What are HIV & AIDS?

Updated on:
July 31, 2021

HIV/AIDS, the medical definitions

HIV stands for Human Immunodeficiency Virus, a virus that can weaken your immune system. This means HIV lowers your body’s self-defense mechanism against illness and disease.

When untreated, HIV can lead to AIDS, Acquired Immuno-Deficiency Syndrome. AIDS progressively compromises your immune system, leaving your body more vulnerable to different infections and diseases. Given modern advances in HIV research, HIV-positive people who have access to treatment don’t develop AIDS, and live normal and healthy lives without being able to transmit the virus.

Are there different types?

There are two main different strains of HIV, HIV-1 and HIV-2.

The most common form of the virus is HIV-1, which accounts for around 95% of all world infections. HIV-2 is much less common and genetically distinct from HIV-1.

HIV-2 is known to be less infectious and progress more slowly, resulting in fewer deaths; it’s most commonly found in West Africa. Among the existing HIV-1 and HIV-2 categories, there are different subtypes of the virus, which represent a variety in transmission speed and infection progression.

The history of HIV & AIDS

How has our understanding of HIV/AIDS evolved?

In the past 4 decades, our understanding of HIV and AIDS has shifted dramatically. Below are some key moments for the HIV & AIDS history:

Early 80s: In 1981, the US Centre for Disease Control (CDC) received reports of “Gay-Related Immune Deficiency” (GRID), as it was thought it only impacted gay men. This term referred to an unusually large number of reports of Pneumocystis carinii pneumonia (PCP) and Kaposi’s sarcoma.

Acquired Immune Deficiency Syndrome (AIDS) replaced GRID and became the name used in 1982. In the beginning of the decade, the first AIDS cases in different countries and continents were found. Around mid-late 80s, there were initial discoveries around transmission methods, and the beginning of local and international efforts to survey and research the infection. In 1984, the AIDS Committee of Toronto (ACT) started its first AIDS Awareness Week. It wasn’t until 1987 that the first antiretroviral drug, AZT, was approved by the FDA. In the same year, the WHO developed its first global strategy on AIDS, Princess Diana was photographed touching a person living with AIDS, and the Clinique L’Actuel, specializing in HIV care, was established in Montreal. In 1988, the Director-General of WHO announced that December 1st is World AIDS Day.

In the early 90s, more developments took place: in 1990, the Canadian HIV Trials Network, and the Canadian Association for HIV Research were founded. In 1991, the Red Ribbon became the recognized symbol of AIDS awareness, and the first AIDS Awareness Week was held across Canada, and the BC Centre for Excellence in HIV/AIDS was founded.

1992 was a particularly special year, as it represented the FDA’s first successful drug combination to treat AIDS; the organization also revised the definition of AIDS to include impacted women and drug users. In the same year, the Canadian HIV/AIDS Legal Network was founded, and the ON Ministry of Health established anonymous testing sites across the province (a service that, almost 30 years later, can still be challenging to access in Canada).

As more treatment research took place, in 1995, the CDC announced that AIDS had become the leading cause of death among 25-44 year-old Americans. It was in the same year that the FDA approved a new family of antiretrovirals, protease inhibitors. In 1996, nucleoside reverse transcriptase inhibitors (NNRTIs) were approved and Highly Active Antiretroviral Therapy (HAART) became the standard HIV treatment. One year later, the US reported its first substantial decrease in AIDS-related deaths.

In 1998, injection drug users in Vancouver experienced an HIV outbreak in Vancouver and doctors started noticing the first strains of drug-resistant HIV. That same year, Post-Exposure Prophylaxis (PEP) was pioneered in San Francisco.

By 2002, HIV became the leading cause of death worldwide among people aged 15-59 years. One year later, the World Trade Organization granted developing countries the right to buy generic life-saving medications. In 2005, Health Canada approved point of care rapid HIV tests for use by healthcare professionals but access was limited and they were only approved for use by the general public in 2021.

It was only in 2010, that the United States government lifted its ban on HIV-positive people from entering the country. A year later, the Supreme Court of Canada ruled that InSite - Vancouver’s supervised consumption site - could continue to operate legally. In that same year, the WHO officially recognized the increased risk of HIV transmission among transgender persons.

In 2012, the FDA approved Truvada for use as Pre-Exposure Prophylaxis. Health Canada followed suit four years later, in 2016. One year before, Canada endorsed the UNAIDS 90-90-90 global HIV treatment targets.

