Note: The answers to these questions are all approved by the National Institute for Health (NIH) and the Center for Disease Control (CDC). Their response is the result of supervised and extensive testing by such prestigious institutions as the Mayo Clinic and Johns Hopkins University Medicine
Note: At this time certain medical professionals are are reluctant to use the term ‘AIDS’ (see below). The acronym was a designation that evolved from several categories of the patient’s health:
a) The patient’s T-Cell (T-4) count is lower than 400 copies per ml of blood.
b) The patient’s HIV Viral load is in excess of 100 copies per ml of blood.
c) The patient has contracted anyone of a dozen opportunistic infections:
- Pneumonitis Pneumonia is a specific type of pneumonia attacks compromised immune systems causing lungs to fail.
- Toxoplasmosis is a disease of the brain to enlarge, putting painful pressure on walls and eye sockets
- Lesions are open sores occurring anywhere on the body that spread in time
- Purple blotches over the body of varying sizes that spread in time
- Other opportunistic infections to be added. For a expanded listing view visit the CDC website.
The acronym is AIDS is currently being replaced with HIV related complications. We will continue to use the term to replace AIDS and slowly begin phasing out the use of the term, AIDS.
What is HIV?
Human Immunodeficiency Virus (HIV) is the virus that weakens the immune system and causes HIV disease and AIDS.
H – Human, because this virus can only infect human beings
I – Immunodeficiency, because the effect of the virus is to create a deficiency, a failure in the normal function of the immune system
V – Virus, because the organism is a virus, which means one of its characteristics is that it is incapable of reproducing by itself. It needs a living cell to reproduce.
Where did HIV come from?
The evidence is strong for a link between HIV and Simian Immunodeficiency Virus (SIV), which infects chimpanzees and many other species of primates. The virus was likely transmitted to humans while hunting and butchering infected chimpanzees or other primates. Evidence indicates the current epidemic probably started in the 1930s.
The earliest known case of HIV was from a blood sample collected in 1959 from a man in the Democratic Republic of Congo. We do know that the virus has existed in the United States since at least the mid-to-late 1970s.
From 1979-1981 doctors in Los Angeles and New York were reporting rare types of pneumonia, cancer, and other illnesses among a number of gay male patients. These were conditions not usually found in people with healthy immune systems.
What is AIDS?
Acquired Immune Deficiency Syndrome is the life-threatening stage of HIV disease, also called Advanced HIV Disease. It is a medical diagnosis for someone whose immune system is so damaged that certain diseases (opportunistic infections) or cancers can develop. It is identified as such because:
A – Acquired; it is an acquired condition or infection, not something transmitted or inherited through the genes.
I – Immune; it affects the body’s immune system, that part of the body which is responsible for protecting the body from germs such as bacteria, fungi and viruses.
D – Deficiency; it makes the immune system deficient (does not work properly).
S – Syndrome; someone with AIDS may experience a wide range of different diseases and opportunistic infections.
What causes AIDS?
HIV is the virus that most researchers believe causes AIDS. However, some scientists remain unconvinced that HIV causes AIDS. These scientists believe that HIV can cause AIDS only in the presence of a cofactor, some other virus or condition which has not been found yet.
How long does it take for HIV to cause AIDS?
If left untreated, HIV gradually weakens the immune system and a person may develop AIDS within 10 years after becoming infected. The time it takes to develop AIDS is different for everyone and depends on genetics, general health status, levels of stress, and other contributing factors. With the development of better drug treatments since 1996, many individuals living with HIV have not and will not develop AIDS.
How can I tell if I'm infected with HIV?
HIV is diagnosed with an antibody test or other methods used by licensed medical professionals. The most common tests are antibody tests and can be administered at an HIV test site, or at a medical clinic. Many sites offer a rapid test which can give results within minutes. The only way you know if you are infected is by taking an HIV test or being diagnosed by a licensed medical professional.
What are the symptoms of HIV?
