HIV and AIDS – Basic facts

General

1) What is HIV?

HIV stands for human immunodeficiency virus. HIV is a retrovirus that infects cells of the human immune system (mainly CD4-positive T-cells and macrophages—key components of the cellular immune system) and destroys or impairs their function. Infection with this virus results in the progressive depletion of the immune system, leading to immunodeficiency.

The immune system is considered deficient when it can no longer fulfil its role of fighting off infection and diseases. People with immunodeficiency are much more vulnerable to a wide range of infections and cancers, most of which are rare among people without immunodeficiency. Diseases associated with severe immunodeficiency are known as opportunistic infections because they take advantage of a weakened immune system.

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2) What is AIDS?

AIDS stands for acquired immunodeficiency syndrome and describes the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV has been established as the underlying cause of AIDS. The level of immunodeficiency or the appearance of certain infections are used as indicators that HIV infection has progressed to AIDS (see question 4).

3) What are the symptoms of HIV?

Most people infected with HIV do not know that they have become infected. Immediately after the infection, some people have a glandular fever-like illness (with fever, rash, joint pains and enlarged lymph nodes), which can occur at the time of seroconversion. Seroconversion refers to the development of antibodies to HIV and usually takes place between one and two months after an infection has occurred (see question 32).

Despite the fact that HIV infection often does not cause any symptoms, a person newly infected with HIV is infectious and can transmit the virus to another person (see question 7). The way to determine whether HIV infection has occurred is by taking an HIV test (see question 31).

HIV infection causes a gradual depletion and weakening of the immune system. This results in an increased susceptibility of the body to infections and cancers and can lead to the development of AIDS (see questions 2 and 4).

4) When does a person have AIDS?

The term AIDS applies to the most advanced stages of HIV infection.

The majority of people infected with HIV, if not treated, develop signs of AIDS within eight to 10 years.

AIDS is identified on the basis of certain infections. Stage 1 HIV disease is asymptomatic and not categorized as AIDS. Stage II (includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections), III (includes unexplained chronic diarrhoea for longer than a month, severe bacterial infections and pulmonary tuberculosis) or IV (includes toxoplasmosis of the brain, candidiasis of the oesophagus, trachea, bronchi or lungs and Kaposi’s sarcoma) HIV disease are used as indicators of AIDS. Most of these conditions are opportunistic infections that can be treated easily in healthy people.

In addition, the United States Centers for Disease Control and Prevention defines AIDS on the basis of a CD4-positive T-cell count of less than 200 per mm3 of blood (see: http://www.cdc.gov/epo/dphsi/print/aids1993.htm). CD4-positive T-cells are critical in mounting an effective immune response to infections.

5) How quickly do people infected with HIV develop AIDS?

The length of time can vary widely between individuals. The time between infection with HIV and becoming ill with AIDS can be 10-15 years, sometimes longer, but sometimes shorter. Antiretroviral therapy can prevent progression to AIDS by decreasing viral load in an infected body (see question 26).

Transmission

6) Where is HIV found?

HIV can be found in body fluids, such as blood, semen, vaginal fluids and breast milk.

7) How can HIV be transmitted?

HIV is transmitted through penetrative (anal or vaginal) sex, blood transfusion, the sharing of contaminated needles in health-care settings and drug injection and between mother and infant during pregnancy, childbirth and breastfeeding.

Sexual transmission

HIV can be transmitted through penetrative sex. HIV is not transmitted very efficiently so the risk of infection through a single act of vaginal sex is low. Transmission through anal sex has been reported to be 10 times higher than by vaginal sex. A person with an untreated sexually transmitted infection, particularly involving ulcers or discharge, is, on average, six to 10 times more likely to pass on or acquire HIV during sex.

Oral sex is regarded as a low-risk sexual activity in terms of HIV transmission.

When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load they are no longer infectious.

