HIV & AIDS - Redbook

HIV is a blood-borne virus and sexually transmitted infection that gradually weakens the immune system if left untreated. Without treatment, this can eventually progress to AIDS (acquired immunodeficiency syndrome), a stage where the body can no longer fight off infections or certain cancers.

Today, AIDS is extremely rare in Australia. We are able to access effective HIV treatment, where people who are diagnosed and treated early essentially never reach this stage, and have the same life expectancy and quality of life as anyone else.

Understanding HIV

HIV is a nationally notifiable infection, meaning that all cases are reported anonymously to state or territory health departments. This is primarily to identify outbreaks and improve healthcare responses. There is currently no cure for HIV, but daily antiretroviral treatment (ART) controls the amount of virus in the blood (the “viral load”) and protects the immune system from damage. Most HIV positive (HIV+) people in Australia manage this with a single tablet a day.

When treatment brings someone’s viral load down to undetectable levels, they cannot transmit HIV to sexual partners. This is known as Undetectable Equals Untransmittable (U=U), and is backed by large clinical trials with zero transmissions recorded between couples where the HIV-positive partner had an undetectable viral load. It’s one of the most important breakthroughs in modern HIV care, and it means living with HIV looks nothing like it did a generation ago.

Stigma and discrimination

Despite these medical advances, stigma surrounding HIV still exists, and is often rooted in outdated and incorrect beliefs. For people living with HIV (PLHIV), this can affect their mental health, social connection, financial stability and access to care. It’s also common to internalise this stigma, which can be extremely isolating.

Stigma doesn’t just affect people living with HIV. It can also prevent people at risk of HIV from getting tested in the first place, out of fear of what a positive result might mean for them. Reducing stigma, and understanding facts like U=U, is part of protecting community health.

If you’re navigating a diagnosis or supporting someone who is, PLHIV community-led organisations exist in every state and territory and can offer peer support specifically for this.

Signs and symptoms of HIV

Some people have no symptoms at all when first infected. Others experience a short flu-like illness, known as seroconversion illness, around one to four weeks after exposure. It can be easy to mistake for another infection and includes:

fatigue, fever and feeling generally unwell
swollen glands
nausea and vomiting
painful ulcers in the mouth or around the anus or penis headache
rash, typically on the torso
muscle and joint pain
weight loss.

After this initial illness passes, HIV typically causes no symptoms for years, even though the virus is still present and active. As always, this is why regular testing is important.

How is HIV transmitted?

HIV is only transmitted through blood, semen, vaginal fluid and breast milk. It doesn’t survive in urine, faeces, saliva, vomit or sweat unless blood is present, and it cannot be spread through kissing, coughing, sneezing, holding hands, or sharing utensils or drinking glasses.

Sexually, HIV is most often transmitted through unprotected anal or vaginal sex. Unprotected oral sex carries a transmission risk too, however it is rare. The presence of another STI, particularly one causing genital ulcers or sores, increases the chance of HIV transmission during sex.
Outside of sex, transmission can happen through sharing injecting equipment, needlestick injuries (relevant to some BDSM services), getting blood or bodily fluid in your eye, tattooing or piercing with unsterile equipment, and, rarely, blood donation or from parent to baby during pregnancy, birth or breastfeeding.
Menstrual blood is a common source of confusion. Contact with unbroken skin carries no HIV risk at all. Contact with broken skin, or swallowing it, carries a small but possible risk. And if the person menstruating has an undetectable viral load, there’s no risk of transmission regardless.

The single most important thing to understand about transmission:

HIV is passed on most often by people who don’t know they have it, or who are in the early, high-viral-load stage of infection. Someone on effective treatment with an undetectable viral load cannot pass HIV on to a sexual partner.

Getting tested for HIV

Below is some information about testing for HIV. You can view a list of sex worker-friendly sexual health clinics on our Where to Test resource, or browse online testing options here.

What happens during the test?

HIV testing is usually a simple blood test from a GP or sexual health clinic. Rapid testing is available in some locations, using a finger-prick blood sample or saliva, with results in 10 to 20 minutes. If your rapid test is positive, it will need to be confirmed with a standard laboratory blood test.

Self-testing (or home testing) works the same way, using a finger-prick sample with results available in a similar timeframe. Testing kits can be ordered online and delivered to your chosen address, including Australia Post Parcel Lockers. For more information, click here.

When should I get tested?

Test at least twice a year as part of routine sexual health screening. Most people will show a positive result within one month of infection, though for some people it can take up to three months. This gap between exposure and a reliable result is called the window period, and it’s also when HIV is most infectious.

Early diagnosis is important, and can be the difference between managing HIV before it develops into a chronic condition and the long-term health issues that come with untreated infection.

