What is HIV?

HIV stands for human immunodeficiency virus.  It is a virus that weakens the immune system, which is the body’s natural defence against illness. The virus attacks and takes over the immune cells, using them to reproduce itself and go on to infect other cells. It is primarily transmitted in blood, semen, vaginal and anal fluids, and breastmilk. HIV is the virus that can cause AIDS if left untreated.

What is AIDS?

Acquired immune deficiency syndrome (AIDS) is not a single disease. It is a set of symptoms caused when a person’s immune system is too weak to fight off infection, after years of attack from HIV. The terms HIV and AIDS cannot be used interchangeably. It is important to remember that a person living with HIV does not necessarily have AIDS. It is possible to have HIV and never get AIDS. However, all people with AIDS have HIV.

How is HIV transmitted?

HIV does not survive for long outside of the body, so it is difficult to transmit, unlike contagious air-borne diseases like influenza. There are three main ways that HIV is transmitted:

  • Unprotected anal or vaginal sexual intercourse
  • Sharing drug injecting or tattooing equipment
  • From mother to child during pregnancy, birth or breastfeeding

HIV cannot be transmitted by:

  • Hugging, shaking hands, touching or kissing
  • Coughing or sneezing
  • Sharing glasses, cups, or utensils

What does ‘viral load’ mean?

Viral load refers to the amount of HIV circulating in the blood. A test can be done to find out what a person’s viral load is, which is written as a number indicating the number of copies of the virus per mL of blood. This can range from less than 20 to over one million copies/mL.  The higher a person’s viral load is, the greater the risk of transmission. When a person’s viral load is below 200 copies/mL, it is considered ‘undetectable’.

What does ‘undetectable’ mean?

A person’s viral load is considered undetectable when it is reduced to a level that cannot be detected by regular tests. This does not mean that their body is free or cured of HIV, only that there is less virus than the test can detect. ‘Undetectable’ is currently considered as less than 200 copies/mL.  

HIV-positive people on sustained antiretroviral (ARV) treatment can often maintain their viral load at low or undetectable levels. Studies have shown that if a person adheres to ARV treatment, and has maintained an undetectable viral load for six months or longer, there is ZERO chance of transmitting HIV to another person.

HIV in South Africa and the Western Cape

South Africa has the largest HIV epidemic in the world. In 2017, 18.8% of the adult population (aged 15-49) were living with HIV, that’s 7.2 million people. There were 270,000 new HIV infections, and 110,000 AIDS-related deaths. Meanwhile, only 61% of positive adults and 58% of children were on antiretroviral treatment.

While HIV does not discriminate, some groups are more vulnerable than others including men who have sex with men (MSM), transgender women, sex workers, people who inject drugs, and women and adolescent girls.  This is due in large part to social stigma and discrimination, patriarchal power structures, and laws that criminalise sex work and drug use.

Men who have sex with men (MSM)

It is estimated that HIV prevalence among MSM is 26.8% nationwide and 22.3% in Cape Town, or around one in four men. This varies significantly between areas though. Prevalence ranges from 10-14% in the city centre, to between 26%-34% in peri-urban areas.

Transgender women

Transgender women in Sub-Saharan Africa are twice as likely to have HIV as men who have sex with men. Trans people have often been neglected by policy and research, and excluded from taking part in studies, or otherwise been wrongly categorised as ‘men who have sex with men’.

Significant stigma and discrimination towards trans people from their families, communities, police, health care and other services further increases vulnerability to HIV. GenderDynamix, a Cape Town-based NGO that promotes transgender rights, have released a report showing the role health care provider stigma can play in putting trans women off accessing HIV prevention services.

Sex Workers

Nationally, HIV prevalence among sex workers is around 57.7%, and around 39.7% in Cape Town. A number of factors increase HIV risk for sex workers in South Africa, including criminalisation of their profession and harassment by police, poverty, lack of alternative career opportunities and number of dependents they have. Sex workers are often arrested by police for carrying condoms as ‘proof’ of criminal activity, which further impedes HIV prevention efforts.

Research has shown that only 19% of sex workers living with HIV nationally, and 27.7% in Cape Town are accessing ARV treatment. This is well below the national average, and highlights the need to further address the social and legal stigma and discrimination against sex workers that prevent accesses to HIV treatment.

