Sexually Transmitted Diseases

The world first learned about HIV and AIDS in the 1980s. Since then, over 40 million people have died from the virus and its complications.

HIV is the abbreviation for human immunodeficiency virus (HI virus). It is, therefore, a virus that attacks the immune system. Our immune system is designed to protect our body from viruses, bacteria and other harmful microorganisms. When a person becomes infected with HIV, their immune system becomes weaker. In addition, HIV can also affect specific organs; it can, for instance, damage the kidneys. Since the HI virus initially causes almost no symptoms, the infected person may not know they have contracted it for years. An untreated HIV infection further weakens the immune system and, after some years, leads to AIDS.

AIDS is an immune deficiency syndrome. The body can no longer defend itself against viruses, bacteria and microorganisms. Harmless diseases can then become life-threatening for those affected.

Transmission of HIV occurs through direct contact between a healthy person's mucous membranes or broken skin and the bodily fluids of an infected person. That is because the body fluids of an infected person contain high levels of the HI virus. These fluids include, for example, blood, semen, the fluid produced before ejaculation (pre-seminal fluid), vaginal fluids and breast milk. Saliva, on the other hand, is not infectious.

The virus can be transmitted through:

• Sexual intercourse without a condom

• Blood-to-blood contact (e.g. transfusions, use of non-sterile instruments or needles, especially when consuming drugs)

• Mothers to their unborn child

• Mother to babies through breastfeeding

Good to know: HIV cannot be transmitted in everyday life. You cannot get infected through kissing, using the same toilet or coughing.

Important: There are HIV medications used in the treatment of HIV. They prevent the virus from multiplying in the blood. The medications also help to reduce the number of HI viruses in the body so that HIV does not harm the body further. The person with HIV is, therefore, no longer contagious. The existing HIV medication does not "cure" the person. However, if they take HIV medication regularly, they can continue to lead a whole life.

If you suspect that you might have been infected with HIV, you can have yourself tested in Germany at any time, if you wish, anonymously. You can check whether you are HIV-positive at your local health department or special organisations designated for this purpose. Such organisations exist in every major city. The addresses and opening times can be found using the search function on the "Deutsche Aidshilfe" website. In the search box, enter your postal code and location and under "categories", select the word "Checkpoint". If you want to see the health department closest to you in the search results, select the word "Testpoint" under "Categories". You will then see a list of test sites where you can get tested anonymously and receive free and anonymous advice on the next steps in the event of an infection. If your search returns no results, narrow the scope of your search. To do so, click on the "Proximity search" field and select the distance you like to search.

If you have been infected with HIV, you can discuss everything either with your doctor or experts from counselling organisations. There are counselling centres specialising in advising and supporting people with HIV. It is essential to start HIV therapy as early as possible. In Germany, doctors specialising in infectious diseases offer HIV therapy. They will help you find the proper medication and dose it correctly. These drugs are intended to stop the multiplication of the HI virus in the body and prevent the eventual development of AIDS. Consistent medication consumption, regular tests, and medical examinations are essential for successful treatment.

Specialists can be found on the website of the "German Association of Outpatient Physicians for Infectious Diseases and HIV Medicine". On kompass.hiv, you can find counselling centres in your area and make an appointment. Enter your postal code and location and select the word "AIDShilfe" under "Categories". If your search returns no results, narrow the scope of your search. To do so, you must select the "Proximity search" field and choose the desired distance you would like to find a centre.

Please note: Anonymous and free counselling is also possible online, e.g. via email (in German, English and French) or in a designated Chat room (only in German)– you can find more information at aidshilfe-beratung.

If you have recently come to Germany and know you are HIV positive, you should seek treatment as soon as possible. In Germany, the treatment is carried out by doctors who specialise in treating infectious diseases. They can help you choose the correct dose of medication. The drugs aim to stop the virus from multiplying in the body and prevent the development of AIDS. Consistent medication consumption, regular testing, and medical examinations are critical to successful treatment.

Your level of access to medical care depends on your residence status in Germany:

• If you already have health insurance, you can go straight to a specialist. You can find one on the website of the German Working Group of Outpatient Physicians for Infectious Diseases and HIV Medicine ("Ärztinnen und Ärzte für Infektionskrankheiten und HIV-Medizin"). The German Aidshilfe can also provide you with the contact details of specialists. You can also find a counselling centre nearby and make an appointment at kompass.hiv. You can also find specialists there. After entering your postal code and place of residence, you can select the word "AIDShilfe" or "HIV Counselling" under "Categories". If your search returns no results, narrow the scope of your search by clicking on the "Proximity search" field and choosing the desired distance within which you would like to find help. You can contact this organisation even if f you need advice in a language other than German. In principle, an interpreter can be invited to the interview.

