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HIV & PrEP Resource Center

HIV: What We Know

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled. People with HIV who get effective HIV treatment can live long, healthy lives and protect their partners. Equality California is committed to ending the stigma against people living with HIV by educating legislators and mobilizing the LGBTQ+ community, and those who are disproportionately impacted by HIV.

What is HIV stigma?
HIV stigma is negative attitudes and beliefs about people with HIV. It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable.

Here are a few examples:

  • Believing that only certain groups of people can get HIV
  • Making moral judgments about people who take steps to prevent HIV transmission
  • Feeling that people deserve to get HIV because of their choices

What is discrimination?
While stigma refers to an attitude or belief, discrimination is the behaviors that result from those attitudes or beliefs. HIV discrimination is the act of treating people living with HIV differently than those without HIV.

Here are a few examples:

  • Refusing casual contact with someone living with HIV
  • Socially isolating a member of a community because they are HIV positive
  • Referring to people as HIVers or Positives

What are the effects of HIV stigma and discrimination?
HIV stigma and discrimination affect the emotional well-being and mental health of people living with HIV. People living with HIV often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed. “Internalized stigma” or “self-stigma” happens when a person takes in the negative ideas and stereotypes about people living with HIV and start to apply them to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and despair. These feelings can keep people from getting tested and treated for HIV.

What causes HIV stigma?
HIV stigma is rooted in a fear of HIV. Many of our ideas about HIV come from the HIV images that first appeared in the early 1980s. There are still misconceptions about how HIV is transmitted and what it means to live with HIV today.

The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people who are living with HIV.

How is HIV transmitted?
Can I get HIV from anal sex?
You can get HIV if you have anal sex with someone who has HIV without using protection (like condoms or medicine to treat or prevent HIV).

Anal sex is the riskiest type of sex for getting or transmitting HIV. Being the receptive partner (bottom) is riskier than being the insertive partner (top). The bottom’s risk is higher because the rectum’s lining is thin and may allow HIV to enter the body during anal sex. The top is also at risk. HIV can enter the body through the opening at the tip of the penis (urethra); the foreskin if the penis isn’t circumcised; or small cuts, scratches, or open sores anywhere on the penis.

Can I get HIV from vaginal sex?
You can get HIV if you have vaginal sex with someone who has HIV without using protection (like condoms or medicine to treat or prevent HIV).

Vaginal sex is less risky for getting HIV than receptive anal sex. Either partner can get HIV during vaginal sex. HIV can enter a person’s body during vaginal sex through the delicate tissue that lines the vagina and cervix. Vaginal fluid and blood can carry HIV, which can pass through the opening at the tip of the penis (urethra); the foreskin if the penis isn’t circumcised; or small cuts, scratches, or open sores anywhere on the penis.

Can HIV be transmitted from a mother to her baby?
HIV can be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. However, it is less common because of advances in HIV prevention and treatment.

This is called perinatal transmission or mother-to-child transmission.
Mother-to-child transmission is the most common way that children get HIV.
Recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV. If a woman with HIV takes HIV medicine as prescribed throughout pregnancy and childbirth, and gives HIV medicine to her baby for 4 to 6 weeks after birth, the risk of transmission can be less than 1%.

Can I get HIV from sharing needles, syringes, or other drug injection equipment?
You are at high risk for getting HIV if you share needles, syringes, or other drug injection equipment (for example, cookers) with someone who has HIV. Never share needles or other equipment to inject drugs, hormones, steroids, or silicone.

Used needles, syringes, and other injection equipment may have someone else’s blood on them, and blood can carry HIV. People who inject drugs are also at risk for getting HIV (and other sexually transmitted diseases) if they engage in risky sexual behaviors like having sex without protection (such as condoms or medicine to prevent or treat HIV). Sharing needles, syringes, or other injection equipment increases your risk for getting hepatitis B and hepatitis C, and other infections.

What are some rare ways that HIV has been transmitted?
Little to No Risk
There is little to no risk of getting HIV from the activities below. For transmission to occur, something very unusual would have to happen.

Oral Sex
Oral sex involves putting the mouth on the penis (fellatio), vagina or vulva (cunnilingus), or anus (rimming). Factors that may affect the risk of getting HIV include:

  • Ejaculation in the mouth with oral ulcers, bleeding gums, or genital sores.
  • The presence of other sexually transmitted diseases (STDs).
  • You can get other STDs from oral sex. If you get feces in your mouth during anilingus, you can get hepatitis A and hepatitis B, parasites like Giardia, and bacteria like Shigella, Salmonella, Campylobacter, and E. coli.

