HIV - daily life

There have been no reports of HIV transmission through normal social contact during the 30 years that the epidemic has been monitored in our part of the world. It is safe to share a household with a person with HIV infection, and regular social contact represents no risk of infection to others.

You can have a social life despite being HIV positive.
Foto: Johnér Bildbyrå AB

​Clothing, bedding, towels or cutlery can be washed as in any other household.

Use of a razor blade can result in small cuts and similarly, toothbrushes may cause gums to bleed. Toothbrushes and razors should therefore not be shared.

Wounds and small cuts should be covered with a plaster. Any items where blood is spilt should be packed in a plastic bag and disposed of in a bin. This applies to tampons and sanitary protection used during menstruation.

If others need to help to clear up blood, vomit, urine or faeces/diarrhoea; wear gloves. Add bleach to the washing water.

Childcare centres

Children with HIV infection may attend childcare centres with other children. The child's parents have no duty of disclosure to the nursery, but should consider informing the head of the unit where the child will attend so that arrangements can be made to ensure safe conditions. Beyond this, there is no other need to inform others about the child's HIV status.

If your child has behavioural problems that could expose other children to contact with the child's blood (biting / scratching), or has skin problems that may expose staff to blood, there should be a medical and educational evaluation of your child before beginning childcare.

Dental care

​HIV infection can cause oral symptoms in some people. It is recommended that people with HIV infection should consult their dentist regularly. As when contacting a doctor, it is appropriate to inform the dentist about your HIV status. Knowledge of HIV status is important when evaluating health status and treatment.

People with HIV infection are entitled to the same dental treatment as other patients. HIV positive people are entitled to compensation from the National Insurance Scheme for preventive treatment. The dentist will complete and send the appropriate form to the Norwegian Health Economics Administration (HELFO).Photo: Johnér Bildbyrå AB

Sex

​A lack of sexual desire is a normal emotional reaction to a positive HIV test but this usually returns after some time. People with HIV infection can have a satisfactory sex life.

How easily is HIV transmitted?

Compared with other sexually transmitted diseases, the risk of infecting others with HIV is low. The risk of disease transmission with one incident of unprotected vaginal intercourse with a person with an untreated HIV infection can be as low as 0.1%. The risk of infection is greatest with anal intercourse, somewhat less during vaginal intercourse and far less for oral sex. The receiving partner has the greatest risk of infection. Receiving semen in the vagina or rectum involves the greatest risk of infection. Semen or vaginal secretions that come into contact with intact skin are not considered to be contagious, and it has never been shown that HIV can be transmitted by kissing.

Factors that affect risk of infection

Condoms and femidoms give good protection against HIV infection. Proper use of condoms /femidoms with vaginal, anal or oral sex also protects against other sexually transmitted diseases like gonorrhoea, syphilis and chlamydia. There are several factors that determine the risk of infecting others with HIV. The most important are:

  • Normally, people with HIV infection have high viral loads in their blood and other bodily fluids for a few months after infection. This means that they are particularly contagious just after they are infected. Viral load can also be high in advanced HIV infection.

  • If one or both partners have other sexual transmitted infection as well as HIV (such as syphilis, gonorrhoea, herpes infection), this increases the risk of HIV transmission.

  • People who are being successfully treated will have a very low viral load in the blood (less than 50 virus copies per ml). This means that they are significantly less infectious than untreated people, and in practice transmission of the virus from a successfully treated HIV positive person has not been seen, although it is possible that infection can occur through sexual intercourse without a condom / femidom.

Do I need to tell my sexual partners that I am infected with HIV?

A person with HIV infection has a responsibility not to put others at risk of infection. In practice this means that a condom / femidom must be used for oral, vaginal or anal sex, and that you should always inform your sexual partner that you are HIV positive. Being open with your partner about HIV infection means you can both take a shared responsibility to practice safe sex.

If you have sex using a condom / femidom that splits or slides off and you have not informed your partner that you have HIV, you must tell them as soon as possible so that he / she can obtain short-term treatment to reduce the risk of infection (see chapter about post-exposure prophylaxis, PEP).

What if the HIV infection is being successfully treated?

If you are being successfully treated with HIV medicine and have been shown to have a stable, low viral load in the blood (less than 50 virus copies per ml), infection risk is minimal compared with HIV positive people who are not on treatment. The premise is that neither of the partners has another sexually transmitted infection.

