What are HIV and AIDS?

HIV stands for human immunodeficiency virus. It harms your immune system by destroying a type of white blood cell that helps your body fight infection.

AIDS is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.

Are there treatments for HIV?

There is no cure for HIV, but there are many medicines to treat both HIV infection and the health problems and infections (called opportunistic infections, or OIs) and that come with it. These other infections are called opportunistic infections (OIs). The medicines allow people with HIV to have long, healthy lives.

How can I live a healthier life with HIV?

IIf you have HIV, you can help yourself by:

• Getting medical care as soon as you find out that you have HIV. You should find a health care provider who has experience in treating HIV.
• Taking your medicines every day.
• Letting your provider know if you get any symptoms or health problems.
• Keeping up with your regular medical and dental care.
• Managing stress and getting support, such as from support groups, therapists, and social service organizations
• Trying to live a healthy lifestyle, including:
  • Eating healthy foods.This can give your body the energy it needs to fight HIV and other infections. It can help you manage HIV symptoms and medicine side effects. It may also improve absorption of your HIV medicines.
  • Getting regular exercise. This can strengthen your body and immune system. It may also reduce the risk of depression.
  • Getting enough sleep. Sleep is important for your physical strength and mental health.
  • Not smoking. People with HIV who smoke have a higher risk of developing conditions such as certain cancers and infections. Smoking can also interfere with your medicines.
  • Avoiding heavy drinking or taking illegal drugs. They can damage your liver, which means your HIV medicine may not work as well. They can also make it harder for your body to fight infections.
  • Protecting yourself from OIs. Talk to your provider about medicines and vaccines that prevent certain OIs. Also be careful to avoid exposure to contaminated food and water.

It is also important to reduce the risk of spreading HIV to other people. You should tell your sex partners that you have HIV and always use latex condoms. If your or your partner is allergic to latex, you can use polyurethane condoms.

What does an HIV diagnosis mean?

• If you receive an HIV diagnosis, it means that you have HIV.
• Unlike some other viruses, the human body can’t get rid of HIV completely. Once you have HIV, you 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.

What should I do if I just got diagnosed with HIV?

Take Time to Process the News

• Receiving an HIV diagnosis can be life changing. You may feel many emotions—sadness, hopelessness, or anger.
• Allied health care providers and social service providers can help you work through the early stages of your diagnosis. They are often available at your health care provider’s office.

Find HIV Care

• If you have a primary health care provider, that person may have the knowledge to treat your HIV. A primary health care provider is someone who manages your regular medical care and annual tests.
• If your primary health care provider does not have the knowledge to treat your HIV, they can refer you to an HIV health care provider. You can also find Ryan White HIV/AIDS Program providers who can help you access the medical care, medications, and essential support services you need.

Start HIV Treatment As Soon As Possible After Diagnosis

• Get in care and take medicine to treat HIV (called antiretroviral therapy or ART).
• Taking HIV medicine can reduce the amount of HIV in the blood (called viral load).
• HIV medicine can make the viral load very low (called viral suppression). Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.
• HIV medicine can make the viral load so low that a test can’t detect it (called an undetectable viral load).
• Getting and keeping an undetectable viral load (or staying virally suppressed) is the best thing you can do to stay healthy. Having an undetectable viral load also prevents transmission to others. In fact, if you have an undetectable viral load, you will not transmit HIV to your sex partner. Most people can get the virus under control within six months.

Who should be on my health care team?

Finding a health care team that is knowledgeable about HIV care is an important step. Your health care team will help you manage your care and treatment.

Primary HIV Health Care Provider

Your primary HIV health care provider should lead your health care team. Your primary HIV health care provider may be a

• Medical Doctor (MD or DO),
• Nurse Practitioner (NP), or
• Physician Assistant (PA).

Your primary HIV health care provider will

• determine which HIV medicine is best for you,
• prescribe HIV medicine (called antiretroviral therapy or ART),
• monitor your progress and help you manage your health, and
• put you in touch with other HIV providers who can address your needs.

Other HIV Providers

Your health care team may include other providers who are experts in taking care of people with HIV.

• Allied health care professionals like nurses, mental health providers, pharmacists, nutritionists, and dentists.
• Social service providers like social workers, case managers, substance use specialists, and patient navigators.

 The Ryan White HIV/AIDS Program provides access to medical care, medication, and essential support services if you need assistance.

What do I need to do as part of my HIV care?

Take Your HIV Medicine as Prescribed

• This will help keep your viral load low and your CD4 count high.
• Take your HIV medicine exactly how your health care provider tells you to—at specific times of the day, with or without certain kinds of food.
• Keep track of your medicine and schedule.
• Talk to your health care provider or pharmacist if you have questions about when or how to take your medicine, or if you are experiencing any side effects.

Keep Your Medical Appointments

• Use a calendar to mark your appointment days.
• Set reminders on your phone.
• Download an app on your phone that can help remind you of your medical appointments.
• Keep your appointment card in a place where you will see it.
• Ask a family member or friend to help you remember your appointment.

Talk Honestly with Your Health Care Provider

• Your health care provider needs to have the most accurate information to manage your care and treatment.
• Write down questions you want to discuss with your health care provider. Be ready to write down the answers.
• Keep track of your lab results, medical visits, and care and treatment plans.
• Make sure your health care providers have your correct contact information.

What can I expect during a medical visit?

During your medical visit, your health care provider may ask questions and conduct routine medical exams to see how HIV is affecting your body.

Your health care provider may

• Take a blood sample to check your viral load.
• Ask questions about your health history.
• Look for other kinds of infections or health problems. Some health problems may weaken your body, make your HIV worse, or prevent your treatment from working.
• Give you immunizations, if you need them.
• Discuss, prescribe, and monitor your HIV medicine.
• Discuss ways to help you follow your HIV treatment plan.
• Help identify other support you may need.
• Ask about your sexual or injection partners and discuss ways to protect them from getting HIV.

What are the different tests that help monitor my HIV?

Your health care provider will use blood tests to monitor your HIV infection. These tests help your health care provider make decisions about changes to your treatment.

CD4 Count

• Your CD4 count is the number of CD4 cells you have in your blood. CD4 cells help your body fight infections.
• HIV attacks and lowers the number of CD4 cells in your blood. This makes it difficult for your body to fight infections.
• Your health care provider will check your CD4 count every 3 to 6 months.

Viral Load Test

• Viral load is the amount of HIV in your blood.
• Your health care provider will use a viral load test to determine your viral load.
• When your viral load is high, you have more HIV in your body. This means your immune system is not fighting HIV very well.
• You should have a viral load test
  • every 4 to 6 months,
  • before you take a new HIV medicine, and
  • around 2 to 8 weeks after starting or changing medicine.

What is HIV treatment?

HIV treatment (antiretroviral therapy or ART) involves taking medicine as prescribed by a health care provider. HIV treatment reduces the amount of HIV in your body and helps you stay healthy.

