HIV is no longer the deadly infection it was in the 1980s and 1990s. For people living with HIV, there are long-standing treatment options, so AIDS rarely develops. Yet for many, the thought of acquiring HIV through unprotected sex remains a nightmare scenario.
Holger Wicht is the spokesperson for the German AIDS Help (DAH) and explains in an interview what it means to be HIV-positive in 2025 and why and how you should protect yourself from infection today.
Mr. Wicht, do we still need to fear HIV in 2025?
There is no longer a broad fear or panic like in the past. HIV is no longer the deadly infection that, within a few years, progressed to AIDS and typically led to death. Today, people with HIV can live well, with a normal life expectancy.
Since 1996 there have been effective therapies against HIV, and since then the medications have improved dramatically and are now gentle, showing few side effects. They suppress the replication of HIV in the body to the point that the virus is no longer detectable in the blood and cause little damage.
This means it is also no longer transmissible via bodily fluids such as semen and mucous membranes. Sexual transmission is thus ruled out. At birth, the risk of transmission is under one percent. People with HIV can live in every respect like others, which includes sexuality and the natural capacity to bear and raise children.
But you probably shouldn’t push your luck and assume you won’t get infected?
Of course, protecting yourself against HIV remains sensible. A certain amount of fear or a sense of threat still serves a protective function, because HIV is still a chronic disease that is not curable at the moment. The immune system of people living with HIV remains chronically activated in the background, because some virus cells persist in so-called reservoirs. To prevent these from reactivating, you must keep a lid on them for life by taking the medications.
And an infection naturally has social consequences. People living with HIV have to decide: Do I share this with my circle or keep it to myself? If they disclose, HIV-positive people still unfortunately experience discrimination.
Many people still have reservations about contact with people living with HIV; for example, they would not drink from the same glass, would not use the same toilet, or would not allow a kiss on the cheek. Yet these are situations where transmission is completely ruled out, even without treatment.
What do you advise people who want to protect themselves from HIV?
We’re talking today about Safer Sex 3.0, because there are three ways to protect yourself from infection during sex. One is protection through therapy: if my partner is HIV-positive, there is no risk of transmission under therapy. You have to trust the other person for that, but in a steady relationship it is usually feasible after some time.
If you have sex with people you don’t know and partners change frequently, protection is especially important. This is particularly true in groups where HIV is more common than average—men who have sex with men, people who inject drugs, and people from countries with high HIV prevalence. The likelihood of encountering a positive partner is simply higher, and you don’t always know whether the other person is HIV-positive and on therapy.
There are two reliable ways to protect yourself. One is the good old condom. And in recent years the so-called pre-exposure prophylaxis, or PrEP, has become available for people at higher HIV risk. This is a medication taken by people who do not have HIV to prevent infection. Both must be used correctly. If you manage condoms well, they provide reliable protection. If you have trouble with them—for example, trouble rolling them on properly or you forget after drinking—you might consider PrEP. The AIDS Help offers guidance by phone and online on how to find a supportive medical practice.
Those groups most affected are also advised to get tested routinely for HIV once a year, regardless of sexual activity or protection behavior. But for everyone else as well: if there was a potential exposure, it’s better to test sooner rather than wait too long.
