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HIV 101

Men who have sex with men (MSM) account for more than half (53%) of all new HIV infections in the U.S. each year, as well as nearly half (48%) of people living with HIV. In San Diego county, MSM account for 75% of all cases of HIV reported between 2007-2011. They also make up at least 75% of people living with HIV in the county.

HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. HIV damages a person’s body by destroying specific blood cells, called CD4 and T cells, which are necessary to helping the body fight diseases.

According to several studies, taking Truvada daily for PrEP is safe and well tolerated.

About 1 in 10 people in the PrEP studies reported that they had headache, stomach pain, or weight loss when they first started taking Truvada. In most people, these side effects improved or went away after they had been taking the Truvada for a few weeks.

A small number of people had a slight decrease in kidney function that normalized when they stopped the medication. Small losses of bone density (thickness) have been seen in people taking Truvada. These changes have not been associated with an increase in fractures in these studies.

 
 

PRE-EXPOSURE PROPHYLAXIS (PrEP)

What is pre-exposure prophylaxis (PrEP)?
PrEP is an HIV prevention method for people who are HIV-negative. It involves taking a daily anti-HIV medication to reduce the risk of becoming infected with HIV. Several studies have shown that, when taken as directed, PrEP dramatically reduces the risk of becoming infected when combined with other prevention services. The CDC currently recommends PrEP for all individuals who are at high risk for HIV infection.

What is considered “high risk” for HIV infection?

There are many factors that place an individual at high risk for HIV infection. These include the following:

  • Having a partner who is HIV-positive (sero-opposite couples);

  • Having had sex or needle-sharing partners of unknown HIV status during the past 12 months;

  • Having had sex under the influence of drugs or alcohol during the past 12 months; and/or

  • Having been diagnosed with an STD during the past 12 months.

What’s in the pill?
The brand name for the medication is Truvada, which contains two medications, tenofovir and emtricitibine. Truvada is commonly used to treat HIV positive individuals in combination with other anti-HIV medications. Truvada was approved by the Food and Drug Administration (FDA) in July 2012 for the prevention of HIV-infection in HIV-negative men and women.

Is it safe?
According to several studies, taking Truvada daily for PrEP is safe and well tolerated.

About 1 in 10 people in the PrEP studies reported that they had headache, stomach pain, or weight loss when they first started taking Truvada. In most people, these side effects improved or went away after they had been taking the Truvada for a few weeks.

A small number of people had a slight decrease in kidney function that normalized when they stopped the medication. Small losses of bone density (thickness) have been seen in people taking Truvada. These changes have not been associated with an increase in fractures in these studies.

How do I know whether PrEP is right for me?

The only way to determine whether PrEP is right for you is to talk to your doctor. You will find a link below for PrEP 101 (hyperlink) that will provide you with information about how you can talk to your doctor about PrEP.

What other resources are available to me besides PrEP?

FREE prevention services include groups, one-on-one support, condoms and help to assess risk online. An online sexual health assessment is available for HIV negative and positive gay and bisexual men to anonymously self-assess their risk and get health information and referrals at www.myonlinesexualhealth.com. For a list of locations that provide free condoms go to www.sdhivprevention.com.

How do I get PrEP?


Truvada for PrEP is covered by many private insurance plans and by Medi-Cal. Talk to your doctor about whether Truvada may be right for you. If you do not have a doctor or health insurance, contact Covered California for information on signing up for insurance or Medi-Cal. See the Covered California website for more info: www.coveredca.com or call 2-1-1 for assistance.

If you are currently uninsured or have a high copay for Truvada, you may be eligible to get Truvada for PrEP through the manufacturer’s (Gilead) Patient Assistance Program. More information is available at: www.truvada.com/truvada-patient-assistance

For More Information about PrEP:

Prevention Strategies

Abstinence

Abstaining from oral, anal and vaginal sex altogether is the only way that you can be completely protected from getting HIV through sex.

Condoms

Studies have shown that latex condoms greatly reduce your chance of getting HIV when used consistently and correctly. These studies looked at HIV negative people considered to be at very high risk of infection because they have sex with HIV positive people. The studies have found that even with repeated sexual contact, 98-100% of those people who used latex condoms correctly and consistently did not become infected with HIV.