• There is no cure for HIV, but you can control it with HIV treatment.
• Most people can get the virus under control within six months.
• HIV treatment does not prevent transmission of other sexually transmitted diseases.

When should I start HIV treatment?

Start HIV treatment as soon as possible after diagnosis.

• All people with HIV should take HIV treatment, no matter how long they’ve had HIV or how healthy they are.
• Talk to your health care provider about any medical conditions or other medicines you are taking.

What if I delay HIV treatment?

If you delay treatment, HIV will continue to harm your immune system. Delaying treatment will put you at higher risk for transmitting HIV to your partners, getting sick, and developing AIDS.

Are there different types of HIV treatment?

There are two types of HIV treatment: pills and shots.

• Pills are recommended for people who are just starting HIV treatment. There are many FDA-approved single pill and combination medicines available.
• People who have had an undetectable viral load (or have been virally suppressed) for at least three months may consider shots.

What are HIV treatment shots?

HIV treatment shots are long-acting injections used to treat people with HIV. The shots are given by your health care provider and require routine office visits. HIV treatment shots are given once a month or once every other month, depending on your treatment plan.

Can I switch my HIV treatment from pills to shots?

Talk to your health care provider about changing your HIV treatment plan. Shots may be right for you if you are an adult with HIV who

• has an undetectable viral load (or has achieved viral suppression),
• has no history of treatment failure, and
• has no known allergy to the medicines in the shot.

If you and your health care provider decide to switch your HIV treatment from pills to shots, you’ll need to visit your provider regularly to receive your shots. Tell your health care provider as soon as possible if you’ve missed or plan to miss an appointment for your shot.

What are the benefits of taking my HIV treatment as prescribed?

HIV treatment reduces the amount of HIV in the blood (viral load).

• Taking your HIV medicine as prescribed will help keep your viral load low.
• HIV treatment can make the viral load very low (viral suppression). Viral suppression means having less than 200 copies of HIV per milliliter of blood.
• HIV treatment can make the viral load so low that a test can’t detect it (undetectable viral load).
• If your viral load goes down after starting HIV treatment, that means treatment is working. Continue to take your HIV treatment as prescribed.
• If you skip your HIV treatment, even now and then, you are giving HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.
• Getting and keeping an undetectable viral load (or staying virally suppressed) is the best way to stay healthy and protect others.

HIV treatment prevents transmission to others.

• If you have an undetectable viral load, you will not transmit HIV through sex.
• Having an undetectable viral load likely reduces the risk of HIV transmission through sharing needles, syringes, or other injection equipment (for example, cookers), but we don’t know by how much.
• Having an undetectable viral load also prevents perinatal transmission. If a person with HIV takes their HIV medicine as prescribed throughout pregnancy and childbirth and gives HIV treatment to their baby for 4 to 6 weeks after birth, the risk of transmission can be 1% or less.
• Having an undetectable viral load greatly reduces the risk of transmitting HIV through breastfeeding but doesn’t eliminate the risk. The current recommendation in the United States is that parents with HIV should not breastfeed their babies.

Taking your HIV medicine as prescribed helps prevent drug resistance.

• Drug resistance develops when people with HIV don’t take their pills as prescribed or miss their shots. The virus can change (mutate) and may limit your options for successful HIV treatment.
• If you develop drug resistance, it will limit your options for successful HIV treatment.
• Drug-resistant strains of HIV can be transmitted to others.

Does HIV treatment cause side effects?

HIV treatment can cause side effects in some people. However, not everyone experiences side effects. The most common side effects are

• Nausea and vomiting
• Diarrhea
• Difficulty sleeping
• Dry mouth
• Headache
• Rash
• Dizziness
• Fatigue
• Temporary pain at the injection site (for shots)

Talk to your health care provider if your HIV treatment makes you sick. Your health care provider may prescribe additional medicines to help manage the side effects or may change your HIV treatment plan.

What should I do if I’m thinking about having a baby?

Let your health care provider know if you or your partner is pregnant or thinking about getting pregnant. They will determine the right type of HIV treatment to help prevent passing HIV to your baby.

Can I take birth control while on HIV treatment?

You can use any method of birth control to prevent pregnancy. However, some HIV treatment may make hormone-based birth control less effective. Talk to your health care provider about which method of birth control is right for you.

Will HIV treatment interfere with my hormone therapy?

Most HIV treatment can be used safely with gender-affirming or menopausal hormone therapy and testosterone replacement therapy. However, side effects may occur. Talk to your health care provider about taking HIV treatment and hormone therapy at the same time. Your health care provider will monitor any side effects and help make sure your HIV treatment and hormone therapy stay on track.

What if my HIV treatment is not working?

• Your health care provider may change your type of HIV treatment.
• A change is not unusual because the same HIV treatment does not affect everyone in the same way.

Sticking to my HIV treatment plan is hard. How can I deal with the challenges?

Tell your health care provider right away if you’re having trouble sticking to your plan. Together you can identify the reasons you’re skipping HIV treatment and decide how to address those reasons.

Talk to your health care provider about problems taking your HIV treatment.

• Problems taking pills. This can make staying on this type of HIV treatment challenging. Your health care provider can offer tips for addressing these problems, including switching to an injectable HIV treatment option.

• Side effects. Nausea or diarrhea can make a person not want to continue their HIV treatment. There are medicines or other support, like nutritional counseling, to make sure you’re getting important nutrients. This can help with the most common side effects.
• HIV treatment fatigue. Some people find that sticking to their HIV treatment plan becomes harder over time. Make it a point to talk to your health care provider about staying on your plan.
• A busy schedule. Work or travel away from home can make it easy to forget to take pills or miss a shot. It may be possible to keep extra pills at work or in your car. But talk to your health care provider first as extreme temperatures can affect some medicine.

Talk to your health care provider if you miss doses of your HIV treatment.

• Missing a dose of pills. In most cases, you can take your pills as soon as you realize you missed a dose. Then take the next dose at your usually scheduled time (unless your pharmacist or health care provider has told you otherwise).
• Missing a shot. If you missed an appointment for your shot, talk to your health care provider about receiving your next shot.

• Missing doses. Talk to your health care provider or pharmacist about ways to help you remember your HIV treatment. Your health care provider may even decide to change your treatment to fit your needs and life situation.

Find help for mental health or substance use disorders.

• Being sick or depressed. How you feel mentally and physically can affect your ability to stick to your HIV treatment plan. Your health care provider, social worker, or case manager can refer you to a mental health provider or local support group.
• Substance use (drug or alcohol). If substance use is interfering with your ability to keep yourself healthy, it may be time to find help.

Join a support group or ask your family and friends for support. They can help you stick to your treatment plan.

Managing Your HIV Medical Appointments

With treatment, HIV is a manageable chronic condition. Part of staying healthy with HIV is seeing a health care provider regularly so that they can track your progress and make sure your treatment is working. That means managing your HIV medical appointments.