If you have vaginal or anal intercourse with a regular partner who is not infected with HIV or who does not know their HIV status, you should discuss if you want to have sex without a condom / femidom and live with this small risk of transmission to the HIV-negative partner. With vaginal or anal intercourse with a casual partner, a condom / femidom should always be used to protect against other sexually transmitted diseases. Never share syringes or other user equipement with others

What about sex with another HIV infected person?

There are a number of genetic variants of HIV. If you are infected with one variant of the virus, by having unprotected intercourse with another HIV positive, you may become infected with another genetic variant of the virus that may be resistant to some HIV medicines. With current effective treatment possibilities, infection with new variants of HIV plays a minor role.

Free condoms

Free condoms can be ordered from http://www.gratiskondomer.no/. Your doctor or other healthcare professional can also order free condoms on your behalf.  Here is a simple guide on how to put on a condom.

Femidom is not available in shops or pharmacies and must be purchased on the internet. Here is a simple guide on how to insert a femidom.

Photo: Sara Winsnes/Johnér Bildbyrå AB 

Use of syringes and equipment

People who inject drugs who have HIV infection should never share syringes / needles or other equipment with others. In all municipalities, it should be possible to obtain clean syringes and needles. Dispose syringes and other user equipment carefully so that others are not exposed to infection.

Travel

Travel, particularly to countries outside Europe and to subtropical and tropical areas, increases the risk of disease for all people, especially those with a weakened immune system. HIV positive people should be careful with food and drink when travelling to areas with poor hygiene. Before making travel plans, consult your doctor and ask about any recommended vaccines.

Photo: Björn Dahlgren/Johnér Bildbyrå AB

The most common diseases when travelling are infections transmitted through food or water, with symptoms such as diarrhoea, nausea and vomiting.
Be sure to take the necessary vaccines and documents for medicines used during travel abroad
General advice:

  • Always wash hands well after using the toilet and before you eat.

  • You can drink newly boiled, warm tea and coffee and water from bottles that you open yourself. Avoid drinking tap water and do not use ice cubes.

  • Microbes are killed by cooking and frying. If food remains at room temperature it can be recontaminated. Avoid cold sauces, unpasteurised milk products, non-dairy packed ice cream, food prepared from raw egg (mayonnaise, desserts), salad, raw shellfish and undercooked or raw meat.

  • Only eat raw fruit/vegetables that can be peeled.

  • Avoid swallowing water when swimming and do not swim in water that may be contaminated.

What about medicines?

If you are using medicines for HIV infection or other diseases, take sufficient amounts for the entire journey, with a certificate in English that the medicine is necessary from your doctor or pharmacist.

It is not advisable to use preventive antibiotics to avoid infection while travelling abroad, even though the risk of infection may be high. It may be wise to take antibiotics with you in case of diarrhoea. Discuss this with your doctor. You should definitely take an anti-diarrhoeal agent with you.

Contact a doctor or hospital if treatment does not work, i.e. if symptoms persist for more than 48 hours, if there is blood in the stools or high fever. In such cases, inform your doctor about your HIV status. A number of diseases are transmitted by bites and stings (malaria, dengue fever, yellow fever, sleeping sickness). Malaria prophylaxis should be used by people with HIV when travelling to certain malaria areas, but there may be some interaction between HIV and malaria medicine.

The choice of medication depends on the destination. Vaccination offices and doctors can give advice. In addition, it is important to use a good insect repellent, use a mosquito net at night, cover the body with clothing and do not walk barefoot elsewhere than on the beach.

In addition to regular medication, it may be wise to bring these prescription-free products;

  • antiseptic

  • compresses

  • plasters

  • motion sickness tablets

  • painkillers

  • nasal spray

  • talcum powder (for skin irritation)

  • glucose-electrolyte powder (rehydration) 

  • a mild anti-diarrhoeal agent

Condoms purchased in Norway undergo strict quality control so it is wise to bring condoms with you.

Countries with entry restrictions for people with HIV infection

Some countries still have some form of entry restrictions for people with HIV infection. This must be checked for each country. Most countries do not require HIV tests for a regular tourist visa which is valid for three months. A number of countries require a HIV test for studying, seeking work or relocation. Some countries only accept tests taken in the country where the applicant has a residence permit.

