WHAT IS HIV AND WHAT IS AIDS?HIV is the virus that causes AIDS. It can enter the body in various ways. Once inside the body, the virus begins to break down the immune system. Normally, the immune system defends the body against harmful bacteria and viruses, thus protecting it from disease. When HIV weakens the immune system, bacteria and viruses gain the opportunity to cause serious illnesses. This is called AIDS.
AIDS is a disease caused by infection with the HIV virus. This causes the body's immune system to function less effectively. People with AIDS develop rare conditions, such as certain types of pneumonia, intestinal infections, or cancer.
Those who contract HIV initially notice little to nothing. Sometimes there are short-lived "flu-like" symptoms (the phase of "acute HIV infection"). After some time, sometimes years, serious symptoms can occur. HIV has by then largely broken down the immune system.
The body can no longer protect itself against diseases that people without HIV rarely or never get. At this point, we speak of AIDS. By starting antiretroviral medication early, someone with HIV can live a long time without developing symptoms. This can prevent or at least delay the onset of AIDS. Thanks to these antiretroviral medications, HIV infection is now considered a chronic disease in Western countries.HOW COMMON IS HIV IN THE NETHERLANDS?The number of people with HIV in the Netherlands is estimated at around 21,500. About 40 percent of them are unaware of this. This harms their own health. Moreover, they can unknowingly infect others, for example, through unsafe sex.HOW CAN SOMEONE GET HIV?There are several ways to contract HIV. There is little to no risk of HIV infection through everyday intercourse. The virus (HIV) can be present in blood, saliva, semen and pre-ejaculate, vaginal fluids, and breast milk, but unsafe acts involving blood and semen pose a significant risk of contracting or transmitting HIV. HIV is most commonly transmitted
through
unsafe sex. The virus is present in semen, pre-ejaculate, and vaginal fluids and can be transmitted through contact with mucous membranes.
Unsafe sex primarily involves sexual intercourse without the protection of a condom.
Although less common, oral sex and oral sex also carry a risk of HIV infection. Transmission of the virus is easier through damaged mucous membranes. HIV can enter the body more easily, especially if people already have an STI that has damaged the skin or mucous membranes of the penis, vagina, or anus. Infection can be prevented primarily through safe sex. Condoms offer protection against infection during intercourse and anal sex. Blowjobs are unsafe if ejaculation occurs in the mouth.
Advice on using condoms:
Always keep them within reach.
Check the expiration date. The expiration date is printed on the packaging.
Only use officially approved condoms, recognizable by the CE logo.
Never use two condoms on top of each other. This does not provide any additional safety. On the contrary, they are more likely to break.
Be careful with teeth, nails, and jewelry to prevent damage or tears.
Always use plenty of lubricant during anal sex (butt sex).
Also use a condom with sex toys, such as dildos.
When is condomless sex safe?
Condomless sex is only safe if it is certain that neither partner is HIV-positive. This certainty is only possible after an HIV test has confirmed this. The presence of HIV in the blood can only be detected three months after the moment of infection. Therefore, it is only possible to determine whether condomless sex is safe three months after the last unsafe contact. To be certain, neither partner must have had unprotected sex with anyone else since the HIV test. HIV can be transmitted
through blood contact
. This can happen through blood transfusions, the use of needles previously used by someone with HIV (for example, for injecting drugs), and through needle sticks with a contaminated needle.
The risk of contracting HIV through receiving blood (blood transfusion) in a hospital is very small in the Netherlands. In Europe and the United States, all blood is tested for HIV as standard practice. HIV-containing blood is not used. Not all countries test blood. In many countries, blood transfusions do pose a risk of HIV infection.
In some professions, people are at a higher risk of contracting HIV through blood contact, for example, bite wounds (police and security guards) or needle sticks (doctors and lab technicians). Rules to reduce the risk of infection vary by work situation. For example, a dentist wears gloves to reduce the risk.
Passing HIV to a child during pregnancy, childbirth, and breastfeeding.
A mother with HIV can transmit the virus to her child during pregnancy or childbirth. She can also transmit HIV through breastfeeding. Therefore, all pregnant women in the Netherlands are routinely tested for HIV, unless they indicate otherwise. If a pregnant woman has HIV, she can take certain medications, antiretroviral drugs, during pregnancy. These ensure that the amount of virus in the blood decreases, significantly reducing the risk of the child becoming infected during pregnancy or childbirth. A cesarean section to reduce the child's risk of infection is usually not necessary. As a precaution, the child will receive HIV medication for four weeks after birth. Furthermore, the mother is advised not to breastfeed her newborn, as the virus can also be transmitted through breast milk.
If all these measures are taken, the risk of the child becoming infected is less than 1 percent.
When is there no risk of infection?