Transmission through sharing of needles and syringes

Re-using or sharing needles or syringes represents a highly efficient way of transmitting HIV. The risk of transmission can be lowered substantially among people who inject drugs by always using new needles and syringes that are disposable or by properly sterilizing reusable needles/syringes before reuse (see question 19). Transmission in a health-care setting can be lowered by health-care workers adhering to universal precautions (see question 20).

Mother-to-child transmission

HIV can be transmitted to an infant during pregnancy, labour, delivery and breastfeeding. Generally, there is a 15-30% risk of transmission from mother to child before and during delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Transmission from mother to child after birth can also occur through breastfeeding (see question 21). The chances of transmission of HIV to a child is very low if the mother is on antiretroviral therapy during pregnancy and when breastfeeding.

Transmission through blood transfusion

There is a high risk (greater than 90%) of acquiring HIV through transfusion of infected blood and blood products. However, the implementation of blood safety standards ensures the provision of safe, adequate and good-quality blood and blood products for all patients requiring transfusion. Blood safety includes screening of all donated blood for HIV and other blood-borne pathogens, as well as appropriate donor selection.

8) What is the risk of transmitting HIV through kissing or deep kissing?

Transmission through kissing on the mouth carries no risk, and no evidence has been found that the virus is spread through saliva by kissing.

9) What is the risk of transmitting HIV through body piercing or tattooing?

A risk of HIV transmission does exist if contaminated instruments are either not sterilized or are shared with others. Instruments that are intended to penetrate the skin should be used once, then disposed of or thoroughly cleaned and sterilized.

10) What is the risk of transmitting HIV through sharing razors with an infected person?

Any kind of cut using an unsterilized object, such as a razor or knife, can transmit HIV. Sharing razors is not advisable unless they are fully sterilized after each use.

11) Is it safe to have sex with a person living with HIV?

Having sex with someone living with HIV is safe if the person’s virus is fully suppressed by treatment. Sex is also safe if a condom is used properly or if you are taking pre-exposure prophylaxis in accordance with your health-care provider’s recommendations.

12) Is it safe for two people living with HIV to engage in unprotected sex exclusively with each other?

It is best for someone living with HIV to avoid becoming infected with a different strain of the virus. Therefore, the advice given in question 11 should be followed, except for the advice about pre-exposure prophylaxis, which is never used by people living with HIV.

Prevention

13) How can HIV infection be prevented?

Sexual transmission of HIV can be prevented by:

• Monogamous relations between uninfected partners.
• Non-penetrative sex.
• Consistent and correct use of male or female condoms
• Sex between two people when one of them is living with HIV but in taking antiretroviral therapy and has undetectable viral load
• Pre-exposure prophylaxis taken by people who are not infected with HIV.
• Voluntary Medical Male Circumcision reduces the chances of men acquiring HIV from women.

Additional ways of avoiding infection:

• If you are an injecting drug user, always use new needles and syringes that are disposable or needles and syringes that have been properly sterilized before reuse (see question 20) or opt for other prevention measures such as Opioid Substitution therapy.

• Ensure that blood and blood products are tested for HIV and that blood safety standards are implemented.
• See questions 19-22.

14) What is safer sex?

Safer sex involves taking precautions that decrease the potential of transmitting or acquiring sexually transmitted infections, including HIV, while having sex. Using condoms correctly and consistently during sex is considered safer sex, as is oral sex and non-penetrative sex or taking pre exposure prophylaxis if you are at risk of HIV infection or having undetectable viral load if you are living with HIV.

15) How effective are condoms in preventing HIV?

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Quality-assured condoms are the only products currently available to protect against sexual infection by HIV and other sexually transmitted infections. When used properly, condoms are a proven and effective means of preventing HIV infection among women and men.

In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect.

16) How do you use a male condom?