The most likely cause is injury with a contaminated needle or another sharp object.
Careful practice of standard precautions protects patients and health care personnel from possible occupational HIV transmission.

Medical Care
The US blood supply and donated organs and tissues are thoroughly tested. It is very unlikely that you would get HIV from blood transfusions, blood products, or organ and tissue transplants.
You cannot get HIV from donating blood. Blood collection procedures are highly regulated and safe.

Food Contamination
The only known cases are among infants. Contamination occurs when blood from a caregiver’s mouth mixes with pre-chewed food and an infant eats it.
You can’t get HIV from consuming food handled by someone with HIV.

Biting and Spitting
The small number of documented cases have involved severe trauma with extensive tissue damage and the presence of blood. This rare transmission can occur through contact between broken skin, wounds, or mucous membranes and blood or body fluids from a person who has HIV. There is no risk of transmission through unbroken skin. There are no documented cases of HIV being transmitted through spitting as HIV is not transmitted through saliva.

Deep, Open-Mouth Kissing
Very rarely, transmission has occurred if both partners have sores or bleeding gums.
You can’t transmit HIV through closed-mouth or “social” kissing with someone who has HIV. You can’t transmit HIV through saliva.

Touching involves putting your hands, other body parts, or sex toys on your partner’s vagina, penis, or anus. The only possible risk would be if body fluids from a person with HIV touch the mucous membranes or damaged tissue of someone without HIV. Mucous membranes are found inside the rectum, vagina, opening of the penis, and mouth. Damaged tissue could include cuts, sores, or open wounds. You can get or transmit some other STDs (like human papillomavirus or HPV, genital herpes, and syphilis) through skin-to-skin contact.

Tattoos and Body Piercings
There are no known cases in the United States of anyone getting HIV this way.
It is possible to get HIV from tattooing or body piercing if the equipment or ink has someone else’s blood in it. This is more likely to happen when the person doing the procedure is unlicensed because they may use unsterilized needles or ink.
If you get a tattoo or a body piercing, be sure that the person doing the procedure is properly licensed and uses only new or sterilized equipment.

Symptoms & Stages
For many, yes. Most people have flu-like symptoms within 2 to 4 weeks after infection. Symptoms may last for a few days or several weeks.

Having these symptoms alone doesn’t mean you have HIV. Other illnesses can cause similar symptoms. Some people have no symptoms at all. The only way to know if you have HIV is to get tested.

What are the stages of HIV?
When people with HIV don’t get treatment, they typically progress through three stages. But HIV treatment can slow or prevent progression of the disease. With advances in HIV treatment, progression to Stage 3 (AIDS) is less common today than in the early years of HIV.

Stage 1: Acute HIV Infection

People have a large amount of HIV in their blood and are very contagious.
Many people have flu-like symptoms.
If you have flu-like symptoms and think you may have been exposed to HIV, get tested.

Stage 2: Chronic Infection

This stage is also called asymptomatic HIV infection or clinical latency.
HIV is still active and continues to reproduce in the body.
People may not have any symptoms or get sick during this phase but can transmit HIV.
People who take HIV treatment as prescribed may never move into Stage 3 (AIDS).
Without HIV treatment, this stage may last a decade or longer, or may progress faster. At the end of this stage, the amount of HIV in the blood (viral load) goes up and the person may move into Stage 3 (AIDS).

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

The most severe stage of HIV infection.
People with AIDS can have a high viral load and may easily transmit HIV to others.
People with AIDS have badly damaged immune systems. They can get an increasing number of opportunistic infections or other serious illnesses.
Without HIV treatment, people with AIDS typically survive about three years.

Prep: What You Need To Know
There are about 1.2 million Americans living with HIV with about 15 percent (1 in 7) unaware they are infected. An estimated 38,700 became newly affected Americans in 2016 and there are an estimated 39,000 new cases of HIV transmission each year. Sadly, most of these cases are among gay and bisexual men of color. That’s why now, more than ever, we need to increase awareness and uptake for Pre-Exposure Prophylaxis (PrEP), a new, highly effective tool to prevent the transmission of HIV.

PrEP involves an HIV-negative person taking the antiretroviral medication preventatively, once per day, to provide a high-level of protection against HIV. When used correctly, studies have shown that PrEP reduces the risk of getting HIV from sex by up to 99%

If you decide that PrEP is right for you, you can speak with your primary care physician or, starting  January 1, 2020, Californians can receive PrEP and PEP directly from a pharmacist and without a physician’s prescription. PrEP is for HIV negative patients only, and routine HIV screening and blood work is required to remain on the medication. To determine if you can get PrEP for free or low cost, check out NASTAD’s PrEP cost calculator, here: PrEPcost.org.