If you are allergic to latex, there are plastic (polyurethane) condoms that can be used as alternatives to latex condoms:

Female Condom. This condom is designed to be worn by women for vaginal sex. It's also easily used by men for anal sex. Made of soft polyurethane, this product actually offers more protection against pregnancy and disease because it covers more area and is compatible with water-, silicon-, and oil-based lubricants.

Polyurethane Condom. Polyurethane condoms are strong, nonporous, and non-permeable to all viruses and protect against STDs including HIV. They are hypoallergenic and thinner than latex, so they can transmit more sensation and warm to the body's temperature unlike latex. They’re safe to use with water-, silicon-, and oil-based lubricants. Because polyurethane isn't quite as elastic as latex, they are slightly larger than the average latex condom. Consumer Reports and the FDA have both reported that polyurethane condoms break more readily than latex condoms, and are recommending them only for those with latex allergies.

DO NOT use lambskin condoms; they do not prevent transmission of HIV.

It is generally believed that it is better to use a single condom at a time, rather than two. When a single condom is used properly, the resulting safety factor for prevention of HIV transmission increases dramatically. When two condoms are used, there is a much bigger chance of friction between the two latex barriers. Heat contact with latex will increase the chance of breakage. Although, if you were to use a small amount of latex-safe (water- or silicone-based) lubricant between the two condoms, the chances of the condoms breaking is reduced significantly.

Spermicide

Recent scientific studies have conclusively proven nonoxyl-9 ineffective in preventing HIV transmission. In fact, it may increase your chances of becoming infected with HIV because it is irritating to mucous membranes. Given the risks and the lack of any preventive benefits, the use of nonoxyl-9 is not recommended as a preventive measure against HIV transmission/infection.

Lubricants

It is always safe to use water-based lubricants and silicone-based lubricants with latex condoms. The lubrication heightens the sexual experience and, if you put a few drops of lube inside the tip of the condom, it can result in stimulation along with added safety.

It is NEVER safe to use oil-based lubricants (skin lotions, baby oil, Vaseline, Crisco, cold cream or even whipped cream) with latex condoms because oil dramatically weakens latex and definitely increases the chances of condom failure/breakage.

For example, mineral oil is a common ingredient in many lotions. According to the CDC, within as little as 60 seconds of exposure, a 90% decrease in latex strength will occur in a condom when using an oil-based lubricant.

Only polyurethane condoms can safely be used with oil-based lubricants, so if you must use an oil-based lubricant, please use only polyurethane condoms. Polyurethane condoms also work well with water- and silicone-based lubricants.

Post-Exposure Prophylaxis (PEP)

If your exposure was within 72 hours, contact your healthcare provider or go to the emergency room. If your risk of contracting HIV from the exposure is high, a doctor may prescribe you a course of anti-HIV medications that may decrease the chances of becoming infected by 81%.

Pre-Exposure Prophylaxis (PrEP)

PrEP is the practice of prescribing daily HIV antiretroviral medication to HIV negative people at high risk to try to lower their chances of becoming infected with HIV if they are exposed to it. To date, PrEP has been shown to be effective in men who have sex with men (MSM) and heterosexual men and women. PrEP should be used in conjunction with other proven HIV prevention strategies and daily adherence to the medication is essential for its effectiveness.

Serosorting

CDC has issued a statement on serosorting. Serosorting is a practice some gay, bisexual and other men who have sex with men (MSM) use in an effort to reduce their HIV risk. This means they try to limit unprotected anal sex to partners with the same HIV status as their own. CDC does not recommend serosorting as a safer sex practice because (1) many MSM who have HIV do not know they are infected because they have not been tested for HIV recently, (2) men's assumptions about the HIV status of their partners may be wrong, and (3) some HIV-positive men may not tell or may misrepresent their HIV status. All of these factors increase the risk that serosorting could lead to HIV infection.

 

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Prevention Providers

Family Health Centers of San Diego
Services in Central, North Central and East Regions

Gay Men’s Health Services – Serving gay men and men who have sex with men

Injection Drug User Services – Serving injection drug users

Project S.T.A.R. – Serving the transgender community

Brothers United – Serving African American men who have sex with men

619.515.2449
4040 30th St.
San Diego, CA 92104
www.fhcsd.org
www.gaymenshealth.org

