HIV Basics

The basics on HIV transmission, testing and treatment

What is HIV?

HIV stands for human immunodeficiency virus.

HIV is a virus that can weaken your immune system, the body’s built-in defence against disease and illness. You can have HIV without knowing it. That’s why it’s so important to get tested.

With proper treatment and care, people with HIV can live long and healthy lives and avoid passing HIV to others. In fact, a person living with HIV who is on successful treatment cannot pass HIV to their sex partners.

There is no vaccine to prevent HIV but there are things you can do to avoid passing or getting HIV. Read on to learn more!

Who can get HIV?

Anyone can get HIV, no matter...

• your age
• your sex, gender or sexual orientation
• your race or ethnic origin

How does a person get HIV?

HIV can only be passed by these five body fluids:

• blood
• semen (including pre-cum)
• rectal fluid
• vaginal fluid
• breast milk

HIV can only be passed when the virus in one of these fluids gets into the bloodstream of an HIV-negative person—through broken skin, the opening of the penis or the wet linings of the body, such as the vagina, rectum or foreskin. HIV cannot be passed through healthy, unbroken skin.

The two main ways that HIV can be passed are:

• through sex
• by sharing needles or other equipment to inject drugs (including steroids or hormones)

HIV can also be passed:

• to a fetus or baby during pregnancy, birth or breastfeeding
• by sharing needles or ink to get a tattoo
• by sharing needles or jewelry to get a body piercing
• by sharing acupuncture needles

HIV cannot be passed by:

• shaking hands, working or eating with someone who has HIV
• hugs or kisses
• coughs, sneezes or spitting
• swimming pools, toilet seats or water fountains
• insects or animals

Since November 1985, all blood products in Canada are checked for HIV, to ensure that it is safe to get a blood transfusion. And there is no chance of getting HIV from donating blood.

HIV and sex

HIV can be passed during sex. But there are ways to protect yourself and your sex partners:

• Condoms and lube. Use a new condom every time you have sex. This will help protect you from HIV and other STIs (sexually transmitted infections), such as gonorrhea and syphilis. Use only water- or silicone-based lubricants; oil-based lubricants can make a condom break.
• HIV treatment. If you have HIV and are not on HIV treatment, talk to your doctor about starting HIV treatment. HIV drugs can protect your health and prevent HIV transmission. When a person is on HIV treatment and has a suppressed viral load, they do not pass HIV during sex.
• PrEP. If you are HIV-negative and at higher risk for HIV, you might be a candidate for PrEP (pre-exposure prophylaxis). PrEP involves an HIV-negative person taking certain HIV drugs to reduce the risk of getting HIV. A person starts PrEP before being exposed to HIV. Talk to your doctor to find out if PrEP might be right for you.
• PEP. If you are HIV-negative and may have been exposed to HIV, you can take PEP (post-exposure prophylaxis). PEP drugs must be started as soon as possible (within 72 hours of being exposed to HIV) and need to be taken for 28 days. A person starts PEP after being exposed to HIV.
• Not sharing sex toys. Avoid sharing sex toys (and if you do, cover the toy with a new condom before each use). It is also important to clean your toys between vaginal and anal use.
• Choosing oral sex, masturbation and forms of sexual stimulation that pose little or no risk of HIV.

People can have HIV or other STIs without knowing it because these infections often do not cause symptoms. Don’t assume that you or your partner knows if they have HIV or any other STI. The only way to know for sure is to get tested.

HIV and drug use

HIV can be passed by sharing needles and other drug equipment.

Sharing needles and other drug equipment can also spread hepatitis B and C, viruses that damage the liver.

Protect yourself and the people you do drugs with.

If you use drugs, there are things you can do to protect yourself and use drugs in a safer way. This is called harm reduction.

To practice safer drug use:

• Use a new needle and syringe every time you inject drugs (or steroids or hormones). Get new needles and supplies from your local harm reduction program, needle/syringe program or community health centre.
• Never share drug equipment (such as cookers, filters, water, alcohol swabs, pipes, straws), not even with your sex partner. Use your own drug equipment every time.
• Get tested for HIV and hepatitis viruses. If you test positive for HIV or hepatitis B and C, talk to your doctor about getting treatment.

When people are on successful HIV treatment there is a lower chance of passing HIV from sharing equipment for using drugs, but we don’t know exactly how much it reduces the risk. It is best to use new needles and equipment every time.

HIV and pregnancy

Without proper treatment and care, HIV can be passed from a pregnant person to their baby during:

• pregnancy
• birth
• breastfeeding

If you are pregnant or thinking about getting pregnant, get tested for HIV.

If you are HIV-positive, with proper treatment and care, you can have an HIV-negative baby.

If you take HIV treatment, get proper care and maintain a suppressed viral load before and during your pregnancy, you will not pass HIV to your baby during pregnancy or delivery. If you are not on treatment when you first get pregnant, starting HIV treatment as soon as possible dramatically lowers the chance of passing HIV to your baby.

To prevent HIV transmission after your baby is born, Canadian guidelines recommend feeding your baby formula instead of breastfeeding.

Talk to a healthcare provider you trust if you wish to breastfeed or if you have questions about infant feeding.

How is HIV treated?

HIV is treated with HIV medications (also called HIV treatment). These medications have to be taken as prescribed by your doctor. They cannot get rid of HIV but they can keep it under control.

If you are diagnosed with HIV, the sooner you start treatment, the better it is for your health.

Taking HIV treatment exactly as prescribed and maintaining a suppressed viral load also prevents HIV transmission.

Without HIV treatment, your immune system can become too weak to fight off serious illnesses, and you can eventually become sick with life-threatening infections and cancers. This is called AIDS (acquired immunodeficiency syndrome). But thanks to effective HIV treatment, these days most people with HIV never get AIDS.

HIV and the law

In Canada, if you have HIV, you have a legal duty to tell your sex partner(s) before having sex in certain circumstances.

HIV laws are evolving in Canada. For the most up-to-date information on HIV and the law, contact the HIV Legal Network

Know your HIV status

The only way to know if you have HIV is to get tested. If you know you have HIV, you can get the treatment and care you need.

It’s important to know your status and start treatment as soon as possible. This can help you stay healthy, live a long life and avoid passing HIV to others.

The HIV test involves having some blood taken from your arm or a couple of drops of blood taken from your finger.

After HIV enters the body, it may take time before the test can detect the virus (this is called the window period). Different HIV tests have different window periods. Ask the person who does your HIV test what the window period for your test is.

Don’t wait. Speak to a healthcare provider about getting tested for HIV as well as other STIs and hepatitis B and C.

You can’t tell whether you have HIV by how you feel.

Some people have flu-like symptoms when they first get HIV (fever, sore throat or swollen glands). But many people have no symptoms at all. You can have HIV and not know it.

If you test positive:

• There have been significant advances in the treatment of HIV. With the right treatment and care, you can stay healthy and not pass HIV to the people you have sex with.
• To protect yourself and your partner(s), practise safer sex and avoid sharing drug equipment.
• Get connected. To find HIV services in your area visit HIV411.ca.

For more information if you are newly diagnosed with HIV, see:

• It's all still possible: Starting points for living well with HIV, an easy-to-read primer on viral load, CD4 counts and healthy living

HIV statistics

For statistics about HIV in Canada, check out this CATIE fact sheet:

• The epidemiology of HIV in Canada

Or visit the HIV statistics webpage.

Contact information

For more on HIV, contact:

• a public health unit
• your local sexual health or family planning clinic
• your local HIV organization
• an HIV and sexual health hotline
• your doctor or primary healthcare provider
• a community health centre or, in Quebec, a CLSC