The initial symptoms of HIV disease may be a flu-like illness lasting up to two weeks (fever, chills, body aches, and swollen lymph nodes). Some people do not experience any symptoms or have symptoms so mild that they may not notice them. Later (sometimes years later) people with HIV may experience night sweats, fever, fatigue, involuntary weight loss, diarrhea, swollen lymph nodes, oral candidiasis, and vaginal yeast infections.
What is the connection between HIV and other sexually transmitted diseases (STDs)?
HIV is a sexually transmitted disease. You can contract HIV the same way you contract other STDs; by having unprotected sex. Also, the presence of other STDs, like syphilis, gonorrhea, or chlamydia, make it more likely to become HIV infected. By lowering your immune system, HIV can also make it easier to contract other diseases.
How is HIV transmitted?
The four common means of transmission are:
- Unprotected sexual intercourse (anal, vaginal, oral).
- Sharing of injection drug paraphernalia – including needles, syringes, cookers, and other Injection equipment.
- From an infected woman to her fetus (vertical or perinatal transmission), or to her child through infected breast milk (neonatal transmission).
- Through other direct exposure to infected blood or needle sticks (occupational transmission) or tattoos or piercing with non-sterile equipment.
Can I get HIV from oral sex?
Yes, but oral sex carries a low risk of HIV transmission. However, other STD’s are easily transmitted by oral sex, especially gonorrhea, chlamydia, syphilis and herpes.
Can I get HIV from having vaginal sex without a condom?
Yes. The HIV virus can penetrate the lining of the vagina, therefore cuts and sores in the vagina greatly increase the risk of infection. Some of these cuts and sores are so small a woman might not know they are there. In a heterosexual encounter, HIV passes more easily from male to female than vice versa. Therefore, the woman is at greater risk of infection.
Can I get HIV from anal sex without a condom?
Yes. Anal intercourse without a condom with an infected person (man or woman) is the riskiest activity for HIV transmission. The receptive partner is at risk because the anal area provides easy access to the bloodstream for HIV carried in semen. The insertive partner is also at risk because the membranes inside the urethra can provide an entry for HIV, possibly coming from the blood inside the anus of the receptive partner, into the bloodstream of the insertive partner.
Can I get HIV from open mouth kissing?
Not likely. Open mouth kissing is not known to pose any risk for HIV infection. Saliva does not transmit HIV. However, if either partner has some evidence of periodontal disease (bleeding gums) or open sores in the mouth, it’s better to err on the side of caution and refrain from kissing.
Can I get HIV from tattoos or through body piercing?
Yes. Any instrument designed to penetrate the skin can transmit disease from person to person. Always ensure that the person doing the tattooing or piercing is using properly sterilized equipment.
Can I get HIV from casual contact? What is casual contact?
No. HIV is not transmitted through casual, everyday contact. Casual contact includes, but is not limited to shaking hands, hugging, sharing a phone, trying on clothes, kissing someone on the mouth or cheek, sharing pens or pencils, sharing food, eating from the same plate, drinking from the same glass, and sharing toilet seats.
Can I get HIV from mosquitoes and/or other insects?
No. Mosquitoes draw blood out of the human body and do not inject blood into the human body. HIV cannot live in the gut of or on any part of a mosquito. No other insect or bug has the ability to carry HIV from human to human.
Can I get HIV from donating blood?
No. When blood is donated, sterilized needles are always used and are not reused. If you are concerned, ask the health worker if they are using new, sterilized needles and equipment to draw blood.
Can I get HIV from blood transfusions?
Not likely. Early in the epidemic, there were cases of HIV contracted through transfusions. Arthur Ashe, the tennis player, was infected this way. Beginning in 1985, the blood supply was tested for HIV. Tests for HIV have come a long way since then so the chances of getting infected by transfusion are very, very small, something like 1 in 600,000. It is recommended that people who will need to get blood for medical procedures bank their own blood in advance to eliminate any risk from blood transfusions.
Can a mother pass HIV to her baby?