San Ysidro Health Center—CASA

Serviicea in the South Region

3045 Beyer Blvd.
San Ysidro, CA 92173
619.662.4161
www.syhc.org
www.embracesouthbay.com

Vista Community Clinic
Services in the North Coastal and North Inland Regions

1000 Vale Terrace
Vista, CA  92084
760.631.5000
www.vistacommunityclinic.org
www.ncsdconnection.org

The LGBT Community Center
Serving the LGBT community in San Diego County

3909 Centre St.
San Diego, CA 92103
619.692.2077
www.thecentersd.org

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Sexually Transmitted Diseases (STDs)

HIV is not the only infection that you can get from sexual contact. You can also get other STDs — such as chlamydia, genital warts, gonorrhea, hepatitis, herpes and syphilis — through unprotected anal, vaginal and oral sex as well as other sexual practices like rimming (oral-anal sex). If you have any of these STDs and do anything sexually that can transmit HIV, you're at much greater risk of getting HIV.

If you think you may have, or have put yourself at risk for any STDs, contact any of the following resources. There is more detailed information about STDs below the list of resources.

County of San Diego STD Clinic Locations
No Appointment necessary, $15 fee may be waived

County Health Services Complex - Rosecrans
3851 Rosecrans St.
San Diego, 92110
619.692.8550
Mondays, Tuesdays, Wednesdays Fridays 7:30 am - 4:00 pm
Thursdays 10:00 am - 4:00 pm,
CLOSED from 12noon - 1:00 pm Monday - Friday

North Coastal Public Health
Center 104 South Barnes St.
Oceanside, 92054
760.967.4401
Wednesdays 12:30 pm - 7:30 pm

Central Region Public Health Center
5202 University Ave. San Diego, 92105
619.229.5400
Tuesdays 1:00 pm - 7:30 pm

South Region Public Health Center
690 Oxford St.
Chula Vista, 91911
619.409.3110
Thursdays 12:00 pm - 6:00 pm

Additional Testing Locations

Family Health Centers of San Diego
Tuesday / Thursday Night Clinic
3544 30th St.
San Diego, 92104
619.515.2449
Tuesdays 5:30 pm - 8:30 pm
Thursdays 5:30 pm - 8:30 pm (Hormone Therapy not offered Thursday Nights)

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STD Screening Recommendations

If you are sexually active, it’s important to get tested for STDs. If you’re HIV negative or don’t know your status, getting tested for STDs routinely can reduce your risk of getting HIV. If you’re HIV positive, having other STDs can increase your viral load, which can increase your chances of spreading HIV.

 

Men who have sex with men

Chlamydia, Gonorrhea – Every 3-6 months if sexually active; testing sites on the body: Urethral (penis), rectal (butt) and pharyngeal (throat)

Syphilis – Every 3-6 months if sexually active

Hepatitis B – At least once (if negative ask about vaccine)

 

HIV-positive men

Chlamydia, Gonorrhea – Every 3-6 months if sexually active; testing sites on the body: Urethral (penis), rectal (butt) and pharyngeal (throat)

Syphilis –Every 3-6 months if sexually active

Hepatitis B – First visit (if negative ask about vaccine)

Hepatitis C – First visit (every 3-6 months if you’ve injected drugs)

Genital Herpes – First visit

 

If you would like to get email and/or text testing reminders every 3-6 months, go to the We All Test website at www.wealltest.com.

 

For assistance with electronically notifying sex partners they may have been exposed to an STD, go to www.inspot.org.

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Common STD Symptoms

What to look out for:

Some STDs cause no symptoms, and when symptoms do occur, they often go unrecognized. Most people with STDs have no symptoms! So you can be infected and even infect someone else without knowing it. However, there are some common signs to watch for. The symptoms listed below can be tricky, as they can show up anywhere from two days to a couple of months after initial exposure to the disease. Sometimes symptoms can show up as long as several years after the initial STD infection. If you have any of these symptoms or think you have been exposed to an STD, contact a healthcare provider immediately.

Look for:

  • sores, bumps, or blisters near the mouth or genitals
     
  • burning or pain during urination or a bowel movement
     
  • flu-like symptoms including fever, chills, and aches
     
  • swelling in the groin area
     
  • discharge from the penis
     
  • pain in the testicles
     
  • sore throat

Syphilis – Syphilis causes a painless sore on the penis, in the anus (butt) or in the mouth. These sores result in breaks that can allow HIV to enter the body. Additionally, as your body tries to heal the sore there are a greater number of cells in the area that can become infected with HIV.

For HIV positive men: It’s important that your healthcare provider know your HIV status in order to give you the best care.

