17 Frequently Asked Questions about HIV, AIDS, STDs, Relationships and Skin Infections among MSM/Sexual Minorities in Uganda

How is HIV Spread?                                                                                                                                 

People infected with HIV carry the virus in their body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can spread only if these HIV-infected fluids enter the bloodstream of another person. This can take place (1) through the walls of the vagina, rectum, mouth, or the opening at the tip of the penis; (2) through injection with a syringe; or (3) through a break in the skin, such as a cut or sore. The most common ways that people become infected with HIV are:

• Unprotected sexual intercourse (either vaginal or anal) with someone who has HIV;
• Sharing needles or syringes (including those used for steroids) with someone who has HIV;
• Mother-to-child transmission during pregnancy, childbirth, or breast-feeding.

Are You Afraid You May Already Have HIV?

Some people develop mild, temporary flu-like symptoms or persistent swollen glands immediately after becoming infected with HIV. But symptoms are not a good indicator of HIV infection, because many people don’t experience any symptoms for many years. Even if you look and feel healthy, you could still be infected.

You may be at risk if you have had unprotected sex or if the condom broke during sex, if you have multiple partners or have discovered your partner was not monogamous, if you have shared needles, if you recently tested positive for another sexually transmitted infection, or if you were sexually assaulted. And it is important to know that HIV is more easily passed from men to women or from the insertive partner to the receptive partner.

If you think there’s a chance you may have been exposed to HIV, you should get tested as soon as possible.

What Happens When You Get Tested?

There are several types of HIV tests. The most basic is the HIV antibody test, which takes one to two weeks to generate results and may produce false positives. A positive antibody test is always followed by an antigen test to confirm the first test. If doubts still persist, doctors usually recommend a third very sensitive and expensive test that can detect the presence of the virus itself.

In addition to the blood tests described above, another option is the OraSure rapid test, which uses a swab of oral mucus or fluid from the inside of your cheek. Rapid tests can detect HIV antibodies in about 20 minutes, eliminating the waiting period between taking an HIV test and learning your status.

Bear in mind—it normally takes three months after the last possible exposure to HIV before a person will test positive. Since the greatest period of contagion is in the earliest weeks after HIV infection, and since HIV antibody tests cannot definitely confirm infection earlier than three months, you should take great care to avoid unprotected sex if you think you may have been exposed to HIV recently.

A positive HIV test result indicates that antibodies to HIV were detected. It does not mean that you have AIDS or that you will get sick right away. And although there is no cure for HIV/AIDS, many opportunistic infections can be prevented or treated.

Likewise, negative test results do not necessarily rule out HIV infection, because there is a window period between HIV infection and the appearance of HIV antibodies. If you have engaged in risky activities, it is important to be re-tested every three months.

 Is it important to Get Tested?

Many young people who are HIV positive don’t know it, which means they can’t take important steps to protect themselves or other people, or to get the medical care they need. One should take initiative to be tested for HIV. It lets one know the status and seek timely management for positive status or seek counselling on how to stay negative.

It's ideal to get tested at a place that provides counselling because counsellors can help you understand what your test results mean, answer questions about how to protect yourself and others, and refer you to local HIV-related resources.

 Why Is It Important to Know if you’ve Got HIV?

If you think you may have HIV, it is important to find out as soon as possible. HIV is most easily transmitted when the level of virus in the body is at its highest—shortly after HIV infection and at the late stage of the disease. Even in the early stages of HIV infection, you can take concrete steps to protect your long-term health. Beginning medical care before you begin to get sick may give you many more years of healthy life. And knowing you’re HIV positive allows you to take the necessary precautions to prevent others from becoming infected.

If you are HIV positive, it is important to see your doctor regularly. Get tested for tuberculosis and other opportunistic infections. Keep your immune system strong through good nutrition, adequate sleep, and not smoking or drinking alcohol. Find a social support system; it is important to remember that you are not alone.

 How Can You Tell if Someone Has HIV/AIDS?

