To announce, as the Health Protection Agency has this week, that the number of people living with the HIV virus has increased might not seem like good news. In some ways it isn't. But what it does show is that a diagnosis of HIV is no longer a death sentence: it has become a long-term condition that can be treated and managed.

In 2007 the number of those living with the virus in the UK increased to an estimated 77,400 and there were 7,734 new diagnoses. Today, to mark next week's 20th World Aids Day, we publish the views of four people who have the virus. Their circumstances are different but they lead normal lives, frustrated only by ignorance about their condition and the discrimination that results.

There is a further worrying offshoot of the positive change in the outlook for those with HIV, and that is the complacency about contracting the virus that is creeping into developed countries where treatment is available. In undeveloped countries the outlook remains bleak. Worldwide, 33 million people are infected with HIV; two million died of Aids last year.

Paul Fleming, 44, fundraising manager

I see my doctor every four months and he tells me that probably something else will get me - old age, heart attack, if not the 55 bus. I've been positive for six years and I'm still not on any medication; there's no difference in my bloods between now and six years ago. There's nothing to do.

When I found out I was positive I was disappointed, angry, sad. It was an accident, I should have been more vigilant. I suffered from a bit of depression that sometimes recurs, but what are you going to do? Sit at home and feel sorry for yourself or get on with it? You question what you're doing in life, you feel that time is more precious. I changed my job. Before I was at a management training company, now I work in the not-for-profit sector, which is less stressful and I feel that I'm doing something useful.

I haven't always been open about it. The gay community is more accepting because still, statistically, more of us are getting infected than the rest of the UK population - our defences have come down and there's a bit of complacency because it's not a death sentence. Peculiar psychology, really.

I don't expect to drop dead next week, next year or next decade. You're managing a long-term condition that for someone as lucky as me is less burdensome than having diabetes. I don't want to belittle the gravity of the situation but daily life is fairly normal. I eat well, work out - I've just done a 10km run in 53 minutes. But my luck is probably down to my genes.

I forget about it, yes. Initially, on receipt of the diagnosis, the issues seemed huge - like an elephant in a small room, you're thinking about it all the time. Everything you do is associated with it and everything that happens is because of it, which may not be true.

As time goes by the elephant shrinks; now he's just a mouse that scrabbles a couple of times when I need to go to the doctor. It hasn't gone away but most of the time it's not in my mind.

Jenny, 42, charity volunteer

I was feeling well, looking well. I remember telling the doctor, ‘This is not my result'. My husband tested negative; how could he be negative and me positive? So we did another test and I was still positive. But I come from Rwanda and given that most of us have been raped I must have contracted it during the rapes when I was 25. My husband couldn't deal with my HIV status, so he left me.

Then I had to cope with pregnancy and my little boy. He's not HIV positive, which is a big relief. When they find out that you're HIV positive they give you treatment during the pregnancy and the child is treated when they are born. I had a Caesarian but now many women with a low blood count can have babies through the birth canal. Also there's what they call sperm wash for men who have the virus. You can have a healthy baby and a healthy relationship if you use protection. My current boyfriend is not HIV positive but we are in a healthy, happy relationship: he trusts me, I trust him, we use condoms and there is no risk.

The biggest problem is the stigma and ignorance and the fear of being rejected if you disclose. I came to the UK in 1999 and at a Home Office interview in 2004 the interviewer said she wouldn't conduct the interview until I produced a letter from my doctor saying that my HIV status was not contagious. She called it Aids. I explained that she couldn't get HIV from meeting me, she argued and a crowd gathered to look at this woman who had HIV. That was the most humiliating thing that ever happened to me. I complained to the Home Office and they wrote back saying that they had to protect their staff. Eventually I got my British citizenship.

I'm on HIV treatment now and I'm doing very well. I am a happy person; my doctor says I will have a normal life span. So the picture of HIV as a death sentence has totally changed. We are working, we are volunteering, we have a lot to offer.

Winnie Sseruma, 47, HIV co-ordinator

A lot of the fears are about being judged, being seen as a bad, promiscuous person. You have to find strength within you.

It's 20 years since my condition was diagnosed. I have a good idea how I contracted it but it's not helpful to think about that; I concentrate on how I live.