See the updated list on the website on HIV travel

Travel insurance

Travel insurance covers expenses for treatment of acute disease or unexpected worsening of chronic diseases. Most people with HIV infection will therefore be covered by insurance if their condition worsens. However, the necessary check-ups and costs of ongoing antiviral treatment will not be covered. If you have advanced HIV infection and substantial treatment and care needs, they will not be covered by insurance. If in doubt, contact your insurance company.

Countries with entry restrictions for people with HIV infection

Some countries still have some form of entry restrictions for people with HIV infection. This must be checked for each country. Most countries do not require HIV tests for a regular tourist visa which is valid for three months. A number of countries require a HIV test for studying, seeking work or relocation. Some countries only accept tests taken in the country where the applicant has a residence permit.

See the updated list on the website on HIV travel

Travel insurance

Travel insurance covers expenses for treatment of acute disease or unexpected worsening of chronic diseases. Most people with HIV infection will therefore be covered by insurance if their condition worsens. However, the necessary check-ups and costs of ongoing antiviral treatment will not be covered. If you have advanced HIV infection and substantial treatment and care needs, they will not be covered by insurance. If in doubt, contact your insurance company.

Vaccines

​People with a weakened immune system need to be protected against disease, and vaccination is the most effective tool we have against a range of infections. Before vaccination it is important to consider:

  • Is the vaccine dangerous for the individual?

  • How effective will the vaccine be?

  • Discuss which travel vaccines are necessary with your doctor

  • Will the individual benefit from certain vaccines?

  • As a rule, a disease is more dangerous than the vaccine. If the infection risk is high, this must be weighed against the risk of vaccination.

Recommended vaccines

People with weakened immune systems may have limited benefits from vaccination because they cannot make antibodies against the disease that the vaccine is intended for. It is therefore wise to consider which vaccines should be taken as soon as possible after diagnosis with HIV infection.

Children with HIV infection should follow the Childhood Immunisation Programme with the exception of the vaccine against tuberculosis (BCG vaccine).

All HIV positive people should be offered the pneumococcal vaccine (against a bacteria that can cause serious pneumonia) and the vaccines against hepatitis A and B. The vaccine against seasonal influenza should be taken every autumn.

Vaccines that should not be taken without careful consideration

Vaccines made from live attenuated viruses and bacteria can cause disease in people with weakened immune systems, i.e. with low CD4 counts. As a rule, it is not recommended to take such vaccines. This includes the BCG vaccine, the vaccine against chickenpox, the oral vaccine against typhoid fever and the yellow fever vaccine when travelling to certain countries (see below). The combined vaccine against measles, rubella and mumps (MMR) can be given to people with HIV infection unless the CD4 cell count is too low.

Vaccination for travel abroad

The choice of vaccination depends on your destination. This can be clarified with your doctor. If this is not possible, the vaccination office should be informed about the HIV infection to ensure a proper assessment of the vaccines that should and should not be given. Most vaccines recommended for international travel can be given to people with HIV.

A booster dose against diphtheria and tetanus is recommended. Polio vaccine given by injection is also recommended. When travelling to countries with a risk of typhoid fever, it is recommended to take the vaccine by injection. Some countries require certification that yellow fever vaccine has been given. In such cases, it is important to get a certificate in English from your doctor stating why it is not prudent to take such a vaccine.

Remember that it often takes several weeks after vaccination before enough antibodies are made to protect against disease. Therefore make sure you are vaccinated in good time.

Diet and nutrition

​The Norwegian Directorate of Health has issued general recommendations for good nutrition. In brief, this means:

  • Eating lots of fruit and vegetables.

  • Whole-grain products and fish are good.

  • Intake of fat, sugar, salt and alcohol should be limited.

  • A good and balanced diet is beneficial for health.

Photo: Benny Karlsson /Johnér Bildbyrå AB

A person with HIV infection experiencing illness or the side effects of medicine may need extra supplements. This may be due to nausea or loss of appetite, vomiting, diarrhoea, or other digestive conditions resulting in poor absorption of important nutrients. When the immune system fails, loss of appetite leads to reduced nutrient absorption, increased weight loss and loss of muscle tissue.

Illness or the side effects of HIV medicines can reduce the absorption of nutrients. There may be a need to take a greater amount of vitamins or supplements than stated on the package. However, it is important not to take too much. For example, many nutritional supplements contain the same ingredients and it is possible to consume too much. Some vitamins in large doses can have a toxic effect. Many major hospitals have a nutritionist that you can ask to talk to.