How does PrEP work?

PrEP works by preventing HIV from establishing in the body. If you are exposed to semen, vaginal fluids or blood from an HIV-positive person, then it acts as a protective measure to halt transmission. For optimal protection, the pill/injection should be taken as recommended by your health provider

The CDC has determined that 1 in 4 gay and bisexual men should be on PrEP. Who else should be on PrEP?

  • If you are HIV-negative and have anal or vaginal sex without a condom.
  • If you have sex with an HIV-positive person or someone whose HIV status you’re unsure of.
  • If your primary sex partner is HIV-positive.
  • If you engage in sex with multiple partners.
  • If you or your sex partner(s) exchange sex for money, housing, or other needs.
  • If you or your sex partner(s) engage in injectable drug use.
  • If you occasionally, rarely, or never use condoms.
  • If in the past year you have taken post-exposure prophylaxis (PEP) to prevent HIV infection, had a sexually transmitted infection (STI), or used recreational drugs such as cocaine, ecstasy, stimulants, or GHB.
  • Are you trying to safely have a child with an HIV-positive partner?

Does PrEP have side effects?

  • The majority of PrEP users report zero side effects. However, some people experience nausea, dizziness, and weightloss, with these minor side effects usually resolving within the first few weeks of starting PrEP.
  • A very small number of individuals experience modest declines in kidney function1 or bone mineral density2, both of which returned to normal once PrEP was discontinued. Your provider will do tests while you are taking PrEP to determine if you are experiencing any of these problems.
  • Importantly, a new study has shown PrEP to be as safe as aspirin.

Talking to your doctor:

  • Patients interested in PrEP should also check out LA County Department of Public Health’s Patient PrEP Self-Assessment Card to see if PreP is right for you!
  • Any doctor can prescribe PrEP. It’s important that you have an open and honest conversation with your doctor about your sexual behavior.
  • Be honest. If you rarely or never use condoms, then tell your doctor. Inconsistent condom-use is a great reason to be on PrEP, and you shouldn’t be ashamed to tell that to your doctor. Remember, while PrEP helps prevent HIV, it does not protect against other sexually transmitted infections (STI). Condoms remain the most effective tool to protect against all STIs.
  • You might need to educate your doctor about the availability and effectiveness of PrEP. The CDC has created a PrEP Healthcare Provider Guidelines document which provides comprehensive information for the use of daily oral antiretroviral PrEP to reduce the risk of acquiring HIV infection in adults. You should also bring this PrEP Service Delivery Checklist, created by the County of Los Angeles Department of Public Health, to ensure your healthcare provider obtains the information necessary to prescribe you PrEP and conducts appropriate follow-up appointments. Additional information on PrEP can be found here.
  • Most hospitals and clinics will have a physician that specializes in HIV. Your doctor might want to talk to them before prescribing you PrEP. This is completely okay! This just means that your doctor might have additional questions on PrEP and is going through the appropriate channels to get you the medicine that you need.
  • If your doctor refuses to prescribe your PrEP, questions your motives, or makes you feel uncomfortable for requesting it, then try to find another doctor. It is important to find a doctor that supports and respects any available preventative tools to enhance your sexual health.

All PrEP educational content and information on this website has been compiled from information consistent with current CDC guidelines for use of PrEP, Risk Evaluation and Mitigation Strategy (REMS) guidelines, and clinical trials of oral daily PrEP.

The information provided on this website is intended for your general knowledge only and is not a substitute for professional medical advice or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your health, including HIV prevention.

Supported by grant funding from Gilead Sciences, Inc. Gilead Sciences, Inc. has had no input into the development or content of these materials.
Nosotros VIHviendo
Nosotros VIHviendo is a new program supporting grassroots organizations in California and Nevada addressing the high risk of HIV infection rates in the Latinx LGBTQ+ community. Launched in March 2022, it is a first of its kind for Equality California Institute. The purpose of Nosotros VIHviendo’s goal is to build community power, strengthen LGBTQ+ and allied networks, and inform policy.

 Equality California Institute train grantees to lead HIV reduction projects in California or Nevada, assign leaders for each region, facilitate peer mentorship opportunities, host community events, and more. 

HIV Is Not A Crime
In partnership with the Elizabeth Taylor AIDS Foundation, we work to support state-based HIV and LGBTQ+ organizations across the country in their work to modernize outdated, ineffective and discriminatory laws that criminalize people living with HIV.