It is possible for an HIV infected mother to pass the virus on to her baby during pregnancy, while giving birth, and through breast milk. If a woman living with HIV who is pregnant does not seek treatment, the chances are as high as 25% that her baby will be born with HIV. If you are pregnant it is important that you get tested for HIV. If you are infected with HIV, there are treatments available that greatly reduce the chances that your baby will be born with HIV. Recent studies have shown that expectant mothers taking a PReP (Truvada) medication have a high percentage of giving birth to an HIV- infant.
Can I be tested for HIV without my consent?
No. HIV testing cannot be done without consent from the patient, except under very specific conditions. People applying for a new or renewal of a license as a professional boxer or martial artist must present evidence of HIV negative status within 30 days of application for the license. People who apply for immigrant visas to the U.S. are also required to document HIV negative status. Finally, the U.S. military, Peace Corps and other government agencies require that people wanting to join these agencies produce proof of HIV status before the applicant will be hired or enlisted.
What are partner services?
Partner services are a broad array of services that should be offered to persons with HIV or other sexually transmitted diseases (STDs) and their sexual or needle-sharing partners. By identifying infected persons, confidentially notifying their partners of their possible exposure, and providing infected persons and their partners a range of medical, prevention, and psychosocial services, partner services can improve the health not only of individuals, but of communities as well.
Who is going to notify my sex partner(s) or anyone I think might be at risk of having the STD for which I was treated?
There is a professional DIS that specializes in notifying people who have or might have STDs. This is an actual profession that has been around in the US for over 50 years. The worker is known as a Sexually Transmitted Disease Intervention Specialist or DIS for short. These are caring and dedicated professionals who are highly trained in the area of STDs and partner notification and they operate under strict standards of confidentiality. The DIS receives intense training on how to discreetly notify people of positive STD tests, and those who were exposed to STDs. The DIS takes his/her work seriously and will go to great extents to protect your confidentiality and privacy while doing the contact notifications. The DIS is specially trained to motivate people to get tested and to discuss medical management of contacts to STD with doctors, so the contacts get the recommended testing and treatment. The DIS is knowledgeable of all different lifestyles, and can do his/her job smoothly in any social, cultural environment. It is critical that you get to know your DIS during this process to make sure that it goes smoothly and is thorough and effective.
Why can't I just tell my own sex partner(s) to go get checked for whatever STD I had?
There are a few drawbacks to telling your partner this way. There is no guarantee that the partner(s) will take action. Often the STDs don’t cause symptoms which could trigger confusion and discredit your efforts. Telling your partner on your own does not make it anonymous. This may not be an issue for some, but for others it is a serious consideration. Partner violence is another possibility. People sometimes get angry when STDs enter their lives and reactions can get out of hand. So by working hand in hand with your DIS you have a much better chance to avoid these drawbacks. Again these are issues that your DIS is aware of and can provide you some tips on how to handle.
How do I know which sex partner(s) to refer?
ALL sex partner(s) within a specified period need to be notified, examined and possibly treated to stop the spread. False assumptions are very dangerous and could result in the chain of infection starting all over again. Consult with your DIS about which of your contacts need to be referred. Depending on which STD you have you may need to refer your partner(s) from within the last 30 days up to 1 year. You will be given some suggestions on this when you speak with your DIS. Don’t make assumptions about who gave you the STD or to whom you could have passed the STD.
Will the DIS tell my sex partner(s) or others that I was the one who named them?
No. The DIS is specially trained to deal with questions about who requested public DIS assistance in doing the notification. The worker is strictly prohibited from giving that information or any clues about who provided information. We think this is the most important rule in maintaining the success of the partner notification process. Your name will not be given to anyone. There is a chance that your contact will confront you about being the one who requested a DIS contact them. This is not unusual and you should be prepared to respond however you think is best for your situation. Being confronted is especially likely if you are their only sex partner. There are ways to deal with that confrontation. Consult with your DIS. She/He can coach you on some responses to possible confrontation that will meet your situation.
What if my sex partner(s) are not local?
No problem. As long as your partner(s) are in the US we can arrange for a specially trained DIS where that person lives to do the notification. Our DIS can forward your request to the right area to get the notification done. Also, the person being notified will not be told that the information came from your area. That policy is necessary to protect confidentiality. If your contacts don’t live in the US, we may be able to get international follow-up depending on where they live. Discuss this with your DIS for specifics.
