AIDS Awareness

What is HIV?

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection.

What is AIDS? What causes AIDS?

AIDS stands for acquired immunodeficiency syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses, (opportunistic infection.) An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts). A CD4+ count of less than 200 indicates a severely damaged immune system and an AIDS diagnosis.

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria.

Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness.

Many of the infections that cause problems or may be life threatening for people with AIDS, are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care.

Also, once a person is diagnosed with AIDS, they will always be considered to have AIDS, regardless of clinical changes later on. For example, if a person has HIV and a CD4 count below 200, they are considered to have AIDS. If their CD4 count later goes back to above 200, they are still considered to have AIDS.

How can I tell if I'm infected with HIV? What are the symptoms?

The only way to determine for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years. An HIV antibody test has been available since 1985. This test was originally licensed for the purpose of screening blood donations, but is now available at various sites for testing persons concerned they may have been exposed to HIV.

The following may be warning signs of infection with HIV:

rapid weight loss

dry cough

recurring fever or profuse night sweats

profound and unexplained fatigue

swollen lymph glands in the armpits, groin, or neck

diarrhea that lasts for more than a week

white spots or unusual blemishes on the tongue, in the mouth, or in the throat

pneumonia

red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids

memory loss, depression, and other neurological disorders

However, no one should assume they are infected if they have any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.

Similarly, you cannot rely on symptoms to establish that a person has AIDS. The symptoms of AIDS are similar to the symptoms of many other illnesses. AIDS is a medical diagnosis made by a doctor based on specific criteria established by the CDC.

How long after a possible exposure should I wait to get tested for HIV?

The tests commonly used to detect HIV infection actually look for antibodies produced by your body to fight HIV. Most people will develop detectable antibodies within 3 months after infection, the average being 25 days. In rare cases, it can take up to 6 months. For this reason, the CDC currently recommends testing 6 months after the last possible exposure (unprotected vaginal, anal, or oral sex or sharing needles). It would be extremely rare to take longer than 6 months to develop detectable antibodies. It is important, during the 6 months between exposure and the test, to protect yourself and others from further possible exposures to HIV.

What do the test results mean?

POSITIVE RESULTS:

Your blood has been tested with both the screening test called the ELISA and a continuing test called the WESTERN BLOT.

You are infected with HIV.

You must assume you can infect other people.

You may or may not develop AIDS or HIV related symptoms

NEGATIVE RESULTS

You are not infected with HIV; or

You may be infected, BUT your body has not yet produced enough antibodies for detection. Antibody production generally takes up to 3 months after infection, but in some cases up to 6 months or longer before antibodies can be detected. Sometimes a retest is necessary.

You may be infected, but your body won't produce antibodies, (which is very rare).

A person who engages in high-risk activities and tests negative should realize there can be false negatives - that is, a person could be infected even though the antibody test is negative. A person who tests positive OR who engages in high-risk activities should NOT donate blood, semen, organs or tissue. They should use risk reduction during sexual activity. A confirmed positive test means you have been infected with HIV. It does NOT mean you have AIDS or will develop AIDS. If you test positive, further evaluation is necessary to see if you have immune damage or any condition that indicates AIDS. A person who tests positive is infectious and can pass the virus to others.

How is HIV transmitted?

HIV transmission can occur when blood, semen (including pre-seminal fluid or "pre-cum"), vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.

HIV can enter the body through the anus or rectum, the vagina, the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), cuts and sores or through a vein (e.g., injection drug use). Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.

These are the most common ways that HIV is transmitted from one person to another:

by having sexual intercourse (anal, vaginal, or oral sex) with an HIV-infected person

by sharing needles or injection equipment with an injection drug user who is infected with HIV

from HIV-infected women to babies before or during birth, or through breast-feeding after birth

HIV also can be transmitted through transfusions of infected blood or blood clotting factors. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world. Some health-care workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood contact with the worker's open cut or through splashes into the worker's eyes or inside their nose.

HIV is not easily transmitted. It is NOT spread through the air, through water, by insects, or during ordinary social contact. It has NEVER been transmitted by casual contact.

Can I get HIV from performing oral sex?

Yes, it is possible for you to become infected with HIV through performing oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.