• Condoms with lubrication are less likely to tear during handling or use. Oil-based lubricants, such as Vaseline, should not be used, as they can damage the condom.
• Only open the package containing the condom when you are ready to use it. Otherwise, the condom will dry out. Be careful not to tear or damage the condom when you open the package. If it does get torn, throw it away and open a new package.
• Condoms come rolled up into a flat circle. Place the rolled-up condom, right side up, on the end of the penis. Hold the tip of the condom between your thumb and first finger to squeeze the air out of the tip. This leaves room for the semen to collect after ejaculation. Keep holding the top of the condom with one hand. With the other hand, unroll the condom all the way down the length of the erect penis to the pubic hair.
• If the condom is not lubricated enough, a water-based lubricant (such as silicone, glycerin or K-Y jelly) can be added. Lubricants made from oil—cooking oil or shortening, mineral or baby oil, petroleum jellies such as Vaseline and most lotions—should never be used because they can damage the condom.

After sex, the condom needs to be removed the right way.

• Right after the man ejaculates, he must hold onto the condom at the base, to be sure that the condom does not slip off.
• Then, the man must pull out while the penis is still erect.
• When the penis is completely withdrawn, remove the condom from the penis and throw away the condom. Do not flush it down the toilet.

If you are going to have sex again, use a new condom and repeat the whole process.

17) What is a female condom?

A female condom is a female-controlled contraceptive barrier method. The female condom is a strong, soft, transparent polyurethane sheath inserted into the vagina before sexual intercourse. It entirely lines the vagina and, therefore, with correct and consistent use, provides protection against both pregnancy and many sexually transmitted infections, including HIV. The female condom has no known side-effects or risks and does not require a prescription or the intervention of a health-care provider.

18) How do you use a female condom?

• Carefully remove the condom from its protective pouch. Add extra lubricant, if desired, to the inner and outer rings of the condom.
• To insert the condom, squat down, sit with your knees apart or stand with one foot on a stool or low chair. Hold the condom with the open end hanging down. While holding the top ring of the pouch (the closed end of the condom) squeeze the ring between your thumb and middle finger.
• Now place your index finger between your thumb and middle fingers. With your fingers in this position, keep the top of the condom squeezed in a flat oval. Use your other hand to spread the lips of your vagina and insert the closed end of the pouch.
• Once you have inserted the closed end of the pouch, use your index finger to push the pouch the rest of the way up into your vagina. Check to be certain that the top of the pouch is up past your pubic bone, which you can feel by curving your index finger upwards once it is a few inches inside your vagina. You can insert the pouch up to eight hours before your have intercourse.
• Make sure that the condom is not twisted inside your vagina: if it is, remove it, add a drop or two of lubricant and re-insert. Note: about two centimetres of the open end of the condom will remain outside your body. If your partner inserts his penis underneath or alongside the pouch, ask him to withdraw immediately. Remove the condom, discard it and use a new pouch. Until you and your partner become familiar with the female condom, it will be helpful if you use your hand to guide his penis into your vagina.
• After your partner ejaculates and withdraws, squeeze and twist the open end of the pouch to keep the sperm inside. Pull out gently. Dispose of the used condom (but do not throw it down the toilet).
• The re-use of female condoms is not recommended (see http://www.who.int/reproductive-health/rtis/reuse.en.html).

See also: http://www.who.int/reproductive-health/publications/RHR_00_8/RHR_00_8_chapter5.en.html.

19) What is post-exposure preventive treatment?

Post-exposure preventive (PEP) treatment consists of medication, laboratory tests and counselling. PEP treatment must be initiated within hours of possible HIV exposure and must continue for a period of approximately four weeks. Research studies suggest that, if the medication is initiated quickly after possible HIV exposure (ideally within two hours and not later than 72 hours following such exposure), it is beneficial in preventing HIV infection.

20) How can injecting drug users reduce their risk of contracting HIV?

For injecting drug users, certain steps can be taken to reduce personal and public health risks:

• Take drugs orally (change from injecting to non-injecting drug use).
• Never re-use or share syringes, water or drug-preparation equipment.
• Use a new syringe (obtained from a reliable source, e.g. a chemist or via a needle-syringe programme) to prepare and inject drugs each time.
• When preparing drugs, use sterile water or clean water from a reliable source.
• Using a fresh alcohol swab, clean the injection site prior to injection.