I don't want to involve my steady partner in this because I will lose the relationship and all that goes with it.
This is a concern for many people. The fear of losing the relationship and support that goes with it is real. The fact is though, that your steady partner could very well be in the chain of infection related to your STD and must be notified. Continuing a sexual relationship without telling your steady partner will cause you to be re-infected or your partner will become seriously ill because the disease has remained in their body for a long period of time. Talk to your DIS on how to best do this notification to ease the impact.
What is U=U?
Undetectable equals Untransmittable. Research by the CDC has recently concluded that the risk of HIV transmission from a person with a sustainable, undetectable viral load is insignificant or negligible. The DHHS has embraced this new information and has presented it on their homepage at the state level. Although any chances of contracting the virus is negligible, persons who are HIV- should consider PrEP to further insure that seroconversion does not happen. This does not include a chance of contracting STIs. Use of a condom is the only way to ensure that STIs are not passed from one person to another.
HIV Transmission and Risks
HIV is transmitted through the following body fluids:
- Rectal fluids
- Vaginal fluids
- Breast milk
Note: Although saliva is a body fluid that is shared or exchanged during sex, it is not considered to have a risk of transmission unless at least one of the partners involved has mouth sores or bleeding gums.
There are several ways this can happen:
- Unprotected sex with someone who is HIV positive. Unprotected sex refers to sexual contact that does not involve the use of condoms or biomedical prevention (i.e., treatment as prevention (TasP), pre-exposure prophylaxis (PEP) or post-exposure prophylaxis (PrEP).
- Sharing needles, syringes or other injection equipment with someone who is HIV positive.
- Mother-to-child transmission. Babies born to HIV-positive women can contract the virus before or during birth or through breast feeding after birth.
Transmission in health care settings. Health care professionals have contracted HIV in the workplace, usually after being stuck with needles or sharp objects containing HIV-positive blood.
- Transmission via donated blood or blood-clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies, including in the United States.
Common Myths About How HIV Is Spread
You are NOT at risk for HIV if you:
- Are bitten by a mosquito or any other bug or animal.
- Eat food handled, prepared or served by somebody who is HIV positive.
- Share toilets, telephones or clothing with somebody who is HIV positive.
- Share forks, spoons, knives or drinking glasses with somebody who is HIV positive.
- Touch, hug or kiss a person who is HIV positive.
- Attend school, church, restaurants, shopping malls or other public places where there are HIV-positive people.
- HIV is not transmitted through saliva, urine, feces, vomit or sweat.
Sexual Transmission of HIV
In the United States, sexual contact is the most common route of HIV transmission. According to the Centers for Disease Control and Prevention (CDC), nearly 70 percent of the estimated number of new HIV infections in 2014, were among men who have sex with other men (MSM). The term “MSM “is important because many men who have sex with men do not necessarily identify themselves as gay or bisexual. HIV transmitted through sexual activity among heterosexuals accounted for nearly 23 percent of new infections; most of these cases were among women who contracted the virus from men. People who inject drugs accounted for 7 percent of new infections, though about 40 percent of those were MSM, so it isn’t possible to know for sure whether those men contracted HIV by sharing injection equipment or through sex.
According to data from UNAIDS, MSM accounted for 12 percent of new infections globally in 2015. Sex workers accounted for 5 percent of new infections; people who inject drugs accounted for 8 percent of new infections.
The reason why sexual activity is a risk for HIV transmission is because it allows for the exchange of body fluids. Researchers have consistently found that HIV can be transmitted via blood, semen and vaginal secretions. It is also true that HIV has been detected in saliva, tears and urine. However, HIV in these fluids is found only in extremely low concentrations. What’s more, there hasn’t been a single case of HIV transmission through these fluids reported to the CDC.
Specific Sexual Practices: What Are the Risks?
Studies have repeatedly demonstrated that certain sexual practices are associated with a higher risk of HIV transmission than others.