I live a full life. I'm part of a family of seven, I look after a 14-year-old niece, I have a good social life. I date. At work some people say they can't believe how normal I am. A lot of times they forget and I forget, too. It's not something I wake up thinking about. HIV is a small part of who I am.

I was living in the US when the virus was diagnosed. It was a shock because I felt healthy. They told me I was lucky there was an antiretroviral drug, AZT, that I could access, so my life would be prolonged. I started the treatment. The only person I felt I owed an explanation to was the one I was dating; fortunately they were negative. We both moved on.

During the next few years my parents and then my brother died - he was HIV positive. I went to Uganda, where my family is from, and when my medication ran out in 1994 I got TB, pneumonia, diarrhoea. I survived because I had a very supportive sister who knew where I could get private care, and I had the money to pay for it.

I disclosed in 1996 when I arrived back here and had a check-up. A normal person would have between 500 and 1,600 of the T4 cells that fight the virus; I had just one.

I was offered treatment and my brother took me to a support group where I met people living with HIV who looked well and energetic. I thought: I want to be like that. From then on I wrote about my experiences of living with HIV; I volunteered to give people information and I've never looked back.

There's a delicate balance between making sure people know that HIV is transmitted sexually and they should use condoms, and explaining that the outlook for people with HIV need not be hopeless. We have to come up with better prevention strategies.

Tom, 16

I was told when I was 12. My doctor explained that I had the virus and that I'd been taking medication all these years because I was born with it. I didn't know much about it. My first reaction was, oh gosh, am I going to die? How long do I have left to live? I didn't know why it took so long to tell me.

Since then it has changed the way I see myself around others. I need to keep a part of me away from my friends. I also felt that I needed to change my attitude towards my schoolwork. I was in Year 7; I felt that I had to buckle down really early, act mature because I thought I shouldn't be wasting time. That's probably why I'm so into my work - I feel like I'm a bit too grown-up.

Gradually I've been talking to the doctor and I feel I can understand what I have but I can't be completely happy with where I am because I can't tell anyone. You have to watch what you're saying. You see on TV how people can react, and I wouldn't want that to happen because I have good friendships that I wouldn't want to jeopardise. Until you told someone you wouldn't know whether they would understand, ignore you or act completely differently around you. I don't want to risk it.

I've been treated all my life. My dad told me to keep it to myself. My mother died because of the virus; my dad doesn't have it. He only helped me in taking the treatment, not how to deal with it.

I'm not sure how I see my future. I'm aiming for university but my medicine will need to be refrigerated and I wonder if that will be a problem. I go to this support session and people tell stories about how their friends haven't taken it well. I admire their courage but it's off-putting. For now I'd like to keep it private.

www.bodyandsoulcharity.org

www.worldaidsday.org

HIV facts

One person in three living with HIV in the UK doesn't know that he or she is infected, putting their health and that of their sexual partners at risk. Undiagnosed HIV is responsible for about half of all new infections.

The estimated number of people infected through heterosexual contact in the UK has increased from 540 new diagnoses in 2003 to 960 in 2007.

For many people the diagnosis is too late for them to start treatment. The virus is more likely to be diagnosed late in heterosexual men (42 per cent) and women (36 per cent) than in gay or bisexual men (19 per cent). A late diagnosis is 13 times more likely to lead to death within a year.

Tests can diagnose the virus 12 days after infection.

Combination antiretroviral therapy (ART) was introduced in the UK in 1996. There are now 24 approved treatment options. ART reduces the level of HIV in body fluids, and so reduces the risk of someone who is being treated passing on HIV.

Half the people who have HIV in the UK live in London.

A study in The Lancet found that the average life expectancy of a 20-year old who had HIV diagnosed in 2003-05 has increased by 13 years compared with those who began therapy in the late 1990s.

Gay and bisexual men continue to be the community most affected by HIV in the UK. In London about one gay man in ten is infected with HIV, in Brighton it is one in eight.

In a recent survey, only 79 per cent of respondents knew that HIV can be transmitted through unprotected sex between a man and a woman, compared with 91 per cent in 2000.

Source: National Aids Trust

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