HIV FAQ: The 10 Questions I Am Asked Most Often

When I give talks about HIV or answer chat messages from patients, the questions keep circling around a few topics, and many of the answers have changed since 10 years ago. So I have gathered the 10 most common questions here. I give a short answer first, and if you want more depth, follow the links to read each topic.

1–3: The basics

1. How is HIV spread?

HIV is spread through blood, semen, vaginal and rectal fluids, and breast milk. The main routes are sex without protection (especially anal sex), sharing needles, and from mother to baby. It is not spread by hugging, kissing, eating together, sharing a toilet or mosquito bites. Read the details in What is HIV and how is it spread?

2. How is HIV different from AIDS?

HIV is the virus. AIDS is the late stage when the immune system has been damaged until it is very weak (usually defined as a CD4 count below 200 or the presence of opportunistic infections), which happens without treatment. Most people who take treatment consistently never reach that stage.

3. Does HIV mean dying young?

Not necessarily. Large cohort data published in 2023 found that people who started antiretroviral treatment after 2015 and stayed on it have an average life expectancy in their late 70s. The earlier treatment starts while the immune system is still strong, the closer it is to everyone else. What leads to early death is "not knowing you have it" or "knowing but not being treated". Read more in HIV does not have to mean a shorter life.

4–6: Testing and protecting yourself

4. If I am on HIV treatment, do I still need condoms?

There are two separate issues. If your viral load stays undetectable, you do not pass HIV to a partner through sex. But HIV medicine does not prevent syphilis, gonorrhea, chlamydia, herpes or HPV, and does not prevent pregnancy. So I still recommend condoms as a mainstay, especially with new partners or several partners. Read about U=U and condoms.

5. Do I need to fast before an HIV test?

No. Food, water and coffee do not affect HIV test results. You can test at any time, with a blood draw at a clinic, a fingerstick, or a self-test kit. But if you are having other blood tests at the same time, such as blood sugar or cholesterol, you may need to fast as your doctor advises.

6. My test is negative. Does that mean I definitely do not have HIV?

It depends on how long after the risk you tested and which test you used, because there is a window period when a person is infected but the test cannot detect it yet. Roughly, according to CDC data:

• Nucleic acid test (NAT), which looks for the virus directly: can detect infection about 10–33 days after exposure
• Antigen/antibody (fourth-generation) blood test from a vein: about 18–45 days
• Antibody tests, including most self-test kits: about 23–90 days

If your risk was within the last 72 hours, the first thing to do is ask about PEP straight away, not wait to test. Read more in How reliable is a negative result?

1. 0–72 h
   Not the time to test

   Ask about PEP immediately

2. 10–33 days
   NAT (direct virus test)

   Detects infection earliest

3. 18–45 days
   4th-generation Ag/Ab

   Blood drawn from a vein

4. 23–90 days
   Antibody test kits

   Including most self-test kits

Windows per CDC data. You don't need to fast for an HIV test.

7–8: PrEP and PEP

7. What is PrEP?

PrEP (pre-exposure prophylaxis) is antiretroviral medicine taken before a risk by people who do not have HIV. It suits people who may be exposed, for example those with several partners, inconsistent condom use, a partner with HIV who is not yet virally suppressed, past PEP use, or a past sexually transmitted infection. Taken correctly, it is highly effective at preventing sexually acquired HIV. It can be taken daily, or on demand (2-1-1), which suits only some groups, and injectable PrEP is now starting to become available in other countries. Read more in PrEP. Before starting, you always need tests for HIV and kidney function.

8. How is PEP different from PrEP?

PEP (post-exposure prophylaxis) is antiretroviral medicine taken after a risk, such as a broken condom, sexual assault or a needlestick injury. It must be started as soon as possible: within a few hours is best, and no later than 72 hours. It is taken for 28 days as prescribed. PrEP, on the other hand, is ongoing protection in advance. People who need PEP often should talk to their doctor about switching to PrEP. Read the comparison in PrEP vs PEP.

9–10: Life after a diagnosis

9. Is it true that HIV treatment stops you passing it on?

Yes. When you take your medicine consistently until the amount of virus in your blood is undetectable, and it stays that way, you do not pass HIV on through sex. The large U=U studies counted viral loads below 200 copies/mL as suppressed, and the WHO's 2023 policy brief states that the risk is zero when the virus is undetectable, and almost zero when it is suppressed below 1,000 copies/mL. You must keep taking your medicine and have viral load tests as scheduled. Breastfeeding and sharing needles are not covered by U=U. Read U=U.

10. Can I have children if I have HIV?

Yes. When the mother takes treatment consistently and the virus stays controlled throughout pregnancy, the chance of passing it to the baby is below 1%. Thailand was the first country in Asia to be validated by the WHO for eliminating mother-to-child transmission of HIV (in 2016). Couples where the man has HIV and is virally suppressed can also plan to have children safely. Read more in HIV and having children.

Old belief

• HIV means dying young
• HIV and AIDS are the same
• Even on treatment, you still infect partners
• You can't have children with HIV

The facts

• On steady treatment, life expectancy is around the late 70s
• AIDS is the late stage if untreated
• Undetectable = no sexual transmission
• With the virus controlled, risk to the baby is under 1%

vs

Thailand was the first country in Asia certified by WHO as eliminating mother-to-child transmission (2016).

Want to talk it through?

If your question is not among these 10, or you are worried about a risk that just happened, get in touch. At Dr. Kris Clinic in Surat Thani, I help assess your risk, plan testing for HIV and other sexually transmitted infections, provide PrEP and PEP, and counsel people who have just received a result, privately and without judgment. Online consultations are available nationwide, and English-speaking consultations are available.