You can’t tell if someone has HIV or AIDS simply by looking. An infected person can appear completely healthy. But anyone infected with HIV can infect other people, even if no symptoms are present and even if they believe they are negative. If you are sexually active, the only way to be sure you don’t have HIV is to get tested.
If you’re not sexually active, you’ve already eliminated the most common cause of HIV infection. But if you have made the decision to have sexual intercourse, you need to protect yourself.
HIV/AIDS doesn’t discriminate. That means that anyone who engages in risky behaviour can become infected with HIV.

Remember, it’s not who you are but what you do that determines whether you can become infected with HIV.

When Is Safer Sex Important?

The rules are simple. Whenever you have sexual intercourse, (or oral sex), practice safer sex by using a condom or dental dam (a square of latex recommended for use during sex). When used properly and consistently, condoms are close to 99 percent effective in preventing transmission of HIV. But remember:

• Use only latex condoms (or dental dams);
• Use only water-based lubricants;
• Use protection each and every time you have sex.

Other methods of birth control (such as the diaphragm and birth control pills) do not protect against HIV and other sexually transmitted infections (STIs).

Practicing safer sex will help you avoid other STIs, many of which can increase your risk of contracting HIV or giving it to someone else. You should also limit the number of sexual partners you have, and limit the use of alcohol or recreational drugs, which can impair judgment and decisions one makes before and during sex.

Is Protection Necessary During Oral Sex?

It is much easier to contract HIV through unprotected vaginal or anal sex. Unprotected oral sex (mouth to penis, mouth to anus, mouth to vagina) is not a completely safe substitute. If you choose to perform or receive oral sex—whether your partner is male or female—it's wise to guard against the transmission of HIV. Here’s how:

• Use a latex condom each and every time you perform oral-penile sex (fellatio); or
• Use plastic food wrap, a latex condom cut open, or a dental dam during oral-vaginal sex (cunnilingus) or oral-anal sex (analingus).

These methods provide a physical barrier to HIV transmission and help keep you safe from other sexually transmitted infections, many of which can increase your risk of contracting HIV or giving it to someone else.

Aren’t HIV and AIDS the Same Thing?

This is a good one. Are the legs and arms the same? They are both limbs but one pair is the upper and the other the lower limb. 

HIV (human immunodeficiency virus) causes AIDS (acquired immunodeficiency syndrome). When HIV infects someone, the virus enters the body and begins to multiply and attack immune cells that normally protect us from disease. Eventually the body's immune system breaks down and is unable to fight off opportunistic infections and other illnesses ranging from pneumonia and cancer to blindness and dementia. Only when someone with HIV begins to experience these specific infections and illnesses are they diagnosed with AIDS.

Is There a Cure for HIV/AIDS?

AIDS is still a fatal disease for which there is no cure and no vaccine. New medications are helping many people with HIV/AIDS live longer, healthier lives, but the combination or “cocktail” treatments don’t work for everyone. They are very expensive and often cause serious side effects, including liver damage, increased risk of heart attack, a form of osteoporosis, chronic diarrhoea, rashes, fat redistribution, and high cholesterol. And because HIV mutates constantly, the virus often develops resistance and the medications become ineffective. The best defence is to use a condom.

Do STIs make me Get HIV?

HIV/AIDS is also a sexually transmitted infection although it can be transmitted non-coitally (without having sex with someone) through blood transfusion with HIV contaminated blood. A list of STIs includes; chlamydia, genital warts, gonorrhoea, herpes, and syphilis. People aged 15–35 years; represent a big percentage of the sexually active population which makes them susceptible to acquiring new STIs when they engage in unprotected sex (WHO).

Having any of the above sexually transmitted infection can increase your risk of acquiring or transmitting HIV and developing AIDS. This is true whether you have open sores or breaks in the skin (as with syphilis, herpes, and chancroid) or not (as with chlamydia and gonorrhoea). Where there are breaks in the skin, HIV can enter and exit the body more easily. But even when you have undamaged skin, STIs can cause biological changes that may make HIV transmission more likely. Studies show that people with HIV who are infected with another STI are two to five times more likely to contract or transmit the virus through sex. What to do? Practice safer sex.

