Nordhaven Clinic - HIV/Hepatitis

HIV/Hepatitis

HIV and hepatitis are known as blood borne viruses (BBV).

HIV is a virus that weakens the body’s defence systems. There is no cure but treatments help people live longer, healthier lives.

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection.

Free Self Testing Kits for HIV

We are pleased to announce the start of a pilot in NHS Orkney to provide free self-testing kits for HIV. Click the HIV Testing tab for more information.

HIV

HIV stands for human immunodeficiency virus. The virus attacks the immune system, the body’s defence against infection and disease. This means that someone with HIV has a higher risk of getting a serious infection or disease, such as cancer.

Is HIV different from AIDS?

AIDS stands for acquired immune deficiency syndrome and refers to the late stages of HIV. The term AIDS is no longer widely used, and specialists prefer to call it advanced or late-stage HIV infection.

How do people get HIV?

HIV is spread through bodily fluids, such as semen or blood. It is most commonly passed on during unprotected sex, including oral and anal sex. It can also be passed on through sharing sex toys. You cannot get HIV from saliva (kissing) or from urine (e.g. from toilet seats).There’s not enough HIV to infect people in tears, sweat, saliva (spit) or faeces.

How is HIV passed on during sex?

HIV is a virus found in an infected person’s body fluids. Only in the following fluids is there enough HIV to infect someone:

Women

vaginal fluid
breast milk
blood (also anal mucus, the lining covering the inside of the rectum).

Men

semen
‘pre-cum’ (the clear liquid that comes from a man’s penis when he is sexually excited)
blood (also anal mucus, the lining covering the inside of the rectum).

If any of these fluids get from the body of someone with HIV into the body of a person who doesn’t have HIV, that person can also become infected.

Who gets HIV?

Anyone can get HIV if they have unprotected sex. People who are at higher risk of catching HIV include:

men who have had unprotected sex with men
women who have had unprotected sex with men who have sex with men
people who have lived in or travelled extensively in Africa
people who have had unprotected sex with a person who has lived in or travelled in Africa
people who inject illegal drugs
people who have had unprotected sex with somebody who has injected illegal drugs
people who have caught another sexually transmitted infection
people who have received a blood transfusion while in Africa, eastern Europe, the countries of the former Soviet Union, Asia or central and southern America

How can I avoid HIV?

Using a condom during sex is the best way to avoid getting HIV, as well as other sexually transmitted infections (STIs).
Don’t use an oil-based lubricant as it can damage the condom, making it more likely to split. Use a water-based lubricant, such as KY Jelly, instead. If you think you have been put at risk of HIV, for example if a condom breaks during sex with a HIV positive partner, see PEP section at the bottom of this page.

Using a condom during sex is the best way to avoid getting HIV, as well as other sexually transmitted infections (STIs). See our Condoms page.

How can I get tested for HIV?

A simple blood test can determine whether you have HIV. It can take up to three months after infection to detect the virus, so you may need to have another test to be sure. There are various places you can get tested, including your GP surgery or a GUM (genitourinary medicine) clinic. You can get a test at the Nordhaven Clinic.

When should I get a test?

If you’re a gay man and you’ve had unprotected sex, it’s important that you have a test. The Health Protection Agency recommends annual HIV testing for gay men who change sexual partners.
Anyone can request a HIV test. Your doctor can discuss your risk with you.

What will happen if the test result is positive?

If your test is positive, you’ll be referred to an HIV clinic. The nearest clinic is in Aberdeen. While there's no cure for HIV, there are medications that can slow its progression and prolong life.

How would I know if I caught HIV?

The only sure way to know is to have a test. Many people experience some symptoms shortly after infection with HIV. Sero-conversion illness (SCI) occurs around two to six weeks after a person has been infected. The main symptoms of sero-conversion illness are a sore throat, fever, body aches and a rash. Other common symptoms include mouth ulcers, joint pain, loss of appetite, weight loss, muscle pain and feeling overly tired or sick. Some people experience severe symptoms and some people experience very mild symptoms.

These symptoms are only linked to infection with HIV if you have put yourself at risk (such as having sex without a condom) in the last six weeks. Because these symptoms are common to other illnesses, many people do not realise that they are a sign that they have become infected with HIV.