What happens if I test positive for HIV?

A positive HIV diagnosis is not the health crisis it once was. With effective treatment, most people reach an undetectable viral load within one to six months, and from that point onwards are unable to transmit HIV sexually.

What treatment options are available?

The most common treatment for HIV is antiretroviral medication (ART), taken for life. Most people in Australia manage this with a single daily tablet combining two to three drugs.

Long-acting HIV medicines are becoming increasingly popular and are injected by a health practitioner every two weeks to six months depending on the drug. This kind of treatment is designed to be more accessible for those who might experience barriers to daily treatment adherence, such as an unpredictable schedule. You can discuss options with your health practitioner and find the treatment that is best suited to you.

How much does treatment cost?

Government-funded sexual health clinics are usually 100% free and confidential for everyone, including tourists and international students, regardless of Medicare status.
If you see a GP, you may pay a fee or be bulk billed. Your GP can talk you through what to expect for your specific treatment plan and medication costs.
The National Association of People with HIV Australia (NAPWHA) has information about how to access private and confidential testing in each state.

Will testing positive for HIV impact my ability to work?

If you are diagnosed with HIV, you do not have to wait until you have an undetectable viral load to continue working. Taking appropriate precautions such as using condoms and dams, having partners utilise pre-exposure prophylaxis (PrEP), being aware of blood and fluid exchange, and regular sexual health screening can significantly reduce your risk of transmitting HIV to others.

Some people experience anxiety/stress about having sex or experience sexual dysfunction after being diagnosed with HIV. Seeking support from your doctor, local HIV support services, and your local sex worker peer organisation can help.

Below are some other things to consider after being diagnosed with HIV that might impact the way that you work.

People living with HIV may experience menopause a little earlier than those who are HIV-negative, which can impact having sex. You can speak with your doctor or other sex workers about sex and menopause.
There are possible interactions between some hormonal contraceptives and HIV treatments. Be sure to talk to your doctor if you are going on HIV treatment while on birth control.
People living with HIV often experience more difficulty maintaining an erection than the general population.
Some HIV medications can either increase or decrease the levels of erectile dysfunction medication, potentially leading to serious side effects. It’s best to speak to your doctor before combining any medications.

Legal considerations

As mentioned above, HIV is a nationally notifiable infection, meaning confirmed cases are reported confidentially to state or territory health departments. For more information specific to where you work, head to our BBV, STI and the Law resource.
Some states and territories also have laws that criminalise sex work or sexual contact while you have an STI or BBV, so it’s worth checking that resource or speaking to your local sex worker peer organisation.
If contact tracing (partner notification) comes up, your peer organisation can advise on a process that accounts for your privacy and the specific transmission risks of sex work.

How can I prevent transmission of HIV?

Reducing HIV transmission risk will likely already be in your skillset as a sex worker, and includes safer sex practices around barrier protection and regular STI screening.

Safer sex strategies

Using protective barriers such as condoms, gloves and dams during bookings lowers the risk of transmission. If you provide any kind of BDSM or kink services involving blood, you should also consider:

Use gloves, keep a sharps bin close by, and cover surfaces that may come into contact with blood with a removable disposable covering (like plastic wrap).
Check your client’s skin for pre-existing breaks before impact play or biting, and cover any open wounds or abrasions on yourself and the client.
If you engage in impact play with a client and their skin breaks and starts to bleed, stop immediately, clean up any blood, and cover the wound. After this, you can then make a decision on whether you should continue the service, offer a lower-risk alternative or end the booking.

Spray, wipe, repeat:

Use a hospital-grade disinfectant, such as Viraclean, to clean your equipment and any surfaces that will be reused between bookings. Follow the product instructions for the correct dilution and contact time.

Medication-based prevention

Alongside barriers, there are three medication-based prevention strategies; Treatment as Prevention, Pre- and Post-Exposure Prophylaxis. You can also talk to your local peer organisation for information on accessibility based on where you work.

Treatment as Prevention (TasP) refers to a person living with HIV taking effective treatment to reach an undetectable viral load, at which point there is zero risk of sexual transmission — this is the same U=U principle covered above, and is one of the most effective prevention tools available.
PrEP (Pre-Exposure Prophylaxis) is regular medication taken by HIV-negative people to reduce their risk of acquiring HIV. See our PrEP resource for more information.
PEP (Post-Exposure Prophylaxis) is a month-long course of medication for HIV-negative people after a potential exposure. A person needs to take PEP within 72 hours for it to be effective. See our PEP resource for more information.

Needle and syringe programs (NSP)

If you are an injecting drug user, avoid sharing needles with others if you can. Always use fresh, sterile syringes and injecting equipment and dispose of them safely. You can use this website to find your nearest NSP.