Gonorrhea – Gonorrhea is a bacterial infection that may or may not cause symptoms: burning when urinating (peeing), thick discharge (puss) from the penis or anus (butt), a sore throat or pain during bowel movements. As your body tries to fight the infection, there are a greater number of cells in the area that can become infected with HIV.

Chlamydia – Chlamydia is caused by a bacterial infection in the penis, anus (butt) or throat. You may or may not have symptoms, which include burning and/or pain when urinating (peeing) and a clear or white drip from the penis or anus (butt). As your body tries to fight the infection, there are a greater number of cells in the area that can become infected with HIV.

Human Papillomavirus (HPV) – HPV (genital warts) is the most common STD in the United States. Warts are typically visible, painless bumps on the penis or around the anus (butt) or mouth. The warts can also be inside your butt, making it hard for you to see or feel them. People with genital warts can be up to five times as likely to become infected with HIV through sexual contact as people without it.

Genital Herpes – Herpes is a very common viral infection that causes itching, tingling, redness, pain, blisters and sores, usually around the penis, anus (butt) and mouth. It is possible to get herpes from someone even if they don’t have sores showing. The blisters and sores make it easier for HIV to enter your body. There is no cure for herpes and once infected, you can get outbreaks again. Talk with your healthcare provider about ways to treat and to help prevent outbreaks.

Hepatitis A – Hepatitis A is transmitted when infected feces (poop) gets into your mouth. This can happen through unsanitary fresh food preparation, during oral-anal sex (rimming) or even when taking a condom off after anal sex. Symptoms may include fatigue, poor appetite, fever, nausea, vomiting and jaundice (yellowing of the skin and eyes). There is a vaccine to protect you against hepatitis A. All men who have sex with men are encouraged to talk to their healthcare provider about hepatitis vaccines.

Hepatitis B – Hepatitis B is transmitted the same way as HIV (such as unprotected sex or sharing syringes or works). However, hepatitis B is much more infectious than HIV. If you are at risk, please get tested. If the tests show that you have never had hepatitis B, talk to your doctor about getting vaccinated. While most people recover from hepatitis B, some will get quite sick and some will remain infectious and can pass hepatitis B to others. Talk to your healthcare provider about hepatitis B.

Hepatitis C – Hepatitis C is spread through contact with the blood of an infected person, primarily through sharing needles, syringes, or other injection drug equipment. Hepatitis C can also be spread through sexual contact, although it is not known how frequently this occurs. Having a sexually transmitted disease or HIV, sex with multiple partners, or rough sex appears to increase a person’s risk for hepatitis C. Hepatitis C treatment is improving. If you are at risk, we encourage you to talk to a healthcare provider and get tested.

For HIV positive men: Co-infection of HIV and hepatitis C can create more health challenges, but each can be treated. If you are at risk, please get tested. It’s important that your healthcare provider know your HIV status in order to give you the best care.

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Alcohol/Drug Use and Sexual Risk

If you want to stop or reduce your drug use, the following organizations can help:

Choices and Recovery
Residential treatment for men and women
733 South Santa Fe Ave.
Vista, CA 92083
760.945.5298

Family Health Centers of San Diego
Outpatient treatment for men and women
4040 30th St.
San Diego, CA 92104
 619.515.2586

Stepping Stone of San Diego
Residential treatment for men and women
Specializing in services for the LGBT community

3767 Central Avenue
San Diego, CA 92105
619.278.0777

The LGBT Community Center
3909 Centre St.
San Diego, CA 92103
619.692.2077

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Injection drug use and risk of HIV

Every time you inject drugs, blood is introduced into needles and syringes. HIV is in the blood of an HIV positive person. The reuse of a blood-contaminated needle or syringe by another drug injector carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream. In addition, sharing drug equipment (or works) can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by:

  • Using blood-contaminated syringes to prepare drugs
     
  • Reusing water
     
  • Reusing bottle caps, spoons or other containers (cookers) used to dissolve drugs in water and to heat drug solutions
     
  • Reusing small pieces of cotton or cigarette filters (cottons) used to filter out particles that could block the needle

Syringes sold on the street may be repackaged and sold falsely as sterile syringes. For this reason, people who inject drugs should obtain syringes from reliable sources of sterile syringes. It is important to know that sharing a needle or syringe for any use, including skin-popping and injecting steroids or vitamins, can carry a risk for HIV and other diseases, like hepatitis.