21) How can mother-to-child transmission be prevented?

Transmission of HIV from a mother living with HIV to her baby can occur during pregnancy, during labour or after delivery through breastfeeding. In the absence of any intervention, an estimated 15-30% of mothers living with HIV will transmit the infection during pregnancy and delivery. Breastfeeding increases the risk of transmission by 10-15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding.

Great progress has been made in reducing the number of children born with HIV. The risk of a woman living with HIV passing the virus on to her child can be reduced to 5% or less with effective antiretroviral therapy during pregnancy, delivery and breastfeeding. Primary prevention of new HIV infections among women of childbearing age, coupled with early access to prenatal care and HIV testing, are key to the strategy, with women living with HIV also encouraged to remain on lifelong treatment for their own health (the Option B+ strategy).

Early infant diagnosis is essential to identify the HIV status of infants and to improve prevention and treatment programmes, as peak mortality occurs between six weeks to four months of age for children who have acquired HIV infection.

22) What procedures should health-care workers follow to prevent transmission in health-care settings?

Health-care workers should follow universal precautions. Universal precautions are infection-control guidelines developed to protect health workers and their patients from exposure to diseases spread by blood and certain body fluids.

Universal precautions include:

• Careful handling and disposal of “sharps” (items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpels and other blades, knives, infusion sets, saws, broken glass and nails).
• Hand-washing with soap and water before and after all procedures.
• Use of protective barriers, such as gloves, gowns, aprons, masks and goggles, when in direct contact with blood and other body fluids.
• Safe disposal of waste contaminated with blood or other body fluids.
• Proper disinfection of instruments and other contaminated equipment.
• Proper handling of soiled linen.

In addition, it is recommended that all health-care workers take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. In accordance with universal precautions, blood and other body fluids from all people are considered as infected with HIV and other possible viruses, regardless of the known or supposed status of the person.

For more information, see http://www.who.int/hiv/topics/precautions/universal/en/.

23) Is there a cure for HIV?

There is no cure for HIV. However, there is effective treatment, which, if started promptly and taken regularly, results in a quality and length of life for someone living with HIV that is similar to that expected in the absence of infection.

24) What treatment is available?

Antiretroviral medicines are used in the treatment of HIV infection. They work against HIV infection by blocking the reproduction of HIV in the body (see question 4). When a person living with HIV is on effective antiretroviral therapy, they are no longer infectious.

25) How do antiretroviral medicines work?

Inside an infected cell, HIV produces new copies of itself, which can then go on to infect other healthy cells within the body. The more cells HIV infects, the greater its impact on the immune system (immunodeficiency). Antiretroviral medicines slow down the replication and, therefore, the spread of the virus within the body by interfering with its replication process in different ways.

Nucleoside reverse transcriptase inhibitors: HIV needs an enzyme called reverse transcriptase to generate new copies of itself. This group of medicines inhibits reverse transcriptase by preventing the process that replicates the virus’s genetic material.

Non-nucleoside reverse transcriptase inhibitors: this group of medicines also interferes with the replication of HIV by binding to the reverse transcriptase enzyme itself. This prevents the enzyme from working and stops the production of new virus particles in the infected cells.

Protease inhibitors: protease is a digestive enzyme that is needed in the replication of HIV to generate new virus particles. It breaks down proteins and enzymes in the infected cells, which can then go on to infect other cells. The protease inhibitors prevent this breakdown of proteins and therefore slows down the production of new virus particles.

Other medicines that inhibit other stages in the virus’s cycle (such as entry of the virus and fusion with an uninfected cell) are currently being tested in clinical trials.

26) Are antiretroviral medicines effective?