Some people with HIV go to an HIV clinic for their medical appointments; others go to a community health center, a Veterans Affairs clinic, or a private medical provider’s office. In addition to seeing your primary HIV health care provider, during a visit you also may need to see a specialist or access the special skills of a nurse, pharmacist, nutritionist, social worker, case manager, or patient navigator, depending on your needs. Preparing a plan can help make this easier.

Frequency of Appointments

Current HIV treatment guidelines recommend that most people with HIV see their health care provider for lab tests every 6 months. Some people may see their provider more frequently, especially during the first two years of treatment or if their HIV viral load is high or detectable. People with HIV who take HIV medicine (called antiretroviral therapy or ART) exactly as prescribed and have an undetectable viral load at every test for more than two years usually only need to have their lab tests checked twice a year. An undetectable viral load is a level of HIV in your blood so low that a standard lab test can’t detect it.

People with HIV who take HIV medicine exactly as prescribed and get and keep an undetectable viral load can stay healthy and will not transmit HIV to an HIV-negative partner through sex.

What About Telehealth?

Some HIV clinics and providers offer telehealth appointments, which are great way to get the health care you need while practicing social distancing during the COVID-19 pandemic or at other times when in-person appointments may not be possible or convenient. Telehealth is the use of technologies to receive care when you and your provider aren’t in the same place at the same time. Through telehealth, you may be able to talk to your doctor over the phone, by videoconferencing, through chat messaging, or through other apps.

Telehealth isn’t a perfect fit for everyone and there may be times when your provider may still have you come in for an in-patient visit or go to a lab for necessary lab tests. Discuss the advantages and disadvantages of telehealth with your provider and what options are available to you. Learn more about telehealth.

Before Your Visit

Whether you are meeting with your provider in person or via telehealth, these tips can help you better prepare for your visits:

1. Start with a list or a notebook. Write down any questions you have about HIV or your treatment before you go. (The Department of Veterans Affairs offers a useful list of sample questions.)
2. Make a list of any symptoms or problems you are having. These may include difficulties taking your HIV medications, sleeping issues, feelings of sadness or anxiety, or issues with intimacy.
3. Bring a list of your medications (or the medications themselves). This includes the names and dosages of all HIV medications, non-HIV medications, over-the-counter medications, vitamins, or supplements you are taking. Include a list of any HIV medications you may have taken in the past and any problems you had when taking them.
4. Bring a copy of your medical recordsif your provider does not already have them, including visits to specialists. You have the right to access your medical records and having copies can help you keep track of your previous lab results, prescriptions, and other health information. It can also help a new provider have a better understanding of your health history.
5. Be prepared to talk about any changes in your living situation. This includes changes in your relationships, insurance, employment, or housing that may affect your ability to take your medication as prescribed, keep up with your HIV appointments and treatment, or to take care of yourself. Your care team may be able to connect you with resources or services to assist you.
6. Be on time. Do your best to plan ahead. If you are late, your provider may not be able to see you the same day.

During Your Visit

1. Be prepared for lab tests. If your provider wants to run some lab tests during or following your visit, make sure you understand what they’re for and what your provider will do with the results. If you don't understand, ask your provider to explain it in everyday terms. Typically, you will be asked to give a sample (blood, urine) during your visit. Your provider’s office will call you with your results in a few days or may post them in an online patient portal. Keep track of your results and call your provider back if you have any questions.
2. Be honest. Your provider needs to have the most accurate information to help you manage your care and treatment. Talk about any HIV medication doses you have missed. Tell your provider about your current sexual or alcohol/drug use activities and your history. These behaviors can put you at risk of developing drug resistance or getting other sexually transmitted infections (STIs) as well as viral hepatitis. Your provider will work with you to develop strategies to stay as healthy as possible.
3. Describe any side effects you may be having. Your provider will want to know how the HIV medications are affecting your body in order to work with you to solve any problems and find the right combination of medications for you.
4. Ask your provider about your next visit. Ask when it should be scheduled, what to expect, and what you should bring to that appointment.
5. Track your upcoming appointments. Work with your case manager, if you have one, to develop a system to help you remember your appointments, such as signing up for phone, text, or email reminders.

Asking Questions and Solving Problems

It’s important for you to be an active participant in your own health care and it’s your right to ask questions. You may need to direct your questions to different people, depending on what you need or want to know.

HIV health care providers (doctors, nurse practitioners, physician assistants) can answer questions about a wide range of issues that affect your health. These include:

1. How HIV is affecting your body
2. Medication issues, including medication changes, new medications, side effects and how to manage them, and medication interactions
3. Sexual health issues, including questions about any sexual symptoms you may be having, how you can prevent or treat STIs, and how you can prevent transmitting HIV to your partner(s)
4. Family planning considerations, including your goals; birth control options for you and/or your partner, if relevant; your options for having children should you wish to do so; and, if you are a woman with HIV who is pregnant or considering getting pregnant, how you can reduce HIV transmission to your baby
5. Smoking, its impact on your health, and the importance of quitting
6. Substance use issues, including how alcohol/drug use can affect your HIV treatment and overall health, how to tell if alcohol use is a problem, and whether you should be referred for substance abuse treatment
7. Your mental wellbeing, including questions about any mental health symptoms you may be having, and whether mental health treatment may be helpful
8. Referrals for other medical issues you may be experiencing
9. The meaning of your lab test results
10. The need for any possible surgical procedures
11. Any clinical trials or research studies that may be relevant for you

Nurses, case managers, or pharmacists can often answer any follow-up questions and can assist you in accessing a range of services that can help you succeed in treatment, particularly around:

1. Understanding your HIV treatment plan, including how many pills of each medicine you should take; when to take each medicine; how to take each medicine (for example, with or without food); and how to store each medicine
2. Understanding possible side effects from your HIV medication and what you should do if you experience them
3. Developing medication adherence strategies and ways to overcome any challenges you may have keeping up with your medical appointments
4. Getting services that can help you manage any issues that might impact your health, such as mental health or substance abuse treatment, housing assistance, food assistance, and other resources that exist in your community
5. Helping you better understand lab reports, tests, and procedures
6. Accessing insurance and pharmacy benefits you may be eligible for, and other aspects of paying for care and treatment
7. Understanding other medical conditions you may have
8. Getting help to quit smoking and resources that are available to assist you

What are opportunistic infections?

• Opportunistic infections (OIs) are illnesses that occur more frequently and are more severe in people with HIV. This is because they have damaged immune systems.

• Today, OIs are less common in people with HIV because of effective HIV treatment.
• But some people with HIV still develop OIs because
  • they may not know they have HIV,
  • they may not be on HIV treatment, or
  • their HIV treatment may not be working properly.

How can I prevent opportunistic infections?

Taking HIV medicine is the best way to prevent getting OIs. HIV medicine can keep your immune system strong and healthy. If you develop an OI, talk to your health care provider about how to treat it.