• If you are still in the asylum procedure, your asylum application has been rejected, or you have a "Duldung", and you have been in Germany for less than 18 months, and you receive financial support from the Social Welfare Office, you are still entitled to receive HIV treatment. The organisation "Deutsche Aidshilfe" can help you to find suitable doctors. You can also find a counselling centre nearby and make an appointment at kompass.hiv. You can also find specialists there. Enter your postal code and place of residence and select the word "AIDShilfe" or "HIV Counselling" under "Categories". You can also contact the organisation if you need advice in a language other than German; in principle, an interpreter can be invited to the interview.

Illegalised people (people without residence status or papers) and those without health insurance can get help anonymously from organisations such as the Medibüro, the Clearingstelle or the Deutschen Aidshilfe. Here, you will also find the addresses and contact details of the organisations in your region and their opening times.

Hepatitis is an inflammation of the liver, usually caused by viruses. Different types of viruses can cause hepatitis. They differ in how they are transmitted, the severity of the ensuing illness, and prevention methods. Some types of hepatitis can be transmitted through unwashed fruit, vegetables, or seafood (types A and E). Others through blood or other body fluids (types B, C, D). Others (types A and B) are transmitted through close contact with other people (e.g. in the same household or kindergarten).

Important: You can protect yourself against hepatitis A and hepatitis B by getting vaccinated. Vaccination against hepatitis B automatically also protects against hepatitis D. There is no vaccination against hepatitis C, the most dangerous form of hepatitis.

Hepatitis A and B: These forms of hepatitis usually do not appear immediately after infection. The first symptoms are often similar to those of ordinary flu. Symptoms include malaise, loss of appetite, and muscle pain. Sometimes, the eyes and skin can turn yellow. A blood test can detect the disease. Hepatitis A can be cured, while in some cases, hepatitis B can become chronic. The good news is that, in principle, anyone who once had one of these forms of hepatitis cannot get infected again. You can always protect yourself by getting vaccinated.

Hepatitis C: This type of hepatitis is the most dangerous form of hepatitis and usually shows no symptoms after infection. You may get infected with hepatitis C several times– and unfortunately, there is no vaccine. Hepatitis C is treatable and curable in most cases. In some cases, however, it becomes a chronic condition. If left untreated, it can lead to liver cirrhosis or liver cancer. A blood test can diagnose hepatitis C. The co-occurrence of hepatitis C and HIV is particularly dangerous if those affected are not taking any medication to treat it, as there is a high chance of fatality.

Hepatitis D and E are very rare in Germany.

If you suspect that you have contracted a form of hepatitis, you can get tested anonymously. Every major city has several facilities that can help you with that. They also offer free counselling there. You can find their addresses and opening hours in the "Deutsche Aidshilfe" search engine. Enter your postal code and location, and under "Categories", select the word "Checkpoint". If your search returns no results, narrow the scope of your search. To do so, click on the "Proximity search" field and select the desired distance you would like to search.

Important: People over 35 can have a Hepatitis B and C Test carried out by their doctor free of charge as part of the check-up. Your health insurance company covers the costs.

In addition to HIV and various forms of hepatitis, there are many other sexually transmitted diseases to watch out for. The "best known" ones include chlamydia, herpes, gonorrhoea, syphilis and human papillomavirus (HPV).

As the name suggests, these diseases are most commonly transmitted through unprotected sex, including oral and sexual intercourse. Kissing and sharing sex toys can also lead to infection. Some infections can be transmitted through close domestic contact, even without sexual relations, e.g., human papillomavirus (HPV).

Important: The use of condoms reduces the risk of infection but does not offer 100% protection.

Often, there are no symptoms after contracting these diseases. However, sometimes skin changes and itching or discharge may occur. Most STDs are usually treatable. But they can also leave lifelong traces in a person's body and immune system. Some can lead to serious complications, such as human papillomavirus (HPV) and, in some cases, cancer. Syphilis can cause cardiovascular or nervous system problems.