Can You Get HIV Through Casual Contact?

HIV is not an easy virus to pass from one person to another, like the flu. It is not transmitted through food or air (for instance, by coughing or sneezing). There has never been a case where a person was infected by a household member, relative, co-worker, or friend through casual or everyday contact such as sharing eating utensils and bathroom facilities or hugging and kissing. (Most scientists agree that while HIV transmission through deep or prolonged “French” kissing might be possible, it’s extremely unlikely.) There have been no recorded cases of transmission through contact with saliva, tears, or sweat.

Mosquitoes, fleas, and other insects do not transmit HIV; when they bite a person, they inject their own saliva, not their blood or the blood of the last person they bit. You can’t get HIV from giving blood at a blood bank or other established blood collection center; they use sterile-packed needles every time they draw blood.

Does Gender-Based Violence in same sex relations exist?

Yes. Gender-based violence refers to a range of harmful customs and behaviours against girls, boys, women, and men, including intimate partners by subjecting them to forms of violence, deprivation, domestic violence. These include assaults against girls, boys, women, men, in various forms such as child sexual abuse, and rape. It generally derives from cultural and social norms where men or dominant partners use power and authority to force their way over those vulnerable, submissive, or over women. Prevalence estimates for GBV vary widely as a result of differing definitions of violence, power play relations, data on who is most vulnerable, reporting systems, collection methods, and time periods used in different studies. Current estimates indicate that between 8% and 70% of submissive partners, weaker partners and women worldwide have been physically or sexually assaulted by a dominant partner at least once in their lives. This variation in estimated prevalence may also be a consequence of significant under reporting due to stigma, shame, or other social and cultural factors that deter weaker partners and women from disclosing episodes of gender-based violence.

I don’t identify as a gay or lesbian who am I?

 Gay or lesbian is a term used as a watered down definition for same sex orientation relations. You may not identify as gay or a lesbian due to reasons you know better and the consequences of your own visibility. This is normal. However, if you are male you are a man who has sex with a man. If you are a female, you are a woman who has sex with a woman. This situation has public health importance that is why there is need to explore and understand your sexual needs and developments. Any risky behaviour can expose you to danger as easily as someone in a hetero-sexual relation.

What are some of the misconceptions about anal sex?

 Anal sex is when the genitals of a partner or someone else are rubbed near or inserted in the anus in the act of consensual sexual consummation, act of rape, experimenting, and play acting. Many who indulge in anal sex are not aware it can expose them to HIV and STDs. Unprotected anal sex with a partner whose status is unknown or with multiple partners is risky and can expose one to infections.

Do condoms protect against HIV and other viral infections?

A condom used consistently and correctly with lubricant in penile- anal sex can protect both consenting partners against infection or in case one is infected it can protect against re-infection. However, if one indulges in oral sex there has to be protection with dental dams.

Why Do I Circumcise When I am A Pure/Total Bottom Who ONLY engages in receptive anal sexual intercourse?

A very good question. Thank you! You have heard of Safe Medical Male Circumcision? What about Voluntary Male Medical Circumcision (VMMC)? Well those two are interventions provided by qualified persons who are trained to perform the procedure and care for you under medically approved conditions. Now, the reason you circumcise is because you have made the decision on your own and have not been forced in any way.  

You circumcise to reduce your chances of picking up germs in the event of exchanging bodily fluids near or around penis head (urethra). 

There are other ways to give yourself sexual pleasure even without penetrating. One such way is suck or be sucked what is also known as "fellatio."  

The other way is the use of sex toys. 

So, when you share them, there is a likelihood of exchanging germs or bodily fluids filled with germs.  

Always use condoms or dental dams consistently and correctly with lubricant in penile- anal sex can protect both consenting partners against infection or in case one is infected it can protect against re-infection. However, if one indulges in oral sex there has to be protection with dental dams. You circumcise to minimize any chances of acquiring or giving infections were your partner to suck your penis. 

Education Materials to improve health seeking/Quality Life preservation decisions for gay persons in Uganda (Project 4)

Picture Courtesy of: Shawn K.