There are also steps you can take to prevent getting OIs:

• Talk to your health care provider about medicines and vaccines that prevent certain OIs.
• Prevent exposure to other sexually transmitted diseases.
• Don’t share needles, syringes, or other drug injection equipment (for example, cookers).
• Limit your exposure to germs that could make you very sick. This includes tuberculosis or germs found in the stools, saliva, or on the skin of animals.
• Don’t consume certain foods, including undercooked eggs, raw milk and cheeses, unpasteurized fruit juices, or raw seed sprouts.
• Don’t drink untreated water, such as water directly from lakes or rivers. Avoid drinking tap water in foreign countries. Use bottled water or water filters.
• Talk to your health care provider about things that could expose you to OIs at work, at home, and on vacation.

Am I legally required to share my HIV status with others?

In some states, there are laws that require you to share your HIV status with your sex or injection partners. Sharing your status with anyone else is your choice.

Sex or Injection Partners

Telling your partners that you have HIV before you have sex or inject drugs may be uncomfortable. But doing so protects you under the law. It also allows your partners to make decisions that can protect their health.

You should also tell your current or former partners if you’ve been diagnosed with another sexually transmitted disease (STD). This lets them know that they should also get tested for other STDs.

There are a few ways to let your partners know:

You tell your partners.

• These conversations can be hard. You may have been exposed to HIV by one of your partners, or you may have exposed one or more of them without knowing.

The health department tells your partners.

• This is sometimes called “Partner Services.”
• Health department staff tell your current and former partners that they may have been exposed to HIV.
• The health department will provide your partners with testing, counseling, and referrals for other services.
• Partner Services programs are available through health departments and some medical offices and clinics.
• Your health care provider, social worker, case manager, patient navigator, or HIV testing center can help you find a Partner Services program.

Health Care Providers

 Health care providers and other HIV service providers need to know so they can support you and protect themselves.

• They can help make sure you have access to the health care services that you need.
• They will remember to be very careful and take precautions such as wearing gloves to avoid direct contact with blood.

Family and Friends

Sharing your HIV status with certain family members and friends has emotional and practical benefits.

• Your family and friends can help you deal with an HIV diagnosis.
• They can support you with the longer-term issues of treatment.
• They can help you disclose your status to others.
• They can speak for you in case of an emergency.
• They can help you navigate the medical system.

Employers

You do not have to tell your employer.

• But you may want to share your status in case you need to take extended leave or alter your schedule. By law, your disclosure is confidential.
• Your state health department can also share your state’s laws and how they apply to disclosure.

Get and Keep an Undetectable Viral Load

• If you take HIV medicine and get and keep an undetectable viral load, you will not transmit HIV to your sex partner.
• Having an undetectable viral load likely reduces the risk of HIV transmission through sharing needles, syringes, or other drug injection equipment (for example, cookers), but we don’t know by how much.
• Getting and keeping an undetectable viral load is the best thing you can do to stay healthy and protect others.

What if I cannot get an undetectable viral load?

Some people face challenges that make it hard to stick to a treatment plan. A few people cannot get an undetectable viral load even though they take HIV medicine as prescribed. If your viral load is not undetectable—or does not stay undetectable—you can still protect your partners by using other prevention options.

Encourage Your Partners to Take PrEP

• PrEP (pre-exposure prophylaxis) is medicine people at risk for HIV take to prevent HIV.
• If taken as prescribed, PrEP is highly effective for preventing HIV from sex and injection drug use.

Use Condoms the Right Way Every Time You Have Sex

• Condoms are highly effective in preventing HIV and other sexually transmitted diseases (STDs), like gonorrhea and chlamydia.
• Use water-based or silicone-based lubricants to help prevent condoms from breaking or slipping during sex.
• Learn the right way to use an external condom (sometimes called a male condom) and an internal condom (sometimes called a female condom).

Choose Sexual Activities with Little to No Risk

• Choose sex that is less risky than anal or vaginal sex. There is little to no risk of getting HIV through oral sex.
• You can’t transmit HIV through sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood).

Get Tested and Treated for Other STDs

• If you get and keep an undetectable viral load, getting an STD does not appear to increase the risk of transmitting HIV. But STDs can cause other problems.
• If you have a detectable viral load, getting tested and treated for other STDs can help lower your chances of transmitting HIV.

Talk to Your Partner About PEP If You Think They May Have Been Recently Exposed to HIV

• PEP (post-exposure prophylaxis) is medicine people take to prevent HIV after a possible exposure (for example, if the condom breaks during sex and you don’t have an undetectable viral load).
• PEP must be started within 72 hours of a possible exposure. The sooner your partner starts PEP, the better. Every hour counts.

Never Share Needles, Syringes, or Other Drug Injection Equipment

• Use new, clean syringes and injection equipment every time you inject.
• Many communities have syringe services programs (SSPs) where you can get new needles and syringes and safely dispose of used ones. SSPs can also link you to substance use disorder treatment, testing, and care and treatment for infectious diseases.
• Some pharmacies sell needles without a prescription.

How can I protect my baby?

Talk to Your Health Care Provider About Medical Care for You and Your Baby

• Your health care provider will order tests and suggest medicine for you to take.
• Discuss all the pros and cons of taking medicine while you’re pregnant.
• Ask your health care provider questions about other prenatal care and family planning.

Take HIV Medicine as Prescribed and Give HIV Medicine to Your Baby After Birth

• Your treatment will not change or change only a little from what it was before you became pregnant.
• If you take HIV medicine as prescribed throughout pregnancy, labor, and delivery and give HIV preventive medicine to your baby after birth as recommended by your health care provider, the chance of your baby getting HIV is less than 1%.

Talk to Your Provider About Options for Feeding Your Baby

• After delivery, you can prevent transmitting HIV to your baby by feeding your infant with properly prepared formula or pasteurized donor human milk from a milk bank. These are recommended if you have a detectable viral load.
• If you have undetectable viral load during pregnancy, and you wish to breast/chestfeed, you can discuss with your provider and make a plan together on the best way to breast/chestfeed safely. Taking HIV medicine and maintaining an undetectable viral load during pregnancy, labor and delivery and while breast/chestfeeding reduces chances of transmission to less than 1% through breast/chestfeeding.

You should also have a pelvic examination and get tested for other sexually transmitted diseases (STDs) during your pregnancy.

If I have an undetectable viral load, do my partner and I need to use anything else to prevent sexual transmission of HIV?

Getting and keeping an undetectable viral load prevents HIV transmission during sex. But there are situations when either partner may want to use additional prevention options.

• Using condoms can help prevent some other STDs.
• Using condoms or having your partner take PrEP can provide added peace of mind.
• Also consider using additional prevention options if you
  • Are unsure, for any reason, that you have an undetectable viral load;
  • Have a high viral load (200 copies of HIV per milliliter of blood or greater);
  • Have trouble taking HIV medicine regularly;
  • Missed some doses since your last viral load test; or
  • Have stopped taking HIV medicine or may do so in the future.