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Risk Reduction Strategies

In order to reduce the risk of getting HIV, the CDC recommends that people who inject drugs should:

  • Stop using and injecting drugs
     
  • Enter and complete substance abuse treatment, including relapse prevention

For injection drug users who are not ready to stop injecting drugs, the following steps may be taken to reduce personal and public health risks:

  • Never reuse or share syringes, water or works
     
  • Only use syringes obtained from a reliable source (such as organizations that provide harm reduction services)
     
  • Use a new, sterile syringe and works to prepare and inject drugs
     
  • If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water)
     
  • Use a new or disinfected container (cooker) and a new filter (cotton) to prepare drugs
     
  • Clean the injection site prior to injection with a new alcohol swab
     
  • Safely dispose of syringes after one use

If new, sterile syringes and works are not available, then previously used syringes should be boiled in water or disinfected with bleach before reuse. Injection drug users and their sex partners also should take precautions, such as using condoms consistently and correctly, to reduce risks of sexual transmission of HIV. Persons who inject drugs should be tested for HIV every 3-6 months.

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Methamphetamine and Risk for HIV

  • Crystal Methamphetamine is highly addictive and its use is directly tied to an increase in STD and HIV infections. Meth use may impair the ability or the desire to be safe, both sexually and when injecting drugs, which may lead to riskier behaviors in general.
     
  • Methamphetamine use is associated with sexual practices that may increase the likelihood of HIV and other STD transmission (e.g., long duration, leading to chafing or sores; multiple partners; lack of inhibition; not using condoms consistently).
     
  • Methamphetamine use may cause mental confusion and impair the ability to take medications that have been prescribed for HIV infection or other conditions.

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Living with HIV

Counseling and Support

The LGBT Community Center
Serving the LGBT community in San Diego County

3909 Centre St.
San Diego, CA 92103
619.692.2077
www.thecentersd.org

Treatment

HIV medications have improved drastically in recent years and newer drugs have fewer side effects and are easier to take. Current treatment guidelines recommend everyone take HIV medication regardless of their health status. Studies have shown that treating HIV early, before the immune system is damaged, leads to better long-term health outcomes. Additionally, people whose viral loads are suppressed or undetectable are less likely to transmit the virus to others.

Achieving an undetectable viral load requires strict daily adherence to HIV antiretroviral medication and regular monitoring of your health by a healthcare provider.

If you are HIV positive and are not currently seeing a doctor for HIV or if you need other support services (like case management, housing, transportation, food and nutrition, benefits counseling, mental health services, emergency financial assistance or legal assistance), you can contact one of the medical or case management providers listed below (even if you don’t have health insurance):

Medical Providers

 

Comprehensive Health Center
Southeast San Diego Coordinated HIV Services Center
286 Euclid Avenue, Suite 308
San Diego, CA 92114
619.527.7390

 

Family Health Centers of San Diego's
North Park Family Health Center
Ciaccio Memorial Clinic

3544 30th St.
San Diego, CA 92104
619.515.2587
www.fhcsd.org
www.gaymenshealth.org

 

Neighborhood Healthcare
1001 East Grand Avenue
Escondido, CA 92025
760.737.7896
www.nhcare.org

 

North County Health Services (NCHS)
Oceanside/Loma Alta
605 Crouch Street, Building C
Oceanside, CA 92054
760.757.4566
www.nchs-health.org

 

Owen Clinic
4168 Front St # 3-1
San Diego, CA 92103-2030
619.543.3995
www.health.ucsd.edu/specialties/owen/

 

San Marcos Health Center
North County Coordinated HIV Services Center
150 Valpreda Road
San Marcos, CA 92069
760.736.6700
www.nchs-health.org

 

San Ysidro Health Center - Main Clinic
4004 Beyer Blvd.
San Ysidro, CA 92173
619.662.4161
www.syhc.org

 

Vista Community Clinic
1000 Vale Terrace
Vista, CA 92084
760.407.1220
www.vistacommunityclinic.org

 

UCSD Antiviral Research Center (AVRC)
Early Intervention Program
220 Dickinson St. Ste. #8208
San Diego, CA 92103
619.543.8080
www.avrctrials.org

Case Management Providers

Neighborhood House Association (NHA)
HIV/AIDS Services Medical Case Management & Peer Support
286 Euclid Ave., Suite 110
San Diego, CA 92114
619.266.9400
www.neighborhoodhouse.org
Services are also provided in-home