The use of antiretroviral medicines in a combination of three medicines has been shown to dramatically reduce AIDS-related illness and death. While not a cure for AIDS, combination antiretroviral therapy has enabled people living with HIV to live longer, healthier, more productive lives by reducing viraemia (the amount of HIV in the blood) and increasing the number of CD4-positive cells (white blood cells that are central to the effective functioning of the immune system).

For antiretroviral treatment to be effective for a long time, different antiretroviral medicines need to be combined. This is what is known as combination therapy. The term highly active antiretroviral therapy (HAART) is used to describe a combination of three or more anti-HIV medicines.

If one medicine is taken on its own, it has been found that, over a period of time, changes in the virus enable it to build up resistance to the medicine. The medicine is then no longer effective and the virus starts to reproduce to the same extent as before. If two or more antiretroviral medicines are taken together, the rate at which resistance develops can be reduced substantially.

Effective antiretroviral therapy also prevents the transmission of HIV. When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load HIV can no longer be transmitted through sex.

Antiretroviral medicines should only be taken as prescribed by a health-care professional.

Testing

27) What is an HIV test?

An HIV test is a test that reveals whether a person has been infected with HIV. Commonly used HIV tests detect the antibodies produced by the immune system in response to HIV, as they are much easier (and cheaper) to detect than the virus itself. Antibodies are produced by the immune system in response to an infection.

For most people, it takes a month for these antibodies to develop. Antibodies can be found in blood or oral fluid.

28) How long after possible exposure should I wait to be tested for HIV?

Generally, it is recommended that you wait three months after possible exposure before being tested for HIV. Although HIV antibody tests are very sensitive, there is a window period of up to two months, depending on the specific test being used, which is the period between infection with HIV and the appearance of detectable antibodies to the virus. In the case of the most sensitive anti-HIV tests currently recommended, the window period is about three weeks. This period may be longer if less-sensitive tests are used.

During the window period, people infected with HIV have no antibodies in their blood that can be detected by an HIV test. However, the person may already have high levels of HIV in their body fluids, such as blood, semen, vaginal fluids and breast milk. HIV can be passed on to another person during the window period even though an HIV test may not show that they are infected with HIV.

29) Why should I get an HIV test?

Knowing your HIV status has two vital benefits. Firstly, if you are HIV-infected, you can start treatment promptly, thereby potentially prolonging your life for many years (see question 36). Secondly, if you know you are infected, you can take all the necessary precautions to prevent the spread of HIV to others (see question 13). If you are not infected with HIV, you can learn how to protect yourself from HIV in the future

30) Where can I get tested?

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There are many places where you can be tested for HIV: in the offices of a private doctor, a local health department, hospitals, family planning clinics and sites specifically set up for HIV testing. Always try to find testing at a place where counselling is provided about HIV. You can also take an HIV test in privacy by using an HIV self-test kit. However you should go and see your health-care provider in the event of a positive test result for confirmation and seeking appropriate treatment.

31) Are my test results confidential?

All people taking an HIV test must give informed consent prior to being tested. The results of the test must be kept absolutely confidential.

There are different types of testing available:

Confidential HIV test: the medical professionals handling the HIV test keep the result of the test confidential within the medical records. Results cannot be shared with another individual unless written permission is provided by the person tested.

Anonymous HIV test: the tested person’s name is not used in connection with the test. Instead, a code or number is assigned to the test, which allows the individual being tested to receive the results of the test. No records are kept that would link the person to the test.

Shared confidentiality is encouraged and refers to confidentiality that is shared with others, who might include family members, loved ones, caregivers and trusted friends. However, care should be taken when revealing the results as it can lead to discrimination in health-care and professional and social settings. Shared confidentiality is therefore at the discretion of the person who will be tested. Although the result of the HIV test should be kept confidential, other professionals, such as counsellors and health and social service workers, might also need to be aware of the person’s HIV-positive status in order to provide appropriate care.

32) What do I do if I have HIV?

Thanks to new treatments, people living with HIV can now live long, healthy lives. It is very important to make sure you have a doctor who knows how to treat HIV. A health-care professional or trained HIV counsellor can provide counselling and help you to find an appropriate doctor.