How can HIV affect my mental health?

​​​Having HIV can be a source of major stress.

• HIV may challenge your sense of well-being or complicate existing mental health conditions.
• HIV, and some opportunistic infections, can also affect your nervous system and can lead to changes in your behavior.

Good mental health will help you live your life to the fullest and is essential to successfully treating HIV.

HIV and Depression

One of the most common mental health conditions that people with HIV face is depression.

What are the symptoms of depression?

Symptoms of depression that can affect your day-to-day life include

• Persistent sadness,
• Anxiety,
• Feeling “empty,”
• Feelings of helplessness,
• Negativity,
• Loss of appetite, and
• Disinterest in engaging with others.

To help manage your mental health, it is important to know when, how, and where to get help. If you need help finding treatment

• use SAMHSA’s Treatment Locator, or
• call the national helpline at 1-800-662-HELP.

Depression can be Treated

Ask your health care provider, social worker, or case manager about local support groups. They may also refer you to a mental health provider who can give you the care you need:

• Psychiatrists treat mental health problems with various therapies, like talk therapy, and by prescribing medicine.
• Psychologists help people cope with life challenges and mental health problems with therapies, like talk therapy. Psychologists usually cannot prescribe medicine.
• Therapists are mental health or marriage and family counselors. They help people cope with life issues and mental health problems.

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:

• A health care professional refusing to provide care or services to a person living with HIV
• 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.

What can be done about HIV stigma?

Talk About HIV

Talking openly about HIV can help normalize the subject. It also provides opportunities to correct misconceptions and help others learn more about HIV. But be mindful of how you talk about HIV and people living with HIV. 

Take Action

We can all help end HIV stigma through our words and actions in our everyday lives. Lead others with your supportive behaviors. 

What should I ask my health care provider about having a baby?

Your health care provider can provide information to help you make the best decision about having a baby. You might ask your health care provider some of these questions:

• What is the safest way to conceive?
• Will HIV cause problems for me during pregnancy or delivery?
• Will my HIV treatment cause problems for my baby?
• What are the pros and cons of taking medicine while I am pregnant?
• Is my viral load undetectable?
• How do I avoid transmitting HIV to my partner, surrogate, or baby during conception, pregnancy, and delivery?
• If my partner is on PrEP, will we have a lower chance of transmitting HIV to our baby?
• What medical and community programs and support groups can help me and my baby?
• What birth control methods are best for me?

Adopting a baby is also an option for people with HIV who want to begin or expand their families. The American with Disabilities Act does not allow adoption agencies to discriminate against individuals or couples with HIV.

Working with HIV

With proper care and treatment, many people living with HIV lead normal, healthy lives, including having a job. Most people living with HIV can continue working at their current jobs or look for a new job in their chosen field. Your overall well-being and financial health can be more stable when you are gainfully employed.

Getting a New Job or Returning to Work

Working will affect a lot of your life: your medical status, your finances, your social life, the way you spend your time, and perhaps even your housing or transportation needs. Before taking action on getting a new job or returning to work, you may want to get information and perspectives from:

• Your HIV case manager or counselor, if you have one
• Benefits counselors at an HIV service organization or other community organization
• The Social Security Administrations Work Incentives Planning and Assistance Program (WIPA)
• Other people living with HIV who are working, or have returned to work
• Providers of any of your housing, medical, or financial benefits
• Public and non-profit employment and training service providers

Here are some questions to discuss with them:

• What are my goals for employment?
• What kind of work do I want to do?
• What are the resources that can help me set and achieve a new career goal?
• Are there state or local laws that further strengthen anti-discrimination protections in the American Disabilities Act (ADA)?
• How do I access training or education that will help me achieve my goals?
• How can I plan to take care of my health if I go to work?
• How will my going to work impact the benefits I am receiving?

Requesting Reasonable Accommodations

Qualified individuals with disabilities, including people living with HIV, have the right to request reasonable accommodations in the workplace. A reasonable accommodation is any modification or adjustment to a job or work environment that enables a qualified person with a disability to apply for or perform a job. An accommodation may be tangible (for example, a certain type of chair) or non-tangible (for example, a modified work schedule for someone with a medical condition requiring regular appointments with a health care provider). You are qualified if you are able to perform the essential functions of the job, with or without reasonable accommodation.

Your supervisor may not be trained in reasonable accommodations or know how to negotiate them. For that reason, often its best to go directly to the person responsible for human resources at your employer, even if that person works in a different location. In a small business, that person may well be the owner.

When you request an accommodation, state clearly what you need (for example, time off for a clinic visit every third Tuesday of the month, a certain type of chair, or a change in your work hours) and be ready to supply a doctors note supporting your request. The initial note need not contain your diagnosis, but it should verify that you are under that doctors care and that he/she believes you need the accommodation to maintain your health or to be able to fulfill essential functions of your job.

Many people living with HIV do not want to give a lot of details about their health. If you prefer not to provide a lot of information, you may want to limit the medical information you initially give to your employer. However, if your need for accommodation is not obvious, your employer may require that you provide medical documentation to establish that you have a disability as defined by the ADA, to show that the employee needs the requested accommodation, and to help determine effective accommodation options. This can, but often does not, include disclosing your specific medical condition.

Be aware that not all people with HIV or AIDS will need accommodations to perform their jobs and many others may only need a few or simple accommodations. The U.S. Department of Labors (DOL) Job Accommodation Network (JAN) provides free, expert, and confidential technical assistance to both employees and employers on workplace accommodations and disability employment issues, which includes resources for employees living with HIV or AIDS. See AskJAN.org, or call 800-526-7234 (voice) or 877-781-9403 (TTY) for one-on-one guidance.

Should People with HIV Exercise?

Yes! Being HIV-positive is no different from being HIV-negative when it comes to exercise. Regular physical activity and exercise are part of a healthy lifestyle for everyone, including people with HIV.

What Are the Benefits of Physical Activity?

Physical activity has many important benefits. It can

• Boost your mood
• Sharpen your focus
• Reduce your stress
• Improve your sleep

Physical activity can also help you reduce your risk of developing cardiovascular disease, high blood pressure, type 2 diabetes, and several types of cancer. These are all health conditions that can affect people living with HIV.

How Much Activity Should You Do?

According to the evidence-based Physical Activity Guidelines (2018), adults need at least 150 to 300 minutes per week of moderate-intensity aerobic activity, like biking, brisk walking, or fast dancing. Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days per week.

If you’re living with HIV or have another chronic health condition, talk to your health care provider or a physical activity specialist to make sure these guidelines are right for you.

The most important thing is to move more and sit less!

What Types of Activity Are Right for People Living with HIV?

People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV.