If you have two or more of these symptoms, and have had unsafe sex in the last six weeks, it is worth visiting your doctor or the Nordhaven Clinic to discuss having an HIV test.

If you haven’t had sex which puts you at risk of infection then these symptoms do not indicate that you have been infected with HIV. Even if you have had recent risky sex, it does not necessarily mean that those flu-like symptoms are sero-conversion illness. It could be the flu.

What are the symptoms of long-standing infection?

After the first stages of HIV infection, it can be many years before you experience any other symptoms or ill health. However, some people do develop medical conditions as HIV wears down the immune system.

Some people notice signs of the effects of HIV infection on their immune system including swollen lymph nodes (small lumps) in the neck, armpit or groin, or fever/night sweats.

HIV can also have a profound effect on the digestive system, so in some cases people experience stomach upsets and diarrhoea more than they used to.

Symptoms associated with breathing (shortness of breath or coughs) usually occur later in the course of the HIV disease and can be a sign of bacterial pneumonia, which is common in untreated HIV infection.

Because your immune system is weakened, you may also be more prone to other viruses, fungi or bacteria which can cause rashes on the skin and sores in the mouth.

I think I might have put myself at risk of HIV, is there anything I can do?

PEP is a treatment to stop a person becoming infected with HIV after it’s got into their body.

It is a course of tablets lasting 1 month. It makes it a lot less likely for HIV infection to occur, but doesn’t work every time.

It might be used if you have had unprotected sex, or a condom has broken, and you are at high risk of contracting HIV. You would be considered higher risk if your partner has HIV, or is in a higher risk group such as a sex worker or IV drug user.

How soon should I take it?

The quicker you start PEP, the more likely it is to work. Ideally it should be started within 24 hours, but can be used up to 72 hours after unsafe sex.

Where can I get PEP?

PEP is available 24 hours a day, 7 days a week at the A&E department at the Balfour Hospital in Kirkwall - (01856) 888 000

The doctor will assess your risk of contracting HIV. If the risk is significant you will be offered a starter pack. They will arrange for you to be seen by a HIV specialist to complete the course. PEP can cause unpleasant side-effects so it is not given to people at low risk of HIV.

Hepatitis B

Hepatitis B is a type of virus that can infect the liver.

Symptoms can include feeling or being sick, poor appetite, flu-like symptoms or yellowing of the skin and eyes (jaundice). However, many people don’t realise they have been infected with the virus, because the symptoms may not develop immediately, or even at all.
It takes between 40 and 160 days for any symptoms to develop after exposure to the virus.

How does hepatitis B spread?

Hepatitis B can be spread through blood and body fluids such as semen and vaginal fluids, so it can be caught:

during unprotected sex, including anal and oral sex
by sharing needles to inject drugs such as heroin

A mother can also pass on the hepatitis B infection to her newborn baby, but if the baby is vaccinated immediately after birth, the infection can be prevented.

In this country, the people who are most at risk of contracting hepatitis B include the following:

people who inject drugs
people who change sexual partners frequently

Acute Hepatitis B

In most cases the hepatitis B virus will only stay in the body for around one to three months. This is known as acute hepatitis B.

The vast majority of people infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months. The infection can be unpleasant to live with, but usually causes no lasting harm.

Chronic Hepatitis B

In around 1 in 20 cases in adults, the virus will stay for six months or longer, usually without causing any noticeable symptoms. This is known as chronic hepatitis B.

Chronic hepatitis B is particularly common in babies and young children: 9 in 10 children infected at birth and around 1 in 5 children infected in early childhood will develop a long-term infection.

People with chronic hepatitis B can still pass the virus on to other people, even if it is not causing any symptoms.

Around 20% of people with chronic hepatitis B will go on to develop scarring of the liver (cirrhosis), which can take 20 years to develop, and around 1 in 10 people with cirrhosis will develop liver cancer.

Therefore it's important to get yourself vaccinated if you fall into one of the high-risk groups for catching hepatitis B.

Who is at increased risk of Hepatitis B?

Hepatitis B is uncommon in the UK and cases are largely confined to certain groups -

drug users
men who have sex with men
certain ethnic communities (South Asian, African and Chinese).

In contrast, hepatitis B is common in other parts of the world, particularly China, central and south-east Asia and sub-Saharan Africa. The World Health Organization estimates that hepatitis B is responsible for 600,000 deaths a year worldwide.