UCSD Mother, Child & Adolescent HIV Program (MCAP)
4076 Third Avenue, Ste. 301
San Diego, CA 92103
619.543-8089
www.avrctrials.org

Family Health Centers of San Diego - North Park Family Health Center
HIV Coordinated HIV Services Center
3514 30th St.
San Diego, CA 92104–4120
619.515.2446
www.fhcsd.org

SEAR Center
324 N. 47th Street
San Diego, CA 92102
619.264.7351

North County Health Services
North County Early Intervention Coordinated HIV Services Center
Community Case Management Program
150 Valpreda Rd., Ste 101A
San Marcos, CA 92069
760.736.6725
www.nchs-health.org
Services are also provided in-home
 

San Ysidro Health Center
CASA South Bay Coordinated HIV Services Center
3045 Beyer Blvd.
San Diego, CA 92154
619.662.4161
www.syhc.org

 

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Partner Services

The County of San Diego offers Partner Services. This free and confidential service provides a safe way for HIV positive people to tell their sexual or needle-sharing partners that they may have been exposed to HIV. Partner Services can help with partner notification for those who are newly diagnosed or have been living with HIV for any length of time. One in five persons infected with HIV does not know they are HIV-positive and may unknowingly pass the virus on to their partner. If you are HIV positive and choose to talk with a Health Advisor, they can help you in one or more of the following ways (click here for more information):

  • Health Advisors use the information you provide to notify your partner for you without ever letting them know who you are. This Partner Service option is called third-party notification.
     
  • Health Advisors can be with you when you tell your partner to provide you with support and to answer any questions either of you may have. This Partner Services option is called dual disclosure assistance.
     
  • Some people feel they’re ready to tell their partner themselves, but may need a little support before they do it. Health Advisors can help you to plan how to tell your partner yourself. They can help you figure out what to say and how and when to say it. They can even give you information about testing and other services that you can share with your partner. This Partner Service option is called self-disclosure assistance.

Remember: Health Advisors can tell your partner(s) about their exposure to HIV without revealing any information about you – your name or any information about the times you were together. Whatever option you chose, a Health Advisor can offer free HIV testing to your partner(s).

www.discloseyourstatus.org

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Health Advisors

Health Advisors are highly trained; public health professionals who help people understand their options for getting assistance to notify their partners. They can help anyone who is HIV positive to choose the best disclosure assistance option for each situation. Once a partner has been told of their exposure to HIV, the Health Advisor provides resources and information to address any questions that might come up and can even provide HIV testing. Health Advisors understand that talking about HIV is not easy; they walk each person through the process at a pace that is comfortable without any judgment and confidentiality is always protected throughout the process. This means that they will never reveal any information to any of the people who are notified.

AIDS is a condition that results from your body's weakened immune system as a result of infection with HIV.

AIDS is medically defined by three criteria:

1) HIV antibodies have been detected in the person’s body,

2) T-cell (CD4) count less than 200, and

3) One or more opportunistic infections, such as thrush, Pneumocystis carinii pneumonia, Kaposi’s sarcoma, toxoplasmosis, and others.

HIV can be found in the blood, cum/pre-cum or vaginal fluid of an infected person. An uninfected person can get HIV if blood, cum/pre-cum or vaginal fluid from an infected person enters the body and gets into the bloodstream. HIV can enter the body through a vein (by IV drug use), the anus/vagina/penis/mouth (by unprotected sex), other mucous membranes (like the eyes or inside of the nose) or any open cuts or sores.

The two major ways you can get infected with HIV are through:

Unprotected sex — Having unprotected (without a condom/barrier) anal, vaginal, and (to a lesser extent) oral sex with an HIV positive person, and/or

Sharing needles — Sharing intravenous (IV) drug needles, syringes, and/or works with an HIV positive person.

You can't get HIV from:

  • day-to-day contact in most workplace, schools, or social settings
     
  • shaking hands, hugging, or a casual kiss
     
  • a toilet seat, a drinking fountain or a doorknob
     
  • dishes, drinking glasses, food or pets

HIV is not an airborne or food-borne virus and does not live long outside the body.

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HIV Testing

CDC estimates that more than one million people are living with HIV in the United States. One in five (21%) of those people living with HIV is unaware of their infection. A recent CDC study found that among urban MSM in 21 cities in 2008 that were unaware of their HIV infection, 55% had not been tested in the previous 12 months.