Unprotected vaginal intercourse is the most common mode of HIV transmission worldwide. In the United States and many other developed nations, it is the second most common mode of sexual HIV transmission (after anal intercourse among MSM).
Studies have demonstrated that male-to-female HIV transmission during vaginal intercourse is significantly more likely than female-to-male HIV transmission. In other words, HIV-positive men are much more likely to transmit the virus to HIV-negative women through vaginal intercourse than HIV-positive women are to HIV-negative men.
There are a few reasons for this. First, there are more men than women in the United States living with HIV, meaning that it’s much more likely for a female to have sex with an HIV-positive male than for a male to have sex with an HIV-positive female. Second, women have a much larger surface area of mucosal tissue—the lining of both the vagina and cervix can chafe easily and is rich in immune system cells that can be infected by HIV—than men. For men, HIV must enter through a cut or abrasion on the penis or through the lining of the urethra inside the tip of the penis.
Research suggests that men who are uncircumcised have a higher risk of contracting HIV as well as a higher risk of transmitting the virus if they are already HIV positive. However, it is important to stress that men who are circumcised can still contract or transmit the virus.
Men or women who have sexually transmitted infections (STIs), such as genital herpes or syphilis, are more likely to transmit the virus if they are HIV positive or to contract the virus if they are HIV negative.
Unprotected anal intercourse is associated with a high risk of HIV.
Being the receptive partner—the bottom—during unprotected anal intercourse puts you at a much higher risk for HIV, but it’s possible for either partner to get HIV. The reason for this is that semen containing HIV can come into contact with anal mucosal tissues, which can absorb HIV during anal intercourse. And the risk of HIV transmission isn’t necessarily reduced if the insertive partner, or top, pulls out before ejaculation. Studies have demonstrated that pre-ejaculate (pre-cum) can contain high amounts of HIV and can result in transmission during anal intercourse.
The insertive partner is at lower risk, but it is possible for HIV to enter through a cut or abrasion on the penis or through the lining of the urethra inside the tip of the penis or through certain cells on the foreskin.
Studies suggest that unprotected insertive anal sex is roughly four to 14 times less risky than unprotected receptive anal sex.
The risk of penile-oral sex causes the greatest amount of confusion in terms of risk—and it raises the greatest number of questions. But most experts agree that fellatio (blow jobs) is not an efficient route of HIV transmission.
Because unprotected fellatio allows body fluids from one person to come into contact with the mucosal tissues or open cuts, sores or breaks in the skin of another person, there is a “theoretical risk” of HIV transmission, meaning that passing an infection from one person to another is considered possible. But the likelihood of it happening is rare, as there are only a few documented cases. These instances all involved MSM—men who were the receptive partners (the person doing the sucking) during unprotected oral sex with an HIV-positive man. There haven’t been any instances of HIV transmission among female receptive partners during unprotected oral sex. And there hasn’t been a single documented case of HIV transmission to an insertive partner (the person being sucked) during unprotected oral sex, either among MSM or heterosexuals.
Like fellatio, this is also considered a low-risk activity. Reports document one case of female-to-female transmission of HIV via cunnilingus and another case of female-to-male transmission of HIV via cunnilingus. Both of these cases involved transmission from receptive partner (the one receiving oral sex) to the insertive partner (the one performing oral sex). There haven’t been any documented cases of HIV transmission from the insertive partner to the receptive partner.
Oral-anal sex is often referred to as analingus. Analingus, or rimming, is not considered to be an independent risk factor for HIV. However, it has been shown to be a route of transmission for hepatitis A and B, as well as parasitic infections like giardiasis and amebiasis.
Digital-Anal or Digital-Vaginal Sex
Digital-anal or digital-vaginal sex is the clinical term for fingering either the anus or the female genitals (including the vagina). While it is theoretically possible that someone with an open cut or fresh abrasion on his or her finger or hand could contract HIV if coming into contact with blood in the anus or vagina or vaginal secretions, there has never been a documented case of HIV transmission via fingering.