Physical activity is any body movement that works your muscles and requires more energy than resting. Brisk walking, running, biking, dancing, jumping rope, and swimming are a few examples of physical activity.

Exercise is a type of physical activity that's planned and structured with the goal of improving your health or fitness. Taking an aerobics class and playing on a sports team are examples of exercise.

Both are part of living healthy.

Take time to find a fitness routine that you enjoy. You may consider taking part in a group activity that allows you to engage with others. Make it fun and commit to being physically active regularly.

Why Is a Good Diet Important for People with HIV?

Good nutrition is important to all people—whether or not they are living with HIV. But some conditions related to treating HIV or AIDS (including wasting, diarrhea, and lipid abnormalities) mean that proper nutrition is really important to people with HIV. Eating well is key to maintaining strength, energy, and a healthy immune system. In addition, because HIV can lead to immune suppression, food safety and proper hygiene are concerns when it comes to preventing infections.

A healthy diet is essential to maintaining good health across your lifespan. The U.S. Food and Drug Administration (FDA) defines a healthy diet as one that: provides enough of each essential nutrient; contains a variety of foods from all of the basic food groups; provides adequate energy to maintain a healthy weight; and does not contain excess fat, sugar, salt, or alcohol. There are six essential nutrients:

• Protein builds muscles and a strong immune system.
• Carbohydrates (including starches and sugars) give you energy.
• Fat gives you extra energy.
• Vitamins regulate body processes.
• Minerals regulate body processes and also make up body tissues.
• Water gives cells shape and acts as a medium in which body processes can occur.

Before you make major changes in your diet, however, contact your primary care provider, or a registered dietician who specializes in HIV care, to get a better assessment of your nutritional needs.

What Do You Need to Know About Food Safety?

Because HIV affects your immune system, you may be at greater risk for food-borne illness. So in addition to eating well, you need to eat safely. By following a few basic safety rules when you prepare and eat your meals, you can protect yourself from food-related illness:

• Avoid eating raw eggs, meats, or seafood (including sushi and oysters/shellfish).
• Wash fruits and vegetables thoroughly.
• Use a separate cutting board for raw meats.
• Wash hands, utensils, and cutting boards with soap and water after each use.
• Water safety is extremely important, as water can carry a variety of parasites, bacteria, and viruses. To protect yourself against these infections, here are some helpful hints:
  • Do not drink water from lakes, ponds, rivers, or streams.
  • You may choose to use a store-bought water filter at home for your drinking water.
  • You can significantly reduce your risk of water-borne illness by using only boiled water for drinking and cooking.
  • When traveling abroad in areas where sanitation is poor or water safety is questionable, drink only bottled water and avoid ice or unpasteurized juices and drinks.

If you've just been diagnosed with HIV, you might be wondering what alcohol and other "recreational" drugs will do to your body. Recreational drugs are drugs that aren't being used for medical purposes, such as cocaine, amphetamines, and pot. This also includes prescription medicines that are being taken not as prescribed and synthetic drugs sold online or in stores.

You may be wondering whether these drugs are bad for your immune system. And what about your HIV medications--can recreational drugs affect those? Each person is different, and a lot depends on which drugs you use, how much you use, and how often you use them.

Most experts would agree that, in large amounts, drugs and alcohol are bad for your immune system and your overall health. Remember, when you have HIV, your immune system is already weakened.

Effects on your immune system

Drinking too much alcohol can weaken your immune system. A weaker immune system will have a harder time fighting off common infections (such as a cold), as well as HIV-related infections. A weaker immune system also increases the chance that you will experience more side effects from your HIV medications. Smoking marijuana or other drugs irritates the lungs. You may be more likely to get serious lung infections, such as pneumonia.

Other common recreational drugs, such as cocaine or crystal methamphetamine, can leave your body dehydrated and exhausted, as well as lead to skin irritation. These stimulants also shunt blood away from your extremities, risking higher rates of infection and significantly increased blood pressure.

If you also have hepatitis, your liver is working very hard to fight the hepatitis and using alcohol or drugs can cause additional damage to your liver.

Interactions with your HIV meds

When you are taking HIV medications, it is important that your liver works as well as possible. Your liver is responsible for getting rid of waste products from medications.

Certain HIV medications can boost the level of recreational drugs in your system in unexpected and potentially dangerous ways. For example, amphetamines (such as crystal meth) can be present at 3 to 22 times their normal levels in the bloodstream when mixed with an HIV drug called ritonavir (Norvir). That's because ritonavir affects the body's ability to break down these other drugs.

Many HIV medications can affect your kidneys. All substances in the blood are filtered through our kidneys. When drugs and alcohol are added, severe permanent damage can occur to our kidney function.

If you are going to take a recreational drug while you are on HIV medication, it is better to start with a very low amount of the recreational drug (as low as 1/4 the normal amount) and allow time to see how it affects you before increasing the amount. Keep in mind that recreational drugs aren't regulated, so you never know exactly how much you are getting.

Although you may feel uncomfortable at first, you should tell your provider what drugs you are using. That way, your provider will know how the substances you are using affect your HIV medications and your overall health.

Drugs, alcohol, and safer sex

Many drugs, including alcohol and methamphetamine, may affect your ability to make decisions. Even if you take your HIV medications regularly and practice safer sex when you're not high, when you're under the influence of drugs you may be willing to take more risks. For example, you might not use a condom or take your HIV medications.

These actions put your partner at risk for HIV and put you at risk for other sexually transmitted diseases or for pregnancy.

Remember to take your HIV medications every day, and to keep condoms handy in places where you might have sex. Also, try to limit the amount of drugs you use or alcohol you drink if you know you are going to have sex or be in high risk social settings.

HIV and injection drug use

Sharing a needle or any equipment when injecting drugs is dangerous for you and for your sharing partners. They could get HIV from you, and you could get another disease, such as hepatitis, from them.

The safest option is not to share. Use clean needles and syringes each time and keep your own equipment to yourself. There are sterile syringe programs that can help provide clean needles..

Because of the dangers of injection drug use, the best way to lower your risk is to stop injecting drugs.

If you do inject drugs, follow these reminders:

• Never reuse or "share" syringes, water, or drug preparation equipment.
• Use only syringes obtained from a reliable source (such as pharmacies and needle or syringe services programs).
• Use a new, sterile syringe each time to prepare and inject drugs. If this is not possible, sterilize your syringe or disinfect your syringe and other equipment with bleach.
• 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 with a new alcohol swab prior to injection.
• Safely dispose of syringes after one use.

Good oral health is an important part of managing HIV and your overall health. Make oral health care a regular part of taking care of yourself.

With the right treatment, your mouth can feel better. That is a big step toward living well with HIV.

How can HIV affect my oral health?

HIV attacks the immune system, which protects the body from infections and illness.

A weakened immune system can lead to oral infections.

HIV can also cause dry mouth. It can affect the glands that produce saliva, which can cause your mouth to produce less saliva.