Anonymous HIV testing means that absolutely no one besides you will have access to your test results since your name is never given or recorded at the testing site. Instead, you are given a unique identifier code, and you (the person being tested) are the only one who is ever made aware of the test results. This protects you from any risk of discrimination or adverse impact, especially in applications for insurance. Anonymous testing is available in many states, including California.

Confidential HIV testing does record your name and contact information. Confidentiality laws and regulations protect this information, but medical personnel and health department personnel will have access to your test records and results. However, other than what is reportable by law, no one else will have access to your testing results unless you sign a release of information. Healthcare workers, insurers, or employers may see it once it becomes part of your medical record. Your status may become known if you make a claim for health insurance benefits, or apply for life insurance or disability insurance. Confidential testing is available in all states.

RNA/Early Test: Another type of test is an RNA test, which detects the HIV virus directly. The time between HIV infection and RNA detection is 9–11 days. These tests, which are more costly and used less often than antibody tests, are used in some parts of the United States, including California.

Rapid Tests: A rapid test is a screening test that produces very quick results, in approximately 20 minutes. Rapid tests use blood from a vein or from a finger stick, or oral fluid, to look for antibodies to HIV. As is true for all screening tests, a reactive rapid HIV test result must be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be made.

Home Testing Kits:  The only home testing kit that is approved by the Food and Drug Administration is  The Home Access HIV-1 Test System. It can be found at most local drug stores. It is not a true home test, but a home collection kit. The testing procedure involves pricking a finger with a special device, placing drops of blood on a specially treated card, and then mailing the card in to be tested at a licensed laboratory. Customers are given an identification number to use when phoning in for the results. Callers may speak to a counselor before taking the test, while waiting for the test result, and when the results are given. Anyone receiving a positive test result is provided a referral for a follow-up confirmatory test, as well as information and resources on treatment and support services.  At-home collection kits are anonymous.

Window period: Most HIV tests are antibody tests that measure the antibodies your body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect. This time period is commonly referred to as the “window period.” Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days). Even so, there is a chance that some individuals will take longer to develop detectable antibodies. Therefore, if the first negative HIV test was done within the first 3 months after possible exposure, consider getting tested again after 3 months to account for the possibility of a false-negative result. Ninety-seven percent of persons will develop antibodies in the first 3 months following the time of their infection. During this period, it’s important to not engage in any behavior that puts you at risk for HIV to be sure of accurate test results. In very rare cases, it can take up to 6 months to develop antibodies to HIV.

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HIV Testing Sites

County Health Services Complex*
3851 Rosecrans St.
San Diego, CA 92110
619-296-2120

HIV rapid testing available

* This clinic has new hours:
Monday, Tuesday and Wednesday: 7:30 a.m. - 4:30 p.m.
Thursday: 10:00 a.m. - 4:00 p.m.
Friday: 7:30 a.m. - 4:00 p.m.

* Esta clínica tiene nuevo horario:
Lunes, Martes y Miércoles: 7:30 a.m. - 4:30 p.m.
Jueves: 10:00 a.m. - 4:00 p.m.
Viernes: 7:30 a.m. - 4:00 p.m.

San Diego LGBT Community Center
3909 Centre Street
San Diego, CA 92103
619-692-2077

HIV rapid testing available

Monday and Wednesday: Anonymous and Confidential HIV Testing: 9:00 a.m. - 2:00 p.m.
Tuesdays, Thursdays and Fridays: UCSD AVRC provides the confidential early test and the anonymous rapid test.
Tuesday and Thursday: 9:00 a.m. - 3:15 p.m.
Friday: 9:00 a.m. - 1:45 p.m.

Central Region Public Health Center
5202 University Ave.
San Diego, CA 92105
619-229-5400

Tuesday: 1:00 p.m. - 7:00 p.m. (rapid testing available)
Friday: 10:00 a.m. - 4:00 p.m.

For information on HIV Mobile Testing sites call 619-296-2120.

Confidential HIV testing is also available at the County of San Diego STD clinics. There is a $15 fee for STD clinic services. View a listing of County STD clinic hours and locations.

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Sexual Risk for HIV

Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS.

All unprotected sex (sex without a condom) with someone who has HIV contains some risk. However:

  • Unprotected anal sex is riskier than unprotected vaginal sex.
     
  • Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.
     
  • Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex.
     
  • Unprotected oral sex can also be a risk for HIV transmission, but it is a lower risk than anal or vaginal sex.