How do you get Hepatitis B?

You are at risk of catching hepatitis B if you are exposed to infected blood:

inject drugs and share needles and other equipment, such as spoons and filters, or you are having a sexual relationship with someone who injects drugs
have an open wound, cut or scratch, and come into contact with the blood of someone with hepatitis B
have medical or dental treatment in a country where equipment is not sterilised properly
work closely with blood (for example, healthcare workers and laboratory technicians are at increased risk of injury when the skin is accidentally punctured by a used needle)
have a blood transfusion in a country where blood is not tested for hepatitis B
have a tattoo or body piercing in an unsafe, unlicensed place
share toothbrushes, razors and towels that are contaminated with infected blood
You also have an increased risk if you (or your sexual partner) grew up, lived or worked in a part of the world where hepatitis B is relatively common.

All blood donations in the UK are tested for hepatitis B

You are also at risk of catching hepatitis B if you are exposed to infected body fluids:

if you have sex with an infected person without using a condom.
Generally, your risk increases if you are sexually active and have unprotected sex with several different partners; this includes unprotected anal and oral sex.
Prostitutes (both women and men) also have an increased risk of contracting hepatitis B

Treatment

There is currently no specific treatment for acute hepatitis B, other than using painkillers to relieve symptoms.

Chronic hepatitis B can be treated using a combination of antiviral medications designed to slow the spread of the virus and prevent damage to the liver.
This treatment is available at Aberdeen Royal Infirmary.

Prevention

There is a vaccine that is thought to be 95% effective in preventing hepatitis B.

Vaccination would usually only be recommended for people in high-risk groups, such as:

people who inject drugs or have a sexual partner who injects drugs
people who change their sexual partner frequently
people travelling to or from a part of the world where hepatitis B is widespread
All medical staff who have contact with blood

Pregnant women are also screened for hepatitis B, and if they are infected their baby can be vaccinated shortly after birth to prevent them from also becoming infected.

Hepatitis C

Hepatitis C is a virus that can infect and damage the liver. You can become infected with hepatitis C if you come into contact with the blood or, less commonly, body fluids of an infected person. In most cases, hepatitis C causes no noticeable symptoms until the liver has been significantly damaged. This can occur many years after the initial infection.

When symptoms do occur, they are often vague, for example flu-like symptoms, tiredness or depression. Because of this, many people remain unaware that they are infected by hepatitis C.

How do you get hepatitis C?

The hepatitis C virus is present in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person. It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact.

Almost 90% of new infections in the UK occur in people who are injecting illegal drugs.

It is not only regular drug users who are at risk, people who have only injected drugs once in their life have been known to develop hepatitis C. Less commonly, people can get hepatitis C through sex or being exposed to infected body fluids at work.

Getting tested

Because hepatitis C often causes no obvious symptoms, testing is usually recommended if you are in a high-risk group, such as being a current or former injecting drug user.

Your GP or the Nordhaven Clinic can test you for Hepatitis C using a simple blood test.

The sooner treatment begins after exposure to the hepatitis C virus, the more likely it is to succeed.

Treating Hepatitis C

Hepatitis C can be treated with antiviral medicines that are designed to stop the virus from multiplying inside the body and prevent liver damage.

The different strains of hepatitis C are known as genotypes, and some genotypes respond better to treatment than others.

The most common genotypes of hepatitis C in the UK are genotypes 1, 2 and 3. With treatment, around half of people with genotype 1 will be cured, and around 8 out of 10 people with genotypes 2 and 3 will be cured.

Who is affected?

There were 7,834 reported new cases of hepatitis C in England during 2010, but the true figure is probably much higher.

It is estimated that around 255,000 people in England have hepatitis C. Hepatitis C is more common in men than women as men are more likely to inject drugs.

Who should be tested?

ex-drug users
current drug users
people who received blood transfusions before September 1991
recipients of organ or tissue transplants before 1992, or in countries where hepatitis C is common
babies and children whose mothers have hepatitis C
anyone accidentally exposed to the virus (needlestick or splash injury), such as health workers
people who have received a tattoo or piercing where equipment may not have been properly sterilised
sexual partners of people with hepatitis C

If you continue to engage in high-risk activities, such as injecting drugs frequently, then regular testing may be recommended. Your GP will be able to advise you.

