Conditions HIV and AIDS

HIV is short for human immunodeficiency virus. The virus infects cells responsible for resisting pathogens. Because the virus thereby weakens the immune system, it is known as an immunodeficiency virus. A person with a weakened immune system is more vulnerable to infections and other diseases. Illnesses that are usually harmless can affect them much more severely.

There are certain illnesses that typically occur when the immune system is weakened by HIV. Doctors refer to these illnesses collectively as AIDS. AIDS stands for “Acquired Immune Deficiency Syndrome”. 

HIV can have different symptoms, depending on the stage of the infection. Within a period of 6 days to 6 weeks following infection – but, in most cases, after 2 to 3 weeks – some people experience flu-like symptoms. These may also be mild. Possible symptoms include:  

• high temperature (fever)
• headaches
• muscle and limb pain
• rash  
• sore throat
• swollen lymph nodes
• generally feeling weak and sick
• sometimes diarrhea
• in rare cases, inflammation of the brain and meninges (brain membranes)

These symptoms are present in many illnesses and are not necessarily signs of an HIV infection. For this reason, HIV often goes unnoticed initially.

After the first symptoms of an HIV infection, often months or years go by without any further symptoms. Only when a large number of defense cells are damaged do different illnesses occur because the body is no longer able to fight off pathogens. These illnesses include, for example, fungal infections, skin infections, pneumonia, toxoplasmosis, cytomegalovirus and certain forms of cancer.

Having unprotected sex is the most common cause of HIV infections. HIV and AIDS are therefore classified as sexually transmitted infections (STIs). In Germany, men who have sex with men are at an increased risk of infection. However, the risk is in itself nothing to do with gender or sexual orientation. A person’s sex life is the decisive factor. 

The HIV virus is mainly found in body fluids with which people come into contact during sex. These are: 

• sperm  
• vaginal fluid
• blood, including menstrual blood
• the film of fluid on the lining of the intestine

If these fluids get into the mucous membranes or open wounds, the virus can be transmitted.

People who share needles or other equipment to inject drugs, for example, are also at an increased risk. The risk of infection decreases significantly when they use sterile needles instead and do not share equipment.

In rare cases, healthcare professionals may become infected with HIV due to injuries with needles or other medical instruments. If the instruments previously came into contact with the blood or other body fluids of an HIV patient, the virus can be passed on in this way.

During pregnancy, it is possible for the virus to be transmitted shortly before, but especially during birth. Successfully treating the mother reduces the risk for the child from 20 to 25 percent to below one percent. After the birth, the infection can be transmitted to the child through breast-feeding. Antiretroviral therapy, i.e. a treatment that targets the virus, also offers a means of protecting the baby from infection.

The following are not contagious:

• coughing
• sneezing
• fondling 
• cuddling  
• caressing
• petting
• kissing, including deep (French) kissing  
• insect bites
• everyday activities, such as going to the cinema, swimming pool or sauna together, or exercising or work

Oral sex is also considered safe in terms of HIV transmission, but not in terms of other sexually transmitted infections (STIs).

The risk of getting infected with the HIV virus in Germany through a blood transfusion is extremely low. This is because all donated blood must be tested for the HIV virus.

HIV infections occur throughout the world. However, it is most prevalent in regions in Africa, countries in South East Asia, and South and Central America.

Globally, the number of new HIV infections and the number of deaths from AIDS are both declining. While around 3 million people were infected with HIV in 2000, this figure dropped to around 1.3 million in 2023. In the same period, the number of deaths from AIDS fell from 1.5 million to 630,000.

In Germany, HIV infections must be reported. At the end of 2023, around 96,700 people in Germany were living with HIV. Around 730 people died with HIV in Germany in 2023.  

The Robert Koch Institute (RKI) estimates that approximately 2,200 people were newly infected with HIV in Germany in 2023. Most cases (1,200) continued to be infections contracted during sex between men, although this figure has declined over the years. 620 people became infected as a result of sexual contact between men and women. It is estimated that 380 people became infected while injecting drugs. 