Saliva, toilet seats, everyday objects, skin contact, breath, coughing, sneezing, insects (mosquitoes or ticks), food, swimming pools, and saunas have nothing to do with the risk of HIV. French kissing, shaking hands, or hugging does not transmit HIV.
What should you do if there is a possible risk of infection?
There is a risk of transmission if you have sexual contact with someone with HIV, without a condom or if the condom has broken, or if someone has been pricked with a contaminated needle.
If this happened recently, for example, less than a day ago, a doctor can discuss the benefit of PEP treatment. (Post-Exposure Prophylaxis: preventive treatment with antiretroviral drugs after probable exposure to HIV.) If PEP treatment is started promptly and the medication is taken correctly, HIV infection can be prevented in most cases. PEP treatment is a month-long course of antiretroviral drugs. It is necessary to start PEP treatment as soon as possible, at least within 72 hours, but preferably within a few hours of the possible infection (the moment the virus entered the body). If someone has been at risk, it is best to contact the Municipal Health Service (GGD) or their general practitioner as soon as possible. Most GGDs are available 24 hours a day for emergencies. The emergency department of a hospital often also has the ability to perform a risk assessment and, if necessary, initiate PEP treatment.
Help for people who have been at risk or are concerned about it.
For those who want to know if they have been at risk of HIV infection and are concerned about it, there are the following options:
Call the AIDS STI Infoline.
The expert staff at the AIDS STI Infoline will assess the risk. They will advise you on the best place to go for testing or treatment.
The AIDS STI Infoline number is 0900-2042040. The infoline is available 24 hours a day, and a call costs 10 cents per minute.
On Mondays, Tuesdays, and Wednesdays from 10:00 AM to 8:00 PM, and on Thursdays and Fridays from 2:00 PM to 8:00 PM, you can speak to a staff member. At other times or days, information about HIV and STIs can be heard via a talking computer. The infoline also provides information about addresses where people can go for help or additional information. The AIDS STI Infoline also offers an email service. For all questions about (un)safe sex, STDs and HIV: sense@soaaids.nl
To your own GP or the local GGD STD clinic
You can always call or make an appointment with your own GP or the local GGD STD clinic. The address and telephone number of the nearest GGD STD clinic can be found at www.soaaids.nl .
The HIV test: why, where and when?
Why get tested?
It can take years for people infected with HIV to become ill or develop symptoms. However, during this time, they can still transmit the virus to others, and the disease can become more severe. It is therefore important to know early whether an HIV infection is present in order to prevent further spread and to start treatment promptly.
Where are there options for testing?
For an HIV test, you can go:
• to your general practitioner
• to a Municipal Health Service (GGD) STI clinic; addresses can be found at www.soaaids.nl
• to a supplier of a 'self-test'
The HIV self-test HIV
tests are also available online. These allow you to test your blood or saliva for HIV antibodies. These self-tests have a number of disadvantages:
• Some self-tests are quite complicated. There is a chance of errors when performing the test.
• If the result is HIV-positive, a doctor must still confirm this, because the result of the self-test is not 100 percent reliable.
• A self-test does not offer the guidance and information that someone can receive at the Municipal Health Service (GGD) STI clinic or their general practitioner.
Advice on using a self-test
: • Read the package insert carefully.
• Wait at least three months from the last time there was a risk of HIV infection before testing.
• Choose a good time for the test. If it shows that someone has HIV, it is important to have someone nearby for support and advice. Many important institutions are closed on weekends. Therefore, the weekend is not a suitable time for a self-test.
How does an HIV test work?
When someone is infected with HIV, the body produces antibodies. Therefore, the doctor tests the blood for antibodies against HIV. If the body produces antibodies, this indicates that HIV is present. We then speak of a positive test.
When should you test?
It takes some time, sometimes up to three months after the infection, for antibodies to be formed. That's why someone who has had a single unsafe sexual encounter is generally advised to wait three months before testing, because only then can they be certain whether they have contracted an infection. For those who are worried, that's obviously a very long time. In the meantime, they can get help and advice from their general practitioner or a nurse at the Municipal Health Service (GGD).
If symptoms occur during this period that could indicate an acute HIV infection (fever, swollen lymph nodes, flu-like symptoms), it is strongly recommended to see a doctor (again) and not to wait until the three months have passed.
If someone has been having regular unsafe sexual contact for more than three months, they are at increased risk of HIV. An HIV test is usually performed immediately and the three-month period is not waited.
If there is a suspected risk: get tested.
If there are any doubts about the risk, someone can seek advice from their general practitioner, the Municipal Health Service (GGD) STI clinic, or the AIDS STI Infoline. An HIV test puts an end to the uncertainty: whether or not someone has HIV. It is very reassuring for someone if it turns out they do not have HIV. It is also good to know if the result is HIV-positive (meaning there is an HIV infection), because then there is the option of being seen by a doctor. This doctor can then closely monitor your health and determine whether treatment is necessary and, if necessary, start it as soon as possible.
