1. How is HIV transmitted?
HIV is spread by direct contact with infected body fluids, including blood, semen, vaginal secretions and breast milk. This means that HIV contained in one of these fluids must get into the bloodstream by direct entry into a vein, a break in the skin or through mucous linings, such as the eyes, mouth, nose, vagina, rectum or penis. Other body fluids such as urine, saliva, vomit, etc., do not pose a risk unless visible blood is present.
HIV is not easily transmissible. Unlike most viral infections colds, flu, measles, etc., HIV is not transmitted through sneezing, coughing, eating or drinking from common utensils or merely being around a person with HIV infection. HIV is not transmitted through air, water, food or casual contact such as handshaking, hugging, or use of restrooms and drinking fountains, etc. Casual contact with people who have HIV infection does not place others at risk. No cases have ever been found where HIV has been transmitted through casual contact with a household member, relative, coworker or friend.
2. What activities put a person at risk for HIV infection?
Activities that put a person at increased risk for HIV infection include:
• Having unprotected anal, oral or vaginal sex (not correctly using a latex condom or dental dam) with a person who has HIV or whose HIV status is unknown; and
• Sharing injection drug needles or "works" with a person who has HIV or whose HIV status is unknown.
Women with HIV infection can pass the virus to their babies during pregnancy, delivery and through breastfeeding. Health care workers may be exposed to HIV through needle-sticks and other blood contact.
3. Does everyone who is exposed to HIV get infected?
No. Infection with HIV may depend on how the virus enters the body and the amount of virus that enters the body. But it is important to know that infection may occur after one exposure to HIV infected blood, semen or vaginal secretions. Exposure can occur during unprotected sex or sharing injection drug needles or "works."
4. Why is injection drug use a high risk activity for HIV infection?
Small amounts of blood from a person infected with HIV may stay in the "works" used to inject drugs (needles, syringes, cotton, cookers, water and other equipment) and can be injected into the bloodstream of the next person who uses the equipment.
Any drug injection activity where equipment is shared with a person who has HIV or whose HIV status is unknown is high risk. This includes injecting drugs into the veins (IV), in the muscles or under the skin.
Used needles and works may also be packaged as new and sold on the street and can transmit HIV if someone with HIV used them.
5. Why is anal sex a high risk activity for HIV infection?
The walls of the anus and rectum are thin and richly supplied with blood vessels which can be injured during anal sex. HIV infected semen can be easily absorbed through these thin walls and into the bloodstream. Injured tissue in the anus and rectum can expose the penis to blood containing HIV, as well. Unprotected anal sex with a partner who is infected or whose HIV status is unknown is the most risky sexual activity for both men and women. While latex condoms provide protection, their failure rate during anal sex is greater than that for vaginal or oral sex.
6. Are men and women both at risk for HIV infection during vaginal sex?
Yes. A growing number of women have become infected through vaginal sex with men who are HIV infected. Though women are at greater risk for HIV infection through vaginal sex than men, HIV is found in vaginal fluids and menstrual blood and can be transmitted to male partners, particularly if there is a cut or sore on the penis.
7. Can HIV be transmitted by having oral to genital sex?
Yes. People have become infected with HIV by performing oral sex on a partner with HIV, though this is less risky than anal or vaginal sex. Since the mouth is lined with mucous membranes, contact with infectious blood, pre-ejaculation fluid (precum), semen or vaginal fluids may make it easier for HIV to enter the body. Cuts such as those caused by tooth brushing, flossing, canker sores, blisters or other open areas in or around the mouth may further increase the risk of HIV infection. (See Risk Reduction.)
8. Can a woman with HIV pass the virus to her baby during pregnancy or through breast feeding?
Yes. There is a 1 in 4 chance that a woman infected with HIV will pass the virus to her baby before birth or during birth, if she is not taking any drugs that fight HIV. The risk of passing HIV to the infant may be reduced to 1 in 12 if the mother takes the medication AZT during pregnancy. HIV is also found in breast milk and babies have become infected by breastfeeding from mothers infected with HIV. Women with HIV should NOT breastfeed their babies.
A woman with HIV infection can pass the virus to her baby during pregnancy, delivery or by breastfeeding even if she has no symptoms.
9. How can pregnant women prevent transmission of HIV to their infants?
All women of childbearing age should be tested for HIV before pregnancy or very early in pregnancy. Now, there are medications women can take during pregnancy to reduce the risk of passing the virus to their babies. The sooner women get tested for HIV, the sooner they can make decisions about their health and decide if they want to take medication to reduce the risk of passing the virus to their babies.