Condoms or medication offer effective protection against an infection with HIV. The term “safe sex” or “safer sex” refers to methods that are used to avoid infection during sexual activity.

Extensive research is being conducted in a possible vaccine against HIV. To date, however, no vaccine has been developed that offers sufficient protection against HIV.

Condoms and femidoms

In most cases, HIV is transmitted as a result of unprotected sex. Condoms, for example, provide protection from this. They also provide protection from other sexually transmitted infections such as chlamydia or hepatitis B. 

Women who don’t want to leave it to their partners to ensure protection can use femidoms. These are a type of large-sized condom that women can insert into the vagina. 

For more information about safe sex, see the website of the German AIDS Federation (Deutsche Aidshilfe).

Medication for protection – pre-exposure prophylaxis

It is possible to use medication to avoid infection with HIV. This method is called pre-exposure prophylaxis, or PrEP for short. It stops the HIV virus from replicating and, when taken correctly, provides up to 99 percent protection against an HIV infection. It generally involves taking a daily tablet that combines two active ingredients.

These active ingredients accumulate in the mucous membranes and prevent HIV from entering the cells. It should be noted that the medication accumulates more or less effectively in the different mucous membranes of the body. The protective effect is likely to begin working more quickly in the lining of the intestinal tract than in the mucous membrane of the vagina after medication is started.

PrEP is recommended for people who are at an increased risk of infection. These include the following:

• Men or trans individuals who have unprotected sex with men
• People who have sex with an HIV-positive partner who is not currently receiving effective treatment
• Sex workers
• People who inject drugs under non-sterile conditions

However, the decisive factor in all cases is the individual risk. This is best assessed in consultation with a doctor.

PrEP must be prescribed by a doctor who is familiar with this type of treatment and with the regular monitoring it requires. In Germany, statutory health insurance providers usually cover the costs of PrEP for people with an increased risk of infection with HIV.

Protection after high-risk contact

If a person suspects that they have been infected with HIV, they can use a post-exposure prophylaxis (PEP). PEP is used in emergencies and reduces the likelihood of getting an infection from an HIV-positive person, e.g., after sharing needles or if a condom breaks.

PEP must be started within 72 hours of exposure to the risk to prevent infection. But the earlier it is started – preferably within the first 24 hours – the more reliable the protective effect. PEP medication is taken for four weeks to prevent the spread of the HIV virus in the body.

PEP is available 24/7 from certain specialized hospitals. PEP is also available during the day from medical practices specializing in HIV.

The website of the German AIDS Federation (Deutsche Aidshilfe) provides more information about PEP and allows you to search for locations where PEP is available.

Safer use – avoiding infection with HIV when using drugs

“Safer use” means taking precautions to reduce the risk of infection with pathogens such as HIV when using drugs. The best way to prevent infection when using drugs is to always avoid sharing equipment and use sterile syringes. Many cities have needle exchange service or vending machines that provide sterile syringes.

Detailed information about safer use of drugs and more information about PrEP is provided on the website of the German AIDS Federation (Deutsche Aidshilfe).

Further information about preventing an infection with HIV, and PrEP in particular, is available from the website of the Robert Koch Institute.

You can use an online STI risk test to assess your risk of contracting HIV or other sexually transmitted diseases. The test is available on the website of the WIR – Walk In Ruhr, Center for Sexual Health and Medicine (Zentrum für Sexuelle Gesundheit und Medizin).

Public health authorities and test centers operated by the German AIDS Federation (Deutsche Aidshilfe) also offer anonymous testing for HIV. Testing is often free or provided at a small charge. You can also get tested for HIV at a medical practice. In this case, the health insurance provider covers the cost if an HIV test is considered useful from a medical perspective.

Self-testing for HIV is also possible. Self-tests can be purchase from pharmacies, drugstores, AIDS support organizations, or online. The CE mark indicates that a test has been tested and approved. Self-tests only provide a reliable result as of 12 weeks following infection. In rare cases, self-tests may indicate an HIV infection even if the person is not infected. Therefore, you should always attend a local public health office or medical practice to take a repeat test after a positive self-test.