Questions about an unfavorable result:
The result may be HIV-positive. This means that HIV is present in the body. This naturally raises a lot of uncertainty and questions: What does my future hold? Should I tell or keep it a secret? How will my friends and family react? What consequences will my HIV infection have for my relationship?
If the result is HIV-positive, it can have consequences, for example, for work or insurance. More information about this is available at the service point of the Dutch HIV Association.
HIV test: the procedure:
During an HIV test, the doctor or nurse takes a blood sample. This is tested in a laboratory for the presence of HIV antibodies. The result usually takes about a week to ten days. With a rapid test, the result is often available within an hour. However, a rapid test is not a standard procedure. Not all institutions have the facilities for a rapid test.
How someone will receive the result is agreed upon in advance. Sharing the result often takes place in a conversation with the doctor or nurse. After a test result detecting HIV in the blood, a second test is always performed to confirm with 100% certainty that someone does indeed have HIV.
During the consultation with the doctor or nurse, you can also discuss how you can avoid future risks to yourself and others. The doctor or nurse is bound by confidentiality. This means they are not permitted to share the results with anyone else. This is only permitted with the person's consent.
Testing for other STIs is also recommended .
If there is a risk of HIV transmission through sex, it is recommended to also be tested for other STIs immediately, as the risk of these also exists. Other STIs are much more common than HIV infection.
Test result: HIV negative or HIV positive.
Risk groups:
Some groups of people are at a higher risk of HIV infection than others. In the Netherlands, for example, HIV is more common among men who have sex with men, drug users, people who have sex for payment, and among ethnic minorities. People from these groups can be tested free of charge at a Municipal Health Service (GGD) STI clinic.
Anonymous testing:
Anonymous testing means that the name of the person involved is not disclosed during the HIV test. A number is printed on the blood tube instead of their name. This way, the general practitioner or health insurer will not know that someone has been tested. Anonymous testing is not possible at the general practitioner or in the hospital. At Municipal Health Service (GGD) STI clinics, it is only possible if someone explicitly requests an anonymous test.
The result is HIV-negative.
This means good news: no HIV was found in the blood. If someone has not been at risk in the three months prior to the test, they can assume they do not have HIV.
The result is HIV-positive.
This means bad news: there is virus in the blood. The infected person may not notice anything at all yet. The doctor will continue to regularly monitor the health and disease progression. This doctor is usually an HIV specialist at a hospital. They can provide guidance and information, for example, about treatment options for the HIV infection.
Confidential results.
The test result is always confidential. The general practitioner is not allowed to share the result. And someone can arrange with the staff of the Municipal Health Service (GGD) whether or not to send the result to the general practitioner.
Testing is never mandatory in the Netherlands.
In the Netherlands, the law stipulates that taking an HIV test is a voluntary and individual decision. No one can be forced to be tested unless there is (suspicion of) crime involved. A person is not required to share the result of an HIV test with their employer.
An HIV test may be a requirement for certain mortgages and (life) insurance policies. Failure to do so may result in a mortgage or insurance policy being rejected.
Living with HIV and combination therapy
Curing an HIV infection is not possible. The virus does not disappear from the body, but the progression of the disease can be slowed by treatment with medication, known as antiretroviral drugs. This involves taking a combination of three or more antiretroviral drugs. Antiretroviral drugs inhibit the activity and multiplication of HIV in the body. This allows the immune system to function better. This means fewer or no symptoms that people with HIV would experience without treatment. The difficulty of antiretroviral treatment is that people have to take the pills at fixed times, once or twice a day, every day, for the rest of their lives.
This "adherence" is a prerequisite for successful treatment. The medications can also have side effects, such as nausea and changes in body fat distribution. Regular monitoring of other bodily functions is necessary, such as liver and kidney function, which are subjected to increased strain by the medications.
If a test shows HIV in the blood, this does not necessarily mean that treatment will be started. Initiating treatment is done in consultation with an HIV treatment specialist, a specialist in this field. This specialist follows guidelines that apply to all HIV treatment providers.
It is important to start combination therapy promptly, at least before HIV develops symptoms. The state of a person's immune system determines when they should start combination therapy. Therefore, someone with HIV must see their doctor regularly for immune system tests. Thanks to combination therapy, someone with HIV can live a relatively normal life. Without treatment, someone with HIV becomes ill more quickly and there is a greater chance of dying from the consequences. Health
insurance
covers combination therapy. For people who are uninsured, treatment can be unaffordable. However, treatment should not be refused to uninsured individuals who cannot afford it. If you have any questions regarding HIV infection and illegal residence in the Netherlands, you can request advice from the Service Point of the Dutch HIV Association.
Partner notification:
It is important that as many (regular) sexual partners as possible in a person's life, and in any case all (regular) partners since the last known negative HIV test, are informed and also get tested for HIV antibodies. |
