long and healthy lives. This is a result of greater access to effective HIV prevention, diagnosis, treatment and care (WHO 2022).

What is HIV?

Human immunodeficiency virus (HIV) is a virus that affects the immune system. Without treatment, HIV can lead to acquired immunodeficiency syndrome (AIDS) (The Kirby Institute 2022).

HIV is transmitted via bodily fluids - specifically, blood, breast milk, semen and vaginal fluid (Healthdirect 2022).

What is the Difference Between HIV and AIDS?

• HIV stands for human immunodeficiency virus. It’s the virus that causes HIV infection.
• AIDS stands for acquired immunodeficiency syndrome and is the most advanced stage of HIV infection.

(Healthdirect 2022)

AIDS is the diagnosis when a person with HIV infection has a very compromised immune system. They then develop a disease caused by an organism that wouldn’t usually affect healthy people as severely (NSW Health 2017).

People with HIV infection who are on effective treatment do not develop AIDS, as the treatment prevents damage to the immune system (NSW Health 2017).

HIV in Australia

There are over 29,000 people in Australia living with HIV (AFAO 2023).

In 2021, Australia reported 552 new cases of HIV - the lowest number of infections since the epidemic first emerged (Woodley 2022).

At the peak of the epidemic in 1987, Australia recorded 2,412 cases (Sedghi 2018).

Since 2019, HIV notifications have declined by 38% - although it’s believed that disruption to HIV testing caused by the COVID-19 pandemic is partially responsible for this decrease (AFAO 2023).

Over the past 10 years, however, notifications have decreased by 48%, and this is likely due to increased testing, treatment, and stronger preventative measures (AFAO 2023; Sedghi 2018).

The most significant decrease in rates of HIV has been among gay and bisexual men (AFAO 2023).

However, this decline is not the case for all population groups.

Among Aboriginal and Torres Strait Islander Peoples, HIV notifications increased by 0.1% per 100,000 people. Although notifications have declined overall since 2016, the rate of HIV is still higher in Aboriginal and Torres Strait Islander Peoples (2.3 per 100,000) compared to non-Indigenous Australians (1.7 per 100,000) (AFAO 2023).

This is could be due to:

• Broader determinants of health that affect Aboriginal and Torres Strait Islander Peoples, such as education, employment, housing and poverty.
• Biomedical prevention methods not appearing to work as well for Aboriginal and Torres Strait Islander Peoples as they do for non-Indigenous populations.
• Reduced access to appropriate preventative and diagnostic healthcare outside of urban environments.

(Sedghi 2018)

How is HIV Transmitted?

HIV is spread via the blood, breast milk, semen or vaginal fluid of people who have the virus. Note that HIV cannot be spread through day-to-day contact such as kissing, hugging, shaking hands or sharing personal objects (Better Health Channel 2020a).

Situations in which HIV may be spread include:

• Anal or vaginal sex without condoms or other protection
• Sharing injecting equipment such as needles or syringes
• Tramission from mother to child during pregnancy, childbirth, or breastfeeding
• Through tattooing or other procedures that involve unsterile or reused equipment
• Needle stick injury.

(Better Health Channel 2020a)

Symptoms of HIV

HIV is initially difficult to recognise, as in the first stages of infection, most people have no symptoms or experience a mild flu-like illness with symptoms such as fever, headache, rash or sore throat (WHO 2022).

As the infection progresses, it gradually weakens the immune system; other signs and symptoms may then occur. These can include swollen lymph nodes, weight loss, fever, diarrhoea and cough (WHO 2022).

Without any treatment, a person who has HIV is at risk of developing severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections and cancers such as lymphomas and Kaposi’s sarcoma (WHO 2022).

Who is at Increased Risk of HIV?

• Men who have sex with men
• People who have sex with people from countries with a high rate of HIV infection
• People who inject drugs
• People who share sex toys
• People with a sexually transmitted infection (STI)
• People who have gotten tattoos or other piercings overseas using unsterile equipment
• People who have undergone a blood transfusion in a country where the blood supply is unsafe
• People who have sex with a person with a high risk of HIV as listed here.

(Healthdirect 2022)

Prevention for HIV

Individuals are able to reduce the risk of HIV infection by limiting exposure to known risk factors.

Key approaches for HIV prevention according to the World Health Organisation are:

• Condom use for both men and women
• Testing and counselling for HIV and STIs
• Voluntary male circumcision
• Not sharing needles, syringes or any injecting equipment
• Use of antiretroviral drugs (ARVs) for prevention
• Harm reduction for people who inject and use drugs
• Preventing mother-to-child transmission of HIV.

(WHO 2022)

Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is an HIV prevention option for people who don’t currently have HIV but who are in the high-risk group for contracting HIV. This greatly reduces the chance of someone who is HIV negative contracting HIV from an HIV positive person (Health NSW 2017).

PrEP consists of two antiretroviral medicines that are also used to treat people who already have HIV. It can be taken daily or on-demand (Better Health Channel 2020b).

When taken properly, antiretroviral treatment prevents the spread of HIV as the level of virus in the blood of the person with HIV lowers significantly. It is advised that condoms are worn even if PrEP is being taken (Health NSW 2017).

Post-Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is an alternative way to take anti-HIV medication to prevent HIV. Unlike PrEP, PEP is taken post a known or suspected exposure to HIV. PEP is taken for 28 days and has to commence within 72 hours of exposure to HIV (Better Health Channel 2020a).

Diagnosing HIV

HIV is diagnosed via blood test. One type of test detects antibodies to the virus, while the other detects for the virus itself. It takes roughly 15-24 days before blood will show a positive test result after an HIV infection, but it can take longer (Health NSW 2017).

Because of this delay, additional blood tests may be necessary after recent exposure to be certain that a new infection has not occurred (Health NSW 2017).

HIV Treatment

Read: Antiretroviral Therapy in the Treatment of HIV and AIDS

Currently, there is no cure or vaccine for HIV infection. However, antiretroviral (ARV) drugs can control the virus and help to prevent transmission to other people (WHO 2022).

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People who are on ART take a combination of HIV medicines every day (HIVinfo 2021).

ART stops HIV from multiplying, which reduces the amount of HIV in the body (the viral load). Having less HIV in the body protects the immune system and prevents HIV from advancing to AIDS (HIVinfo 2021).

The main goal of treatment is to reduce the viral load of HIV to undetectable levels. People with an undetectable viral load have virtually no risk of transmitting HIV to others through sex (HIVinfo 2021).

ART does not cure HIV, but it helps people who have HIV to live longer and healthier lives (HIVinfo 2021).