10. Do STDs (sexually transmitted diseases) increase the risk of getting HIV?
Yes. They increase the risk of getting HIV and of transmitting HIV.
Any inflammation or sore caused by an STD such as herpes, gonorrhea, chlamydia or syphilis makes it easier for HIV to enter the bloodstream during sexual contact, so people with STDs are more susceptible to getting HIV infection. Because many STDs do not produce symptoms at all, particularly among women, it is extremely important for sexually active women to be tested for STDs, even if there are no apparent symptoms.
Studies have also shown that STDs increase the amount of HIV in the semen and vaginal fluids of people infected with HIV. These increased levels of HIV may make it more likely that sex partners will become infected during unprotected sex. Studies have also shown that treatment for STDs may reduce the likelihood of HIV transmission.
11. Does sexual contact with many partners increase the risk of HIV infection?
Yes. Unprotected sex with many partners increases the risk of coming into contact with someone who is infected with HIV, as well as someone who may have other sexually transmitted diseases, such as syphilis, gonorrhea, chlamydia and herpes.
12. Is a condom 100% safe in preventing HIV infection?
No. Condoms are not 100% safe, especially if they are not used consistently and correctly. However, latex condoms used during sex can reduce the risk of HIV infection since they minimize direct contact with semen, blood and vaginal secretions (fluids known to carry the virus). When using a lubricant with a latex condom, always use a water based lubricant, such as KY jelly . DO NOT use oil based lubricants, such as Vaseline or hand lotion, because they weaken latex condoms and cause them to break.
The new polyurethane condoms are intended for latex sensitive users only. The risks of pregnancy and sexually transmitted diseases (STD' s), including HIV infection are not known for this type of condom.
The actual protection provided by condoms can vary widely and is affected by such factors as storage, handling, proper use, or quality control by the manufacturer. In general, the rate of condom failure during anal sex is greater than for vaginal or oral sex. It is safest to avoid anal, vaginal or oral sex unless it is known for certain, through an HIV antibody test, that one's partner is not infected.
Natural lambskin condoms are not effective protection against HIV because they allow the virus to pass through.
13. How do women become infected with HIV?
Women can become infected by having unprotected sex or by sharing injection drug needles and works with an infected person. Of the women in New York State known to have AIDS, more than half (about 60%) became infected through injection drug use. However, the fastest growing number of cases is among female sex partners of men who use injection drugs. Women who have unprotected sex, particularly anal sex, with men are at increased risk for HIV infection.
Women who have sex with other women may be at some risk for HIV infection because the virus can be transmitted by infected vaginal secretions and menstrual blood. Unprotected oral sex and sharing sex toys are activities which may place these women at risk for HIV infection, in addition to other risk factors such as substance use.
14. Can a person with HIV who is not sick or who has no symptoms transmit HIV?
Yes. Initially, most people with HIV infection have no symptoms and may not be aware they are infected. Any person infected with HIV can transmit the virus to another person through sexual contact or sharing needles or drug injection equipment.
15. Can a person become infected from a partner who has a low or an undetectable viral load?
It is possible to become infected from a partner who has a low or an undetectable viral load.
Tests measuring viral loads show the amount of HIV in a person's blood. An undetectable viral load means the amount of a virus in a person' s blood is lower than can be measured by the test—IT DOES NOT MEAN THERE IS NO HIV IN THE PERSON'S BODY. Commercially available viral load tests do not measure the amount of HIV in a person' s lymph nodes, organs, semen, vaginal secretions or other body fluids.
Although a low or undetectable viral load indicates how well drug therapy is working, it does not eliminate the possibility of spreading HIV to sex and needle-sharing partners.
A person can become infected from a partner who has a low or undetectable viral load.
16. Can a person get HIV by kissing?
There has been one reported case of HIV transmission where a woman became infected by deep kissing with a man with AIDS. The man reported his gums often bled after brushing and flossing his teeth and that after this activity, the couple often engaged in deep kissing and protected sex. Although HIV transmission most likely occurred during deep kissing, it was probably the blood in the man's saliva, not his saliva alone, that caused the infection. Both the man and the woman had gum disease which may also have contributed to the woman becoming infected.
Trace amounts of HIV have been found in the saliva of some people with AIDS. However, to date there have been no cases of HIV transmission through exposure to saliva alone. Casual kissing, such as between parents and children, has not transmitted HIV.
17. Can a person get HIV from using someone's razor or toothbrush?
It is possible to get HIV from using someone ' s razor or toothbrush since these items can cause cuts and scrapes, and may contain blood from the infected person. It is wise to avoid sharing personal items that may come into contact with another person's blood.