In 2016, Equality California was one of the founding members of Californians for HIV Criminalization Reform, a broad coalition of people living with HIV, community activists, and healthcare and civil rights organizations that successfully worked with California Senator Scott Wiener (D-San Francisco) to modernize California’s HIV criminal laws.

In 2017, Governor Jerry Brown signed Senate Bill 239 into law, transforming the legal landscape with respect to HIV criminalization in California. Click here for a Q&A on the new changes to the law.

Under the new law, authored by Senator Scott Wiener (D- San Francisco) and Assemblymember Todd Gloria (D-San Diego), criminal penalties based on a person’s HIV status cannot be imposed unless the person acts with the intent to harm another person. Read our Q&A to understand the changes to the law, how these changes will improve public health, and the steps those previously convicted under these laws may be able to take to clear up their criminal record.

In October 2019, California Governor Gavin Newsom signed Sen. Scott Wiener (D-San Francisco) and Asm. Todd Gloria’s  (D-San Diego) Senate Bill 159 — co-sponsored by Equality California — expanding access to life-saving HIV prevention medication. When it goes into effect on January 1, 2020, California will become the first state in the nation to authorize pharmacists to furnish at least a 30-day supply — and up to a 60-day supply — of PrEP and a complete course of PEP without a physician’s prescription. The bill is a key step in California’s work to eliminate HIV and delivers on Newsom’s campaign pledge to take aggressive action to end the HIV epidemic.

Fair Laws, Not Fear Laws
It’s time to bring California’s laws in line with current science. These laws are outdated and contribute to HIV stigma and discrimination. We should treat HIV the same as all other serious communicable diseases.

Californians for HIV Criminalization Reform (CHCR) is a coalition of organizations and individuals dedicated to ending the criminalization of HIV in California. Our mission is to mobilize a broad coalition, including individuals and communities who are disproportionately impacted by HIV, to replace fear-based, stigmatizing laws that criminalize HIV-status with evidence-based, nondiscriminatory laws that protect public health. CHCR is led by a steering committee including:

  • ACLU of California
  • APLA Health
  • Black AIDS Institute
  • Erotic Service Provider Legal Educational and Research Project
  • Equality California
  • Health Officers Association
  • Lambda Legal
  • Los Angeles HIV Law and Policy Project
  • Los Angeles LGBT Center
  • Mexican American Legal Defense and Educational Fund
  • Positive Women’s Network
  • Sex Workers Outreach Project
  • Transgender Law Center

Over the past 25 years, laws were passed in California that criminalized otherwise legal behaviors or added penalties to existing crimes for people living with HIV. These laws were largely based on irrational fears about people with HIV, our limited understanding of the routes and risks of HIV transmission, a limited number of effective prevention options, and the perception of that time of HIV as an incurable and inevitably fatal disease. In the years since, medical science has greatly improved our understanding of the routes and risks of transmission, there are increasingly more effective biomedical methods of preventing acquisition of HIV, and effective treatments have dramatically lengthened and improved the quality of life for people living with HIV. We need to modernize these laws to take into account current scientific knowledge about HIV.

Why are laws that criminalize people living with HIV a problem in California?

  • 800 Californians have come into contact with the criminal justice system under these laws.
  • 90% of individuals who are charged under these laws are sentenced to custody/confinement.
  • Every incident in which one or more HIV-specific charges were brought resulted in a conviction (385 out of 385 incidents) for at least one of the HIV-specific charges.
  • HIV criminalization impacts communities most affected by HIV, including the gay, bisexual and transgender communities.
  • These laws have a particularly harsh impact on sex workers and women living with HIV.
  • The individuals who are criminalized multiple times tend to be black men and black women.
  • Black men have been found to be more likely to be charged under these laws multiple times more than white men.
  • These laws create a disincentive for individuals to seek HIV testing and treatment.
  • By singling out one specific disease for criminal sanction, these laws portray people living with HIV as sexual predators and contribute to HIV-related stigma.

The efforts of the coalition are based on specific principles to modernize these laws and eliminate these problems. We believe a model law must include:

  • Criminal intent to infect.
  • Conduct likely to transmit.
  • No new crimes or increased penalties for any other disease.
  • Punishment proportionate to the actual harm.
  • Classification as a misdemeanor, not a felony.

For more information, please visit our Frequently Asked Questions page.

The CHCR webpages are supported through the generous contribution and support from the Elizabeth Taylor AIDS Foundation and the Elton John AIDS Foundation.

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The information provided on this website is intended for your general knowledge only and is not a substitute for professional medical advice or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your health.

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