Go to the website of the German AIDS Federation (Deutsche Aidshilfe) to find a test center near you.

The Paul Ehrlich Institute (PEI) provides information about which self-tests are suitable.

How exactly do tests to detect an HIV infection work?

There are various tests to detect an infection with HIV. The tests detect either the virus itself or specific antibodies in the blood. The body’s immune system forms specific antibodies against HIV following infection. A distinction is made between laboratory tests and rapid tests.

With a laboratory test, the blood is tested both for antibodies and for certain components of the virus itself. For this purpose, a blood sample is taken and sent to a lab for analysis. The result is available after a few days. If the test in the lab indicates an infection, a test to confirm the result can be performed immediately. Another blood sample may need to be taken in certain cases. Lab tests provide a reliable result within 6 weeks at most of exposure to a risk.  

Lab tests are now also available that allow you to take a fingertip blood sample yourself at home and then send the sample to a lab by mail. These are known as at-home sample collection kits, and can also be used to test for other sexually transmitted diseases.

A rapid test only requires a small drop of blood, for example, from the fingertip. Self-tests taken at home are a form of rapid test. 

If an HIV infection is detected, the result needs to be confirmed with a blood sample.

There are also PCR tests that can detect the HIV virus in the blood directly. These are normally used for testing during HIV treatment to monitor the effectiveness of the medication.

An HIV infection can be treated very effectively with medication. Treatment prevents the virus from spreading and AIDS from developing. With effective treatment, individuals are no longer able to pass the virus on to other people.

Highly effective drugs mean people with HIV can lead a normal life in almost all respects. They have a similar life expectancy to people without HIV and are not contagious. They are not restricted in their professional life or their free time. They can also express their sexuality and have children naturally without any risk. 

What treatment is available if an HIV infection is confirmed?

Treatment of HIV is also called antiretroviral therapy or ART for short. This involves taking daily medication that combines several active ingredients. These stop the HIV virus from replicating. The number of infected cells drops drastically, so that the infection cannot spread and the person does not develop AIDS. If the medication is taken regularly for at least half a year and if the virus can no longer be detected in the blood, it is almost impossible to infect others. The success of the treatment is monitored on an ongoing basis with regular blood tests.

ART does not remove the HIV virus from the body completely. From a medical point of view, the infection cannot be cured. People must therefore take this medication their whole lives. There must always be a sufficient quantity of medication in the blood to permanently stop the virus from replicating. For this reason, it is extremely important to take the medication regularly.

Patients are supported at the start of and throughout their HIV treatment by medical practices that specialize in HIV. Doctors in these practices know best how to select the most suitable treatment and what monitoring is necessary.

Accompanying illnesses are also treated as part of HIV therapy. These can be treated using antibiotics, for example.

You can use our doctor search function to find doctors in your area that specialize in HIV. Search under “Special services” using the keyword “HIV”.

If an HIV infection is treated, the person can live a normal life – just like people with many other chronic health conditions. People with HIV are not ill more often than other people without HIV and can achieve just as much. Nevertheless, they often face discrimination or rejection. World AIDS Day was initiated to raise awareness of this and call on all people to show solidarity. It has been taking place every year on 1 December since 1988.

The website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit) has a page dedicated to World AIDS Day, where you will find more information about this topic.

The website of the German AIDS Federation (Deutsche Aidshilfe) provides information about self-help groups and opportunities for exchanging information with other people with similar experiences. 

On the “Liebesleben” (Love life) website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG), you will find various sources of advice and support, including online and phone options. The website also provides general information about the topics of love, sex and protection. 

The Kompass website operated by the German AIDS Federation (Deutsche Aidshilfe) can help you find information centers, test centers, and doctors specializing in HIV in your local area.

Anonymous online support and advice is available from the Caritas website.

The website of the WIR – Walk In Ruhr, Center for Sexual Health and Medicine (Zentrum für Sexuelle Gesundheit und Medizin) offers information about HIV and other sexually transmitted infections, as well as a list of information and support services in the Bochum area.