33) What does it mean if I test negative for HIV?

A negative test result means that no HIV antibodies were found in your blood at the time of testing. If you are negative, make sure you stay that way: learn the facts about HIV transmission and avoid engaging in unsafe behaviour.

However, there is still a possibility of being infected, since it can take up to three months for your immune system to produce enough antibodies to show infection in a blood test. It is advisable to be retested at a later date and to take appropriate precautions in the meantime. During the window period, a person is highly infectious, and should therefore take measures to prevent any possible transmission.

Myths

34) Are mosquito bites a risk of infection with HIV?

HIV is not spread by mosquitoes or other biting insects. Even if the virus enters a mosquito or another sucking or biting insect, it cannot reproduce in the insect. Since the insect cannot be infected with HIV, it cannot transmit HIV to the next human it feeds on or bites.

35) Should I be concerned about being infected with HIV while playing a sport?

There is no evidence that HIV can be transmitted while playing a sport.

36) Can I get HIV from casual contact (shaking hands, hugging, using a toilet, drinking from the same glass as someone who is living with HIV or being close to an infected person who is sneezing or coughing)?

HIV is not transmitted by day-to-day contact in social settings, schools or the workplace. You cannot be infected by shaking someone’s hand, by hugging someone, by using the same toilet or drinking from the same glass as someone living with HIV or by being exposed to coughing or sneezing by an infected person (see question 7).

37) Does HIV only affect homosexuals and drug users?

No. Anyone who has condom-less sex, shares injecting equipment or has a transfusion with contaminated blood can become infected with HIV. Infants can be infected with HIV from their mothers during pregnancy, during labour or after delivery through breastfeeding.

38) Can you tell if someone has HIV just by looking at them?

You cannot tell if someone has HIV by just looking at them. A person infected with HIV may look healthy and feel good, but they can still pass the virus to you. An HIV test is the only way a person can find out if he or she is infected with HIV.

39) Can I have more than one sexually transmitted infection at a time?

Yes, you can have more than one sexually transmitted infection at the same time. Each infection requires its own treatment. You cannot become immune to sexually transmitted infections. You can catch the same infection over and over again. Many men and women do not see or feel any early symptoms when they first become infected with a sexually transmitted infection; however, they can still infect their sexual partner.

40) When you are on antiretroviral therapy, can you transmit HIV to others?

If the antiretroviral therapy is effective and the virus is fully suppressed, you cannot transmit HIV to others. For this reason, monitoring of the suppression of the viral load is recommended as part of ongoing care for people living with HIV.

HIV and COVID-19

41) I’m living with HIV. What should I know about COVID-19?

COVID-19 is a serious disease and all people living with HIV should take all recommended preventive measures to minimize exposure to, and prevent infection by, the virus that causes COVID-19.

As in the general population, older people living with HIV or people living with HIV with heart or lung problems may be at a higher risk of becoming infected with the virus and of suffering more serious symptoms.

We will actively learn more about how HIV and COVID-19 together impact on people living with HIV from countries and communities responding to both epidemics. Lessons in rolling out innovations or adapting service delivery to minimize the impact on people living with HIV will be shared and replicated as they become available. Until more is known, people living with HIV—especially those with advanced or poorly controlled HIV disease—should be cautious and pay attention to the prevention measures and recommendations.

42) How should people living with HIV protect themselves from the virus that causes COVID-19?

People living with HIV should protect themselves and others from the virus that causes COVID-19 in the same way that all people are advised to reduce exposure:

• Regular and thorough hand washing with soap and water or alcohol-based hand rub.
• Maintain at least 1 metre distance between yourself and anyone who is coughing or sneezing.
• Avoid touching your eyes, nose and mouth.
• Make sure that you, and the people around you, follow good respiratory hygiene—cover your mouth and nose with your bent elbow or tissue when you cough or sneeze and dispose of the used tissue immediately.
• Follow local health service advice on social distancing measures regarding staying at home except for essential business, health needs and exercise.
• Avoid gatherings of more than a few people.
• Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

UNAIDS recognizes, however, that in many countries, owing to weaker health-care systems, informal settlements, overcrowded cities and public transportation and a lack of clean water and sanitation, the current approaches to self-protection, social distancing and containment may not be viable.