Abstaining from oral, anal and vaginal sex altogether is the only way that you can be completely protected from getting HIV through sex. However, by using condoms or other barriers between the mouth and genitals, you can reduce the risk of HIV or another STD through sex.

Post-Exposure Prophylaxis (PEP): If your exposure was within 72 hours, contact your healthcare provider or go to the emergency room. If your risk of contracting HIV from the exposure is high, a doctor may prescribe you a course of anti-HIV medications that may decrease the chances of becoming infected by 81%.

 

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Oral Sex

  • The risk of getting HIV through oral sex is much lower than the risk of HIV transmission from anal or vaginal sex.
  • Figuring out exactly how risky is difficult. Plus, because most sexually active people practice oral sex in addition to other forms of sex, such as vaginal and/or anal sex, it is hard to know whether HIV infection was as a result of oral sex or other more risky sexual activities. 
  • There are things that can increase your risk of getting HIV through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STDs. It is known that HIV has been transmitted through oral sex.

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Anal Sex

  • Both the top (insertive partner) and the bottom (receptive partner) can get HIV during anal sex.
     
  • HIV can be found in the blood, semen, pre-cum, or vaginal fluid of an HIV positive person. 
     
  • In general, the bottom is at greater risk of getting HIV because the lining of the rectum (inside the butt) is thin and may allow HIV to get into the body during anal sex.
     
  • However, the top is also at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.
     
  • Having unprotected (without a condom) anal sex is very risky behavior. If you're going to have anal sex, you can reduce the risk of getting HIV significantly by using a latex or plastic (polyurethane) condom.
     
  • Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. So, even with a condom, anal sex can be risky.
     
  • You should also be sure to use a water-based lubricant (rather than an oil-based lube) in addition to the condom to reduce the chances of the condom breaking.
     
  • Use lots of lube, to make sure that your anus and rectum are as thoroughly lubricated as possible, which also helps to avoid cuts and tears which would make it easier for HIV to get into your body's blood stream.
     
  • Douching (enema) immediately before anal sex can increase your risk of getting HIV. Douching may wash away helpful or “good” bacteria in your anus (butt) as well as reducing your natural lubrication. This increases the friction of being penetrated, which can cause tears in the rectum and anus. It's also not good to douche after being penetrated since this could spread the virus around even more. If you douche, use only warm water and allow time for tissues to normalize before sex.
     
  • If you are barebacking (anal sex without a condom), have the top pull out before ejaculating.

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Vaginal Sex

  • It is possible to get HIV through vaginal intercourse.
     
  • HIV can be found in the blood, semen, pre-cum, or vaginal fluid of an HIV positive person.
     
  • Men may be at less risk for HIV transmission than women are through vaginal intercourse. However, HIV can enter the body of the male through his urethra (the opening at the tip of the penis), or through small cuts or open sores on the penis.
     
  • The risk for HIV infection also increases if you or a partner has a sexually transmitted disease (STD).
     
  • If you choose to have vaginal intercourse, use a latex condom to help protect both you and your partner from the risk of HIV and other STDs.
     
  • Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission when used correctly and consistently.
     
  • If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

 

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PrEP (Pre-exposure prophylaxis)

What is pre-exposure prophylaxis (PrEP)?
 
PrEP is an HIV prevention method for people who are HIV-negative. It involves taking a daily anti-HIV medication to reduce the risk of becoming infected with HIV. Several studies have shown that, when taken as directed, PrEP dramatically reduces the risk of becoming infected when combined with other prevention services. The CDC currently recommends PrEP for all individuals who are at high risk for HIV infection.
 
What is considered “high risk” for HIV infection?
There are many factors that place an individual at high risk for HIV infection. These include the following:
  • Having a partner who is HIV-positive (sero-opposite couples);
  • Having had sex or needle-sharing partners of unknown HIV status during the past 12 months;
  • Having had sex under the influence of drugs or alcohol during the past 12 months; and/or
  • Having been diagnosed with an STD during the past 12 months.
 
What’s in the pill?
 

The brand name for the medication is Truvada, which contains two medications, tenofovir and emtricitibine. Truvada is commonly used to treat HIV positive individuals in combination with other anti-HIV medications. Truvada was approved by the Food and Drug Administration (FDA) in July 2012 for the prevention of HIV-infection in HIV-negative men and women.

 

Is it safe?