• Saliva protects your teeth and gums from plaque, which is a sticky film of bacteria. Plaque buildup can cause tooth decay (cavities), gum disease, and bad breath. Saliva also helps fight off infections.
• If dry mouth is not treated, it can lead to other health problems.
• Dry mouth can also be a side effect of some HIV medicines.

If you have HIV, you’re also at increased risk for oral health problems such as:

• Cavities
• Bleeding gums
• Loose teeth
• Bone loss around the teeth – also known as periodontitis
• Thrush – a mouth infection also called oral candidiasis
• Kaposi sarcoma – a cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat, or in other organs
• Oral papillomas (warts)
• Canker sores or fever blisters – fluid-filled blisters on the outside of the mouth around the lips

How can I take care of my oral health?

• See your dentist regularly for check-ups, even if you have no natural teeth or have dentures.
  • Discuss your HIV status with them to be sure you get the best care.
  • Ask about the best way to care for your mouth.
  • Ask them to repeat anything you don’t understand.
  • Tell them if you experience dry mouth, mouth sores, or notice white, purple, or red patches inside your mouth.
  • Tell them if you notice any unusual changes in the way your mouth looks or feels.
  • Talk to them about developing an oral health plan.
• Brush your teeth. Brushing is necessary for removing dental plaque.
• Floss every day. Flossing cleans plaque from the parts of your teeth that your toothbrush can’t reach.
• Take all your HIV medications on schedule to protect your immune system and help prevent oral infections.
• Don’t smoke.
  • If you smoke and have HIV, you’re at greater risk of getting HIV-related infections, including hairy leukoplakia (white mouth sores) and thrush.
  • Smoking increases your risk of gum disease, tooth loss, and cancers of the mouth, throat, and lips.
  • If you smoke, ask your dentist for help with quitting. Your dentist can help develop a quit plan that works best for you, such as nicotine replacement therapy (patch, gum, lozenge, or nasal spray), prescription medications, or other methods.

Vaccines are especially critical for people with chronic health conditions such as HIV infection.

If you have HIV infection and your CD4 count test is 200 or greater, talk with your doctor about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Pneumococcal vaccine to protect against pneumonia and other pneumococcal diseases
• Meningococcal conjugate vaccine series which protects against meningococcal disease
• Hepatitis B vaccine series to protect against hepatitis B
• HPV vaccine series to protect against human papillomavirus if you are a man or woman up to age 26 years
• MMR vaccine to protect against measles, mumps, and rubella if you were born in 1957 or after and have not gotten this vaccine or do not have immunity to these diseases
• Varicella vaccine to protect against chickenpox if you were born in 1980 or after and have not gotten two doses of this vaccine or do not have immunity to this disease

If you have HIV infection and your CD4 count test is less than 200, talk with your doctor about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Pneumococcal vaccine to protect against pneumonia and other pneumococcal diseases
• Meningococcal conjugate vaccine series which protects against meningococcal disease
• Hepatitis B vaccine series to protect against hepatitis B
• HPV vaccine series to protect against human papillomavirus if you are a man or woman up to age 26 years

Why do I need to take precautions when traveling abroad?

Traveling outside the United States can be risky for anyone. However, it may require special precautions for people with HIV. For example, travel to some developing countries can increase the risk of getting an opportunistic infection. For some destinations, you may need certain vaccines. Your health care provider can review your medical record to ensure the vaccines are safe for you.

Before You Travel

Talk to your health care provider at least 4 to 6 weeks before you travel.

• Discuss medicine, such as antibiotics to treat travelers’ diarrhea, and vaccines you may need.
• Learn about the health risks in the places you plan to visit.
• Learn about specific measures you need to take to stay healthy.
• Gather the names of HIV health care providers or clinics in the area you plan to visit.

 Learn about your insurance.

• Review your medical insurance to see what travel coverage it provides.
• Take proof of insurance. Copy or scan your policy and send the image to an email address you can access when traveling.
• Leave a copy of your insurance at home and tell your friends or family where you left it.
• Consider purchasing additional travel insurance if your insurance doesn’t cover emergency transportation to a health care facility, or the cost of care received in other countries.

Learn about your destination.

• Find out if the countries you plan to visit have special health rules for visitors, especially visitors with HIV.

During Travel

Stick to safe eating and drinking habits.

• Food and water in some developing countries may contain germs that could make you sick.
• Eat only hot foods.
• Drink bottled water or drinks, hot coffee or tea, wine, beer, or other alcoholic beverages.
• Avoid raw fruit or vegetables that you do not peel yourself.
• Avoid eating raw or undercooked seafood or meat or unpasteurized dairy products.
• Tap water and drinks or ice made with tap water could make you sick.

Take care of yourself and protect others.

• Take all your medications on schedule.
• Stick to your special diet if you are on one.
• Take the same precautions you take at home to prevent transmitting HIV to others.

Avoid direct contact with animal waste.

• Animal waste (stool) in soil or on sidewalks can be harmful to people with HIV.
• Wear shoes to protect yourself from direct contact with animal waste.
• Use towels to protect yourself from animal waste when lying on a beach or in parks.
• Wash your hands with soap and water after physical contact with animals.

Avoid hospitals and clinics where coughing tuberculosis (TB) patients are treated.

• TB is very common worldwide and can be severe in people with HIV.
• See your health care provider when you return to discuss whether you should be tested for TB.

Growing Older with HIV

Today, thanks to improvements in the effectiveness of treatment with HIV medicine (called antiretroviral therapy or ART), people with HIV who are diagnosed early and who get and stay on ART can keep the virus suppressed and live long and healthy lives. For this reason, nearly half of people living with diagnosed HIV in the United States are aged 50 and older. Many of them have been living with HIV for many years; others were diagnosed with HIV later in life.

That’s a significant change from the early years of the epidemic when people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after their diagnosis. This meant that the issues of aging were not a major focus for people with HIV disease.

According to the Centers for Disease Control and Prevention (CDC), in 2018, over half (51%) of people in the United States and dependent areas with diagnosed HIV were aged 50 and older. In addition, people aged 50 and older accounted for 17% of the 37,968 new HIV diagnoses in 2018 in the United States and dependent areas. Though new HIV diagnoses are declining among people aged 50 and older, around 1 in 6 HIV diagnoses in 2018 were in this group.

People over age 50 with HIV make up 46.8% of the over half a million clients served by the Ryan White HIV/AIDS Program (RWHAP). In 2019, 92.2% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average (88.1%).

Health Issues and Aging with HIV

People aging with HIV share many of the same health concerns as the general population aged 50 and older: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors. In addition, while effective HIV treatment has decreased the likelihood of AIDS-defining illnesses among people aging with HIV, many HIV-associated non-AIDS conditions occur frequently in older persons with HIV, such as cardiovascular disease, diabetes, renal disease, and cancer. These conditions are likely related to a number of interacting factors, including chronic inflammation caused by HIV. Researchers are working to better understand what causes chronic inflammation, even when people are being treated with ART.