Prevention

Unlike other forms of hepatitis, there is no vaccine for hepatitis C. Two ways to reduce your risk of catching hepatitis C are:

Never share any drug-injecting equipment with other people (not just needles, but also syringes, spoons and filters). See our Needle Exchange page for more information.
Use a condom during sex.

Stages of infection

The first six months of a hepatitis C infection are known as acute hepatitis C. Around one in four people will fight off the infection and will be free of the virus.
In the remaining three out of four people, the virus will stay in their body for many years. This is known as chronic hepatitis C.

Depending on other risk factors, such as alcohol use, between 10% and 40% of people with untreated chronic hepatitis C will go on to develop scarring of the liver (known as cirrhosis).

Around one in five people with cirrhosis will then develop liver failure, and 1 in 20 will develop liver cancer, both of which can be fatal.

If you think you are at risk of Hepatitis C infection, even if that risk was many years ago, please make an appointment for a test by calling Nordhaven Clinic on 01856 888 917.

Pre Exposure Prophylaxis (PrEP)

Pre Exposure Prophylaxis, or PrEP as it is known, is a medicine that HIV-negative people can take before sex to help reduce the risk of getting HIV.

When PrEP is taken correctly, it stops HIV from entering your cells and replicating (making copies of itself). This protects you against getting the virus.

PrEP can be used by anyone from a community or group that is most at risk of HIV, or people who have sex with people from those networks.

People who take PrEP will require regular HIV and STI testing.

For more detailed information, please visit: Pre Exposure Prophylaxis (PrEP)

Post Exposure Prophylaxis (Treatment)

I think I might have put myself at risk of HIV, is there anything I can do?

PEP is a treatment to stop a person becoming infected with HIV after it’s got into their body.

It is a course of tablets lasting 1 month. It makes it a lot less likely for HIV infection to occur, but doesn’t work every time.

How soon should I take it?

The quicker you start PEP, the more likely it is to work. Ideally it should be started within 24 hours, but can be used up to 72 hours after unsafe sex.

Where can I get PEP?

PEP is available 24 hours a day, 7 days a week at the A&E department at the Balfour Hospital in Kirkwall - 01856 888 000

HIV Testing

If you are concerned about HIV there are a number of ways you can obtain a test. It is usually a simple blood test or a finger prick test.

It is important to remember 2 things:-

Post-exposure Prophylaxis (PEP)

If you think you have put yourself at risk of HIV in the last 72 hours, you may be entitled to PEP.

PEP is a treatment to stop a person becoming infected with HIV after it’s got into their body. It makes it a lot less likely for HIV infection to occur, but doesn’t work every time. It might be used if you have had unprotected sex, or a condom has broken, and you are at high risk of contracting HIV.

PEP is available at Balfour Hospital A&E department.

Window Period

It may take up to 12 weeks for a HIV test to become positive. This means that a negative test today cannot rule out that you have picked up HIV in the last 12 weeks.

Where can I get a test?

AT YOUR GP SURGERY – your GP will be able to discuss the pros and cons of HIV testing and also offer you other STI screening.

AT A SEXUAL HEALTH CLINIC – these tests are usually sent anonymously i.e. using a number rather than your name. You can call the Nordhaven Clinic to arrange a test.

FREE SELF-TESTING KITS – We are pleased to announce the start of a pilot in NHS Orkney to provide free self-testing kits for HIV. This will run along side the free Condoms by Post service.

A HIV self-testing kit will be posted out to your address. By following the simple advice, you can have your result within minutes. Please see the following information about HIV Self Testing Kits: Quick Guide to Instant Result HIV Self-Test Kits

If you test positive for HIV, this must be repeated on a sample taken by your GP or by a sexual health service, such as the Nordhaven Clinic.

If you would like us to send you a free kit, please fill in our request form: HIV Self-Test Request Form

A POSTAL TEST - Fasted Direct Scotland - will post out a free testing kit to anyone concerned about HIV. The kit is returned by post and the result will be available in a few days.

BUY A HOME TEST - HIV testing kits are now available to purchase on-line from hivselftest.co.uk. These tests cost about £30 and use a fingerprick test. The result is available in 15 minutes. However a positive test should always be followed up by a blood sample taken by a healthcare professional.