43) Does UNAIDS have any specific recommendations for people living with HIV during the COVID-19 pandemic?

UNAIDS recommends that people living with HIV should have a supply of necessary medical supplies on hand—ideally for 30 days or more. This includes both antiretroviral therapy and other regular medicines, such as tuberculosis treatment, contraceptives and other ongoing treatment for noncommunicable diseases and mental health.

The World Health Organization HIV treatment guidelines now recommend multimonth dispensing of three months or more of HIV medicines for most people at routine visits. Although this has not yet been widely implemented in all countries, UNAIDS calls on all countries to provide such multimonth dispensing.

Know how to contact your clinic by telephone in the event that you need advice. Know how to access treatment and other support within your community. This treatment could include antiretroviral therapy, tuberculosis medication (if on tuberculosis treatment) and any other medication for other illnesses that you may have.

Remember that other illnesses continue despite the COVID-19 pandemic. Do not hesitate to seek medical advice for new or worsening symptoms, sexual and reproductive health services, mental health challenges or injuries. The risks of poor or inadequate medical treatment are usually greater than the risks of contracting COVID-19 in a health centre.

44) How should key populations protect themselves against HIV during the COVID-19 pandemic?

Key populations, including people who use drugs, sex workers, gay men and other men who have sex with men, transgender people and prisoners, should continue to ensure that they have essential means to prevent HIV infection, such as sterile needles and syringes and/or opioid substitution therapy, condoms and pre-exposure prophylaxis (PrEP).

45) How do we ensure that human rights are respected and reduce stigma and discrimination during the COVID-19 pandemic?

UNAIDS urges all countries to ensure an appropriate balance between protecting health, preventing economic and social disruption and respecting human rights.

UNAIDS and partners are working to ensure that human rights are not eroded in the response to COVID-19 and to ensure that people living with or affected by HIV are offered the same access to services as others and to ensure that HIV-related services continue without disruption.

In the light of overcrowding in many prisons and other places of detention, which undermines hygiene, health, safety and human dignity, a health response alone to COVID-19 in closed settings alone is insufficient. UNAIDS urges political leaders to ensure that COVID-19 preparedness and responses in closed settings are identified and implemented in line with fundamental human rights.

46) What should I do if I am worried about gender-based violence during the COVID-19 pandemic?

If you are experiencing violence, it may be helpful to reach out to family, friends and neighbours, to seek support from a hotline or, if safe, from an online service for survivors of violence. Find out if local services (e.g. shelters, counselling) are open and reach out to them if available.

Make a safety plan in case the violence against you or your children escalates. This includes:

• Identifying a neighbour, friend, relative, colleague or shelter to go to in case you need to leave the house immediately for safety.
• Have a plan for how you will exit the house safely and how you will reach there (e.g. transport).
• Keep a few essential items (e.g. identification documents, phone, money, medicines, and clothes) available, and a list of telephone numbers in case of an emergency.
• If possible, develop a code with a trusted neighbour so they can come to your aid in case of an emergency.

47) What should I do if I am concerned about my mental health during the COVID-19 pandemic?

Pay particular attention to your mental health by:

• Avoiding excessive exposure to media coverage of COVID-19. Only read information from trusted sources.
• Taking care of your body. Take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and, where possible, avoid alcohol and drugs.
• Making time to unwind and reminding yourself that negative feelings will fade. Take breaks from watching, reading or listening to news stories—it can be upsetting to hear about the crisis repeatedly. Try to do some other activities you enjoy in order to return to your normal life.
• Connecting with others. Share your concerns and how you are feeling with a friend or family member.

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