HIV and its treatment can also have effects on the brain. Researchers estimate that between 25 and 50% of people with HIV have HIV-Associated Neurocognitive Disorder (HAND), a spectrum of cognitive, motor, and/or mood disorders categorized into three levels: asymptomatic, mild, and HIV-associated dementia. Researchers are studying how HIV and its treatment affect the brain, including the effects on older people living with HIV.

Late HIV Diagnosis

Older Americans are more likely than younger Americans to be diagnosed with HIV late in the course of their disease, meaning they get a late start receiving the benefits of HIV treatment and possibly incur more damage to their immune system. This can lead to poorer prognoses and shorter survival after an HIV diagnosis. Late diagnoses can occur because health care providers may not always test older people for HIV infection, and older people may mistake HIV symptoms for signs of normal aging and don’t consider HIV as a possible cause they should discuss with their provider.

According to CDC, in 2018, 35% of people aged 50 and older already had late-stage HIV infection (AIDS) when they received a diagnosis (i.e., they received a diagnosis later in the course of their disease.)

COVID-19 and Older Adults with HIV

Researchers are still learning about COVID-19 and how it affects people with HIV. Based on limited data, scientists believe people with HIV who are on effective HIV treatment have the same risk for COVID-19 as people who do not have HIV.

Older adults and people of any age who have serious underlying medical conditions might be at increased risk for severe illness. This includes people who have weakened immune systems. The risk for people with HIV getting very sick is greatest in people with a low CD4 cell count and people not on effective HIV treatment (antiretroviral therapy or ART).

The Importance of Support Services

Living with HIV presents certain challenges, no matter what your age. But older people with HIV may face different issues than their younger counterparts, including greater social isolation and loneliness. Stigma is also a particular concern among older people with HIV. Stigma negatively affects people’s quality of life, self-image, and behaviors, and may prevent them disclosing their HIV status or seeking the health care or social services that many aging adults my require. HIV care.

Therefore, it is important for older people with HIV to get linked to HIV care and have access to mental health and other support services to help them stay healthy and remain engaged in HIV care. You can find support services through your health care provider, your local community center, or an HIV service organization.

Emergency Preparedness: What Do People with HIV Need to Know?

All Americans should have a plan for what to do during a hurricane, wildfire, or other emergency. But for people with HIV, it’s especially important to be prepared.

Plan ahead. To stay healthy, people with HIV must take HIV medicine (called antiretroviral therapy or ART) exactly as prescribed and get and keep an undetectable viral load—a level of HIV in your blood so low that a standard lab test can’t detect it. A natural disaster or other emergency may make it harder for you to do this. To avoid interruptions in your HIV treatment, ask your health care provider if you can get a 30-day (or longer) emergency prescription refill of your HIV medicine. Some states permit coverage for advanced refills of prescription medicine during an emergency, but laws vary by state. Learn more about Emergency Prescription Laws in your state.

Make a list of medicines and gather other medical paperwork. Keep a list of your HIV medicines and any others you take, their dosage amounts, and frequency, and a summary of your HIV treatment history in case you have to see another provider temporarily. Make sure you have a copy of your insurance card and the phone numbers for your providers and pharmacies.

Communicate with your provider. Talk to your healthcare provider about what you should do if you run out of medicine due to an emergency. In addition, in the event of an outbreak of a disease (like the flu), ask your provider whether you need to take specific precautions because you have HIV. See information about COVID-19 below.

Follow safety guidelines. Be aware that some types of disasters may affect air and water quality—which can be even harder on people with HIV and others with weakened immune systems. If you have HIV, disruptions in the availability of food and clean water can increase your risk for opportunistic infections. If proper sanitation and hygiene are an issue, it’s important to follow proper food and water safety guidelines. See CDC’s information on keeping food and water safe after a disaster or emergency. Also follow local guidance about exercise and going outside on days with poor air quality. See CDC’s information on protecting yourself during wildfire season.

Wash your hands. Regular handwashing with soap and clean water is the best way to remove germs that can make you and others sick. If you don’t have soap and clean water, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Stay up to date on your vaccines. Make sure your vaccines for infections and illnesses such as tetanus and seasonal flu are up to date. Know the date of your last tetanus shot in case of injury in an emergency. (Learn more about COVID-19 vaccines, below.)

Learn how you can get emergency prescription assistance. The Department of Health and Human Service’s Emergency Prescription Assistance Program may be activated after a disaster. It is a free service that helps people in a federally-identified disaster who do not have health insurance get the prescription drugs, vaccinations, medical supplies, and equipment that they need. Visit PHE.gov/EPAP for details.

COVID-19 and Emergency Preparedness

The COVID-19 pandemic has made preparing for and responding to disasters and emergencies more complicated, and this makes being informed and having a personal emergency plan even more important.

Get vaccinated for COVID-19, including a booster shot. CDC advises that people who have certain medical conditions, including HIV, are more likely to get severely ill from COVID-19 and should stay up to date with COVID-19 vaccination including booster shots for their age group. Some people who have moderately or severely compromised immune systems, including those with advanced or untreated HIV, should receive a third primary dose of COVID-19 vaccine and the most recent booster dose recommended to them by CDC. If you have questions about getting a COVID-19 vaccine, you should talk to your healthcare providers for advice.

If you are moderately or severely immunocompromised or severely allergic to COVID-19 vaccines, you may be eligible for Evusheld, a medicine given every six months by your healthcare provider to help prevent you from getting COVID-19. Talk to your healthcare provider to find out if this option is right for you.

CDC also recommends additional actions for people with chronic diseases, including:

• Develop a disaster plan, and create an emergency “go kit” that includes personal items, disinfectant wipes and spray, bar or liquid soap, hand sanitizer with at least 60% alcohol, and multiple, clean masks for everyone age 2 or older. Masks should have two or more layers and fit snugly against your face. Children under 2 should not wear masks. You can also include medicines and medical supplies, and copies of your COVID-19 vaccination record card and other medical records.
• Do not delay getting emergency care for your underlying medical condition because of COVID-19. Emergency departments urgent care, clinics, and your health provider or doctor have infection prevention plans in place to protect you from getting COVID-19 if you need care.
• Do not avoid seeking shelter with friends or relatives or at a disaster shelter, if needed. Emergency managers, shelter managers, and public health professionals are taking measures to reduce the possible spread of COVID-19 among people who seek safety in a disaster shelter during severe weather events. Follow CDC recommendations to help you shelter safely during the COVID-19 pandemic and remember your shelter location may be different this year due to the COVID-19 pandemic.
• Tell shelter staff if you have any medical needs, including medicines that need to be refrigerated.
• Follow CDC’s COVID-19 preventive actions, including washing your hands often and covering coughs and sneezes.  Avoid sharing food and drink with anyone if possible. And follow disaster policies for wearing masks and giving people space.