Triangle Project proudly advocates for the decriminalisation of sex work in South Africa, and respects sex work as legitimate work. For more information about sex work, sex worker support and advocacy, check out the Sex Worker Education & Advocacy Taskforce (SWEAT) website.

People who inject drugs (PWID)

There is very limited research on injecting drug use and HIV in South Africa. It is estimated that around 17% of PWID are living with HIV, and are also at higher risk of other bloodborne viruses (BBVs) such as Hepatitis C. Injecting drug use often occurs covertly or in dangerous environments (such as dilapidated buildings or tunnels) and rapidly (for fear of being arrested by police). This increases the health-related risks of injecting. Stigma and discrimination by community members and health providers contributes to delayed health-seeking behaviours.

Countries such a Portugal, which has decriminalised drugs and adopted a public health focused harm reduction approach to drug use (rather than a criminal approach), has seen drastic reductions in HIV, blood-borne viruses, and other drug-related harms such as overdose.

Woman and adolescent girls

HIV prevalence among young women in South Africa is nearly four times greater than that of men their age. Young women aged 15-24 make up 37% of new HIV infections in South Africa. This is driven by patriarchal social structures and gender inequality, gender-based violence, poverty and intergenerational relationships between older men and younger women. Gender-based violence is attributable to an estimated 20-25% of new HIV infections among young women.

HIV Transmission

Sexual transmission

Penetrative sex

The primary mode of HIV transmission in South Africa is through vaginal or anal sex. This happens when body fluids from the positive partner enter the body of the negative partner. Body fluids that can contain HIV are seminal fluid (cum) and pre-cum, vaginal fluids, menstrual blood and anal mucous (the lining of the anus).

Some people believe that being the insertive partner during sex means that they are not at risk of contracting HIV. This is not true. HIV can still be transmitted from fluids in the vagina or anus to the penis, however the risk is lower.

Oral sex

There are many myths around oral sex and the transmission of HIV. Whilst it is biologically possible, it is basically impossible for HIV to be transmitted through oral sex. There have been no recorded cases of HIV being transmitted through oral sex (however other STIs can still be transmitted!). The factors might increase the possibility of HIV transmission include:

  • If there are cuts or abrasions in the receptive partner’s mouth
  • The insertive partner needs to be HIV positive, have a very high viral load, and not be on treatment
  • Ejaculation needs to occur from the insertive partner into receptive partner’s mouth.

If you are worried about transmission through oral sex, then there are some tips you can employ to make you feel more at ease, including:

  • Use a condom
  • Avoid brushing or flossing your teeth before oral sex
  • Rinse or gargle salty water, mouthwash or alcohol to see if you have any cuts in your mouth.

Blood to blood

HIV can be transmitted through blood to blood contact, such as from sharing injecting or tattooing equipment. HIV does not live for long outside of the body, so blood to blood transmission requires HIV positive blood to be directly inserted into the blood stream of someone who is HIV negative.

The best way to avoid blood to blood transmission if you inject drugs is to use a new needle and syringe every time you inject, and never share with anyone else. Make sure you go to a registered tattoo establishment where you can see that the equipment has been sterilised.

Parent to child

When conceiving a child, there is a risk of HIV infection when one parent is HIV positive. However, there are many things that prospective parents can do to reduce the risk, including being on effective ARV treatment. 

Mother to child

The main method of transmitting HIV from parent to child is from mother to child during pregnancy, birth or breastfeeding. There are a number of options to help prevent onward transmission of HIV from mother to child, including:

  • Being on anti-retroviral treatment
  • Using anti-retroviral treatment for the child
  • Choosing to have a caesarean section rather than a vaginal delivery
  • To not breast feed once the baby is born.

HIV Testing

Positive or negative, everybody has an HIV status, and it is important to know yours. Finding out that you’re positive can be frightening, but the sooner you know, the sooner you can start treatment, stay healthy and protect your partners from onward transmission. If you test negative, you get the peace of mind of knowing for sure. Combining your HIV test with a general STI screening is also a good way of staying on top of your sexual health. 