In 2017, some progress was made by making PrEP more accessible through the approval of generic versions of Truvada in Canada. The Canadian Coalition to Reform HIV Criminalization released their ‘End Unjust HIV Criminalization’ statement and the ON government announced they will no longer prosecute cases where people who’ve had a suppressed viral load for six months do not disclose their status to sexual partner(s). It was also in 2017 that Canada's Chief Medical Officers of Health supported the Undetectable = Unstransmissable (U=U) statement.

More recently, different Canadian provinces started offering public PrEP programs. However, the global 90-90-90 targets for 2020 were not reached in Canada despite some other countries being successful. 

How prevalent is HIV in at-risk groups?

Although HIV does not discriminate as it can impact anyone, some communities are at higher risk for the infection given a history of marginalization and unequal health access.

Gay, bisexual, and other men who have sex with men (gbMSM): Among those living with HIV in Canada, about 51.7% are gbMSM as of 2018. Even though they represent only 3 to 4% of the adult male population in Canada, gbMSM also represent 52.2% of all new HIV infections in the country.

People who inject drugs (PWID): In 2018, 372, or 16.6%, of all new HIV infections in Canada were among people who inject drugs.

Indigenous people: About 10% of all people in Canada living with HIV are Indigenous. Approximately 14% of all new infections in 2018 are among indigenous persons, despite making up only 4.9% of the total Canadian population.

HIV & AIDS myths

HIV only impacts gay men

HIV does not discriminate, it can impact anyone.

If I have HIV, I will have symptoms and know about it

Some people don’t show any HIV symptoms, the only way to be sure about your HIV status is to get tested

HIV and AIDS are no longer a problem, that’s a thing from the past

HIV infections continue despite treatment as prevention (undetectable = untransmittable) and other prevention strategies, like PrEP.  

While HIV today is a manageable condition, care is inequitably distributed - meaning it’s not easy for everyone to access. Overcoming these barriers are key to ending transmission of HIV. 

How is HIV transmitted?

There are only five bodily fluids that can transmit HIV. Transmission can occur when one of these fluids enters the bloodstream of somebody else:

  1. Blood
  2. Semen (including pre-cum)
  3. Anal fluids
  4. Vaginal fluids
  5. Breastmilk

These fluids can transmit HIV through broken skin, the opening of the penis, vaginal linings, rectum, or foreskin. The main ways HIV can be passed are through sex and by sharing needles. It can also be passed from parent to child through birth or Breastfeeding.

HIV cannot be passed by hugs, kisses, coughs, spit, & sharing food.

How to protect yourself from HIV transmission

Today, there are different ways to prevent HIV, such as consistent and correct condom use, daily use of Pre-Exposure Prophylaxis (PrEP), use of Post-Exposure Prophylaxis (PEP), and HIV treatment.

For people who inject drugs, accessing new needles and ensuring safe disposal of used needles can help in lowering your HIV risk.

Is HIV treatable & curable?

Although there is no cure for HIV, treatment ensures that people living with HIV can live normal and healthy lives without the risk of transmitting the virus to their sexual partners.

HIV treatment ensures one’s viral load is suppressed (reduced to undetectable levels), which means somebody cannot transmit HIV to others. The earlier somebody starts treatment after being diagnosed, the better for one’s health. People with an undetectable viral load, are unstransmissable (U=U), as treatment keeps the virus under control

Are there any current studies to improve available treatments?

There are different forms of treatment, as well as different vaccines being trialed. In 2020, Canada was the first country to approve an injectable monthly treatment (Cabenuva). Although new trials are exciting and encouraging, progress is still needed to find an HIV cure. Many countries and communities still lack basic access to HIV testing and treatment.

Sources:

  • https://www.avert.org/professionals/hiv-science/types-strains
  • https://www.catie.ca/en/world-aids-day/history
Reviewed by:
Dr. Caley Shukalek

Caley is passionate about evidence-based, patient-centred care, including telemedicine that can provide high quality care from wherever a patient may choose.

He helped create Alberta's PrEP guidelines and works as a specialist in General Internal Medicine with additional training in sexual health, including HIV and sexually transmitted infections.

He holds an Masters of Public Health from Johns Hopkins University, an MD from the University of Calgary and an MSc from the University of Alberta.