According to a 2018 Ministry of Health report, there are 450 new HIV cases in Singapore every year on average. In 2017, there were 434 new infections, 26 of which occurred in women. Seven of the women were in their 20s, and 96% of the new infections were acquired through sexual intercourse.
Given these statistics, it might help you to know more about this virus that damages the immune system, and what you can do ASAP to prevent an infection should you be exposed to it—particularly since there is no known cure.
How does someone get HIV?
HIV is transmitted through the exchange of certain bodily fluids such as blood, semen, vaginal fluid, anal fluid and breast milk.
“These fluids must come into direct contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream for transmission to occur,” says Dr Chester Lan of Dr. Tan & Partners @ Holland V.
Mucous membranes are found inside the rectum, vagina, penis and mouth, so HIV can be spread through vaginal sex, anal sex, breastfeeding, and contaminated injection needles with HIV blood.
It can also be spread through oral sex, but Dr Lan points out the odds of this happening are “extremely low” unless there are other factors involved.
“The risk increases when there are open sores on the mucous membranes, bleeding gums, oral contact with menstrual blood, and the presence of other sexually transmitted diseases (STDS),” he says.
There’s no risk of getting HIV from regular social contact including holding hands and hugging, because the mentioned bodily fluids aren’t exchanged during these activities. HIV also can’t be spread via saliva, sweat or urine, so the sharing of toilets and even food poses no risk. Closed-mouth kissing is also generally safe, except in the rare case that a person with HIV has blood in their mouth and the person receiving the kiss has a bleeding wound in the mouth (such as cuts, open sores and bleeding gums).
Can you tell by looking?
It won’t be easy.
“Four out of five people exposed to HIV suffer from acute retroviral syndrome after one to four weeks,” says Dr Lan. “The symptoms can be quite similar to that of a bad cold.” They include fever, rash, headache, body aches, joint pains, ulcers, nausea, diarrhoea, lethargy, swollen lymph nodes and loss of appetite.
He points out that the remaining one out of five infected individuals may never show any symptoms during the early stages of the infection, and that many people don’t realise that someone with HIV will at some point become asymptomatic. In other words, the person stops showing symptoms. This stage can last for many years.
“During this time, a person living with HIV may appear completely healthy,” he says. “This is worrying because they might not show any symptoms until they develop AIDS. This is why it’s important to get screened for HIV, because early treatment is the key to staying healthy. If someone is infected with the virus, they can start treatment as early as possible,” says Dr Lan.
The current recommended first-line testing is called the 4th generation HIV Antigen/Antibody test, which can pick up on an HIV infection as early as 14 days after exposure. But for a conclusive test, it’s recommended to go for testing 28 days after exposure.
In Singapore, HIV is a notifiable infection, which means someone who has tested positive will generally need to notify the Ministry of Health of their status.
However, there are now 10 Anonymous HIV Testing Sites across the island—so anyone is able to test for HIV without the need for registration or the disclosure of personal details in the event of a positive result.
It’s good to practise safe sex, but even condoms cannot offer 100 percent protection from HIV.
“While condoms greatly reduce the risk, they aren’t absolutely foolproof,” says Dr Lan. “Studies have shown that… during sexual intercourse even with a condom, there might be some inadvertent exchange of bodily fluids.” For example, you can be exposed to HIV via pre-cum or oral sex.
He notes that another common misconception is that parents with HIV cannot have children, or that their children will also definitely have HIV.
“Parents with HIV can have children. If they are treated properly with anti-HIV medications, and a caesarean is performed for delivery, the majority of children born to them do not have HIV.”
HIV and AIDS: What’s the difference?
AIDS is Acquired Immunodeficiency Syndrome—and is the final stage of a HIV infection.
“People with HIV are diagnosed with AIDS if they have a CD4 count of less than 200, or if they have specific unusual infections,” say Dr Jonathan Ti and Dr Grace Huang of Dr. Tan & Partners @ Robertson.
CD4 counts show the strength of someone’s immune system, and a healthy immune system typically has a CD4 count ranging from 500 to 1,600.
“HIV is a virus that attacks the immune system, while AIDS is a specific condition that occurs when a HIV infection goes untreated and the virus multiplies in the body,” they add. “Full-blown AIDS is characterised by certain opportunistic infections and unusual cancers such as Kaposi’s sarcoma.”
However, they point out that someone with HIV won’t necessarily go on to develop AIDS.
“If they keep the virus under control with regular antiviral medications, their immune systems can remain healthy and the virus will not progress to AIDS.”
How to stay safe
There are a number of ways to protect yourself from HIV.
“If you’re going to have penetrative sex, you can protect yourself by ensuring that your sexual partner has tested negative for HIV and other sexually transmitted diseases,” say Dr Ti and Dr Huang.
“And do make sure to use a condom—this will greatly reduce the risk of HIV and STDs by more than 90 percent.”
If you’ve had unprotected sex and are worried that you may have been exposed to HIV, go to a clinic ASAP. Because if someone takes a short course of antiviral medications within 72 hours of exposure to HIV, they can reduce the infection rate by over 90 percent. This course is also known as Post-Exposure Prophylaxis (PEP).
“PEP has been established as a cornerstone of HIV prevention therapy,” say Dr Ti and Dr Huang. “It involves taking a 28-day course of antiviral tablets to be started within 72 hours of exposure.”
They add that there will be an initial consultation with a doctor to assess the risk of exposure, and to find out if this course of treatment is appropriate. The medication is available in Singapore at the Department of Sexually Transmitted Infections Control Clinic or through private GP clinics such as the Dr Tan & Partners group of clinics.
There is no cure for HIV. But thanks to modern medicine, an infected person can still lead a regular life.
“Any individual diagnosed with HIV should begin on anti-retroviral therapy as soon as possible,” say Dr Ti and Dr Huang. Anti-retroviral therapy involves taking a combination of medications to suppress the virus.
“By taking these medications, the virus can be suppressed to an undetectable level, allowing the individual to live a healthy life with the life expectancy of someone without HIV.”
The medications need to be taken consistently, because missing doses frequently may result in the virus developing drug resistance, which would make treatment more difficult. And the sooner an infected person starts on anti-retroviral treatment, the better.
“There is evidence to show that starting treatment earlier in the disease improves the outcome,” say Dr Ti and Dr Huang. “Early treatment is the reason why people living with HIV in developed countries fare much better compared to those in third-world countries, where diagnosis and treatment may be greatly delayed.”
A version of this story first appeared in the July/August 2019 print issue of CLEO.