Getting tested

There are two ways to get tested for HIV: a rapid test and a conventional blood test. A rapid test will prick your finger to get a small drop of blood, which is then applied to a testing strip. This will give you the results in a few minutes. A blood test requires taking blood from your arm using a needle, which is then tested in a laboratory.  

Depending on how often you have sex, how safe your sex is, and with whom, it is recommended that you get tested every 3-6 months.

The window period

The ‘window period’ refers to the time between a possible exposure to HIV, and when an HIV test will give an accurate result.

An HIV tests looks for antibodies that your body produces once the virus has entered your body, rather than testing for the virus itself. It takes around 6 weeks from the time of infection for your body to start producing these antibodies, so during this time you may test negative for HIV even if you have recently been infected.


  • If you think you have been exposed to HIV, start taking PEP within 72 hours to reduce the likelihood of becoming positive.
  • If you think you have been exposed to HIV, and it had been longer than 72 hours, get tested, and then get tested again 6 weeks later, to confirm the results from the first test.

Testing services

Triangle Project offers free rapid HIV tests through its clinic and its outreach services.

Testing positive

Finding out that you are HIV positive can be an overwhelming, frightening, confusing and lonely experience. But know that you are not alone. Many people and resources are available to support you in this time.

See our page for People Living with HIV for more information about treatment and support.  

HIV Prevention

Whether you are positive or negative, there are several ways to prevent the transmission of HIV, including condoms, PEP, PrEP and TasP. It’s now easier than ever to help put an end to HIV.

Male condoms

Whoever you have sex with, using condoms is always a good idea. As well as stopping HIV, condoms are the only way to prevent transmission of other sexually transmitted infections (STIs) such as gonorrhoea, chlamydia and syphilis. Make sure to only use water based lubricant with condoms. Silicone based lube, or any other product such as Vaseline, creams, lotion or oil can harm the condom and make it easier to break.

If a condom breaks, and you think you have potentially been exposed to HIV, taking a 4-week course of post-exposure prophylaxis (PEP) can significantly reduce the likelihood of contracting HIV. This must be started within 72 hours of the HIV exposure.

Free condoms and lube are always available from Triangle Project’s office and outreach services

Female condoms (femidoms)

Female condoms are a thin pouch that can be inserted into the vagina before sex.  They can also be used for anal sex (with men or women). Some people find this is a good option for them as they are not reliant on their male partner to wear a condom. Female condoms protect against HIV, STIs, and pregnancy.

Free female condoms and lube are always available from Triangle Project’s office and outreach services.

Pre Exposure Prophylaxis (PrEP)

PrEP is when someone who is HIV negative takes a particular HIV medication to prevent getting the virus. When taken as prescribed it is 99% effective at preventing transmission. It only protects against HIV, so unless you use a condom you are still at risk of other STIs. Unlike medication for people who are HIV positive, PrEP does not need to be taken forever, but you will only be protected so long as you are taking it.

PrEP is available from any retail pharmacy in South Africa with a script from a GP, but you will need an HIV test and a kidney function test first. The retail cost for PrEP is approximately R600/month for the brand name drug (Truvada) or R250/month for a generic version. It is currently available for free to men who have sex with men and sex workers at selected state facilities. In Cape Town, men who have sex with men can obtain PrEP for free from the Ivan Toms Centre for Men’s Health (021 447 2844).

Post Exposure Prophylaxis (PEP)

If you think that you have been exposed to HIV, start taking PEP to reduce the likelihood of becoming HIV positive. PEP is a course of antiretroviral medication, and needs to be started less than 72 hours after being exposed. The sooner you start, the more effective it will be. You will need to take the medication for around 4 weeks.

Treatment as Prevention (TasP)/Undetectable = Untransmittable (U=U)

When you take your ARVs as directed it’s possible to achieve what is known as ‘undetectable’ status. This means that your medication has reduced your viral load (the amount of HIV in your body) to such a low level that a regular HIV test cannot detect it. When you have maintained an undetectable viral load for at least six months, there is zero chance that you can transmit the virus to somebody else. This is known as Treatment as Prevention (TasP), as effective treatment acts as a form of HIV prevention. It is critical that you take your medication every day as directed by your doctor to stay undetectable, and have your viral load checked regularly.