There is one documented case of a child becoming HIV infected by sharing toothbrushes with parents who were both HIV infected. Transmission probably occurred from blood left on the toothbrushes.
18. Have people become infected with HIV as a result of living in the same household as a person with HIV infection or AIDS?
There are no reported cases of AIDS from casual contact with someone who has HIV or AIDS and there is no evidence that being around someone with HIV or AIDS, even for an extended period of time, puts people at risk. However, there have been four reported cases where household members became infected with HIV as a result of blood to blood contact, either by sharing a razor, getting stuck with a needle used for treatment, or by getting infected blood on a rash and/or on open sores.
19. Can a person get HIV from body piercing, ear piercing or tattoo needles?
So far, no AIDS cases have been linked with any body part piercing or tattooing. However, to guard against possible infection, all needles or equipment used for these procedures should be new or sterilized between uses, and new, unused ink should be used.
20. Can the use of injectable steroids or hormones increase the risk of HIV infection?
Injection steroids or hormones do not increase the risk of HIV infection. However, sharing needles or injection equipment increases the risk of HIV infection. Small amounts of blood from a person infected with HIV may remain on the equipment and can be injected into the bloodstream of the next person who uses the equipment. To reduce the risk of transmission, injection equipment should not be shared with another person unless it has been cleaned. See question 58 on how to clean syringes.
21. Can HIV be transmitted through food, water or the air?
No. HIV is not transmitted through the air, food or water, or by touching any object handled, touched or breathed on by a person infected with HIV.
22. Can mosquitoes transmit HIV?
No. Studies have shown that mosquitoes, other insects, or rodents play no role in the transmission of HIV to humans.
23. Can HIV be transmitted in swimming pools or hot tubs?
No. There are no cases of HIV transmission through swimming pools or hot tubs. The virus is killed by the normal levels of chlorine used to disinfect public swimming pools, saunas or hot tubs.
24. Can HIV be transmitted through bites?
While it is not a likely occurrence, it is possible for a person with HIV to transmit the virus by biting another person if very specific circumstances exist. The person who has HIV must have visible blood in his or her mouth and must break the skin of the uninfected person. The break in the skin would allow the infected blood to enter the other person' s bloodstream. It is important to know that this is consistent with the way HIV is transmitted, through blood to blood contact. Saliva, however, is not a factor in HIV transmission.
25. What is being done to keep the blood supply and other blood products safe from HIV?
Since May 1985, all blood donations are screened for HIV antibodies. In addition, the FDA recommended in 1994 that the p24 antigen assay (a blood test that detects protein particles of HIV) be used to screen all U.S. blood donations. This test helps identify blood donors who are in the process of developing antibodies to HIV.
Since 1984, all blood products, such as clotting factor, undergo heat treatment and at least one other process to kill HIV. No HIV infections have occurred among uninfected persons using clotting factor products now on the market.
26. What's being done to reduce the risk of HIV infection to health care workers?
Over the last decade, standard infection control procedures and use of prevention devices have been promoted to reduce the risk of occupational HIV infection. While these efforts have helped to reduce the frequency of exposure to HIV, needle-sticks and other contact with blood and body fluids continue to occur. This demonstrates the need for health care workers and other occupational groups who come in contact with blood and/or body fluids to strictly follow safety guidelines to prevent exposure to potentially infectious blood and/or body fluids during patient care.
AZT, which has been shown to reduce the risk of HIV transmission, is now considered to be more effective when taken in combination with other drugs that fight HIV such as protease inhibitors. Combination therapy should be taken immediately after a needle-stick exposure. Anyone who has had a needle-stick should go as soon as possible to a hospital emergency room that has experience treating HIV. Staff there will decide if treatment would be beneficial, based on the exact type of exposure.
27. Can victims of sexual assault do anything to lower the risk of getting HIV?
It is important to seek medical care immediately after rape, for a number of reasons, including getting treatment that may prevent sexually transmitted diseases. For certain types of sexual assault, some doctors now recommend taking drugs that fight HIV, to decrease the likelihood of transmission of HIV. Although there is no proof yet that this treatment will work after sexual assault, information about the reduced risk of HIV transmission when medications are used after certain occupational needle-stick injuries means that this might be beneficial if used soon after a sexual assault.
28. Should people be concerned about getting HIV from doctors, dentists or other health care professionals?
Getting infected with HIV or other blood borne diseases from a doctor, dentist or other health care professional is extremely unlikely. For their protection, as well as for patients, health care workers are required to use standard infection control procedures to reduce the risk of exposure to patients' or workers' blood or body fluids. Patients can ask their health care providers about how standard infection control procedures are followed where they receive their care.