These diseases are particularly dangerous when they occur in conjunction with HIV infection. That's why getting tested regularly is essential if you're sexually active. You can always consult your doctor if you are concerned about your health. In Germany, you can also get tested anonymously. In every major city, various organisations can provide you with accurate information in this regard. Addresses and opening hours can be found in the "Deutsche Aidshilfe" search engine. In the search field, enter your postal code and your place of residence and under "Categories", select the word "Checkpoint". You will then receive a list of facilities in your area where you can get tested and receive free and anonymous advice. If your search didn't return any results, try broadening the scope of your search. To do so, click on the "Proximity search" field and select the desired distance you'd like to search.

The most effective way to protect yourself and others is through safe sex. Using condoms (a new one each time you have sex) significantly reduces the risk of contracting HIV, hepatitis, or other sexually transmitted diseases. In Germany, you can find condoms in supermarkets, pharmacies and drugstores. Remember only to use condoms approved in the European Union with the CE mark (the abbreviation "CE" and a number printed on the packaging). Also, pay attention to the expiry date.

Condoms aren't just for men; they are also condoms designed for women, known as "Femidomes", which are also usually sold in supermarkets, pharmacies and drugstores. These condoms are also intended to protect against HIV, hepatitis and other sexually transmitted diseases– and must be changed after each sexual intercourse. Again, only buy condoms with a CE mark on the packaging and pay attention to the expiry date. You can find more information about "Femidomes" at Liebesleben.

Important: Alcohol and drugs increase the risk of infection because they lower the inhibition threshold and often lead to forgetting basic preventive measures.

You can protect yourself from many diseases by getting vaccinated. For example, you can get vaccinated against hepatitis A and B (which also protect against hepatitis D) or human papillomavirus (HPV). Vaccination against human papillomavirus is offered in Germany for children and adolescents aged 9 to 14, along with other scheduled vaccinations. You can learn more about them in our "Vaccinations for Children and Adolescents" chapter.

There are also medications for preventive treatment (PrEP or HIV-PrEP) which prevent HIV infection. Risk groups can get a prescription for them from an HIV specialist. You can find specialists on the website of the German Association of Outpatient Physicians for Infectious Diseases and HIV Medicine ("Deutschen Arbeitsgemeinschaft ambulant tätiger Ärztinnen und Ärzte für Infektionskrankheiten und HIV-Medizin"). Since 2019, statutory health insurance companies have been covering the costs of these medications.

If you notice changes in your body or feel a burning or itching sensation, do not hesitate to seek help from a doctor or support organisation and get tested. The earlier you know you've contracted the virus, the easier it is to treat the disease.

If you suspect you have been infected or are worried about your health, you can have yourself tested anonymously in Germany at any time. See the "Where can I get help and support for STDs?" section for more information.

If you suspect you have been infected or are worried about your health condition, contact your doctor as soon as possible and get professional help.

If you wish to remain anonymous, contact a counselling centre. You can easily find one using the Deutschen AIDSHilfe search engine:

• If you are looking for free counselling or a free HIV test, enter your postal code and place of residence and select the word "AIDShilfe" or "HIV Counselling" under "Categories". You can choose "Testpoint" to see your nearest health department in the search results. If your search returns no results, narrow the scope of your search. To do so, click on the "Proximity search" field and select the desired distance you'd like to search.

• If you want to be tested for hepatitis or other sexually transmitted diseases, enter your postal code and city and under "Categories," select the word "Checkpoint". If your search returns no results, narrow the scope of your search. To do so, click on the "Proximity search" field and select the desired distance you'd like to search.

• If you enter your postal code and place of residence and select "self-help contact" under "Categories", you can find like-minded people or self-help groups and exchange experiences and tips with them. A support group is a group of people who meet to discuss similar problems, such as an illness or personal concerns. They share experiences, support each other and consult in a safe and understanding environment. If your search returns no results, narrow the scope of your search. To do so, click on the "Proximity search" field and select the desired distance you'd like to search.

• You can also seek advice online free of charge and anonymously, e.g. via email (in German, English and French) or via the designated chat room (only in German). More information can be found at aidshilfe-beratung.

Please note: The consultations and tests are anonymous. So you don't have to give your real name. You can also get help regardless of your current residency status. If you need advice in a language other than German, contact an organisation in English, e.g. via email. You can also ask someone you trust to make an appointment for you.

Important: If you do not have health insurance, organisations such as Medibüro or Clearingstelle will help you get all the medication you need.