Blood, semen, pre-seminal fluid, and vaginal fluid all may contain the virus. Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. The risk increases

if you have cuts or sores around or in your mouth or throat;

if your partner ejaculates in your mouth; or

If your partner has another sexually transmitted disease (STD).

If you choose to have oral sex, and your partner is male,

use a latex condom on the penis; or

If you or your partner is allergic to latex, plastic (polyurethane) condoms can be used.

Research has shown the effectiveness of latex condoms used on the penis to prevent the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus.

If you choose to have oral sex, and your partner is female,

Use a latex barrier (such as a dental dam or a cut-open condom that makes a square) between your mouth and the vagina. Plastic food wrap also can be used as a barrier.

The barrier reduces the risk of blood or vaginal fluids entering your mouth.

Can I get HIV from having vaginal sex?

Yes, it is possible to become infected with HIV through vaginal intercourse. In fact, it is the most common way the virus is transmitted in much of the world. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. The lining of the vagina can tear and possibly allow HIV to enter the body. Direct absorption of HIV through the mucous membranes that line the vagina also is a possibility.

The male may be at less risk for HIV transmission than the female through vaginal intercourse. However, HIV can enter the body of the male through his urethra (the opening at the tip of the penis) or through small cuts or open sores on the penis.

Risk for HIV infection increases if you or a partner has a sexually transmitted disease (STD).

If you choose to have vaginal intercourse, use a latex condom to help protect both you and your partner from the risk of HIV and other STD's. Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

Can I get HIV from anal sex?

Yes, it is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.

Having unprotected (without a condom) anal sex is considered to be a very risky behavior. If people choose to have anal sex, they should use a latex condom. Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use a water-based lubricant in addition to the condom to reduce the chances of the condom breaking.

How effective are latex condoms in preventing HIV?

Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently and correctly. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected.

What is safe sex?

Although no sexual act is 100% safe, safer sex involves finding ways to be intimate while minimizing the risk of STD transmission. The most important safer sex principles are:

The only absolutely Safe Sex is abstinence from any behavior which exposes another person to bodily fluids.

Use barrier precautions (latex condoms) for anal and vaginal intercourse and oral sex. Use a water-based lubricant, oil based can destroy latex. A drop of lubricant inside the condom may increase sensitivity.

Nonoxynol-9 may provide extra protection, but don't rely on it alone. Some studies show that Nonoxynol-9 can cause genital irritation that may promote HIV infection, especially with very frequent intercourse. The effects of ingesting Nonoxynol-9 are unstudied.

Use an unlubricated condom for oral sex if a man will cum in your mouth. For oral sex on a woman or oral-anal sex, use a dental dam (latex square), a condom or latex glove cut to produce a flat sheet, or non-microwaveable food wrap. Use barriers only once and only on one person.

Oral sex on a man or non-menstruating woman is thought to be a low risk activity. There is a risk that HIV could enter through small cuts or openings in the mouth, gums or throat: avoid brushing teeth two hours before or after oral sex to reduce risk.

Safe sex means sex which is absolutely safe. Lots of activities are completely safe. You can kiss, cuddle, massage and rub each other's bodies. But if you have any cuts or sores on your hands make sure they are covered with band-aids or latex gloves.

Practicing safer sex may also protect you against other sexually transmitted diseases.

Why is injecting drugs a risk for HIV?

At the start of every intravenous injection, blood is introduced into needles and syringes. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing") carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream.

In addition, sharing drug equipment (or "works") can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by

using blood-contaminated syringes to prepare drugs;

reusing water;

reusing bottle caps, spoons, or other containers ("spoons" and "cookers") used to dissolve drugs in water and to heat drug solutions; or

Reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.

"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. For this reason, people who continue to inject drugs should obtain syringes from reliable sources of sterile syringes, such as pharmacies. It is important to know that sharing a needle or syringe for any use, including skin-popping and injecting steroids, can put one at risk for HIV and other blood-borne infections.

How can people who use injection drugs reduce their risk for HIV infection?

The CDC recommends that people who inject drugs should be regularly counseled to:

Stop using and injecting drugs.

Enter and complete substance abuse treatment, including relapse prevention. For injection drug users who cannot or will not stop injecting drugs, the following steps may be taken to reduce personal and public health risks:

Never reuse or "share" syringes, water, or drug preparation equipment.

Only use syringes obtained from a reliable source (such as pharmacies or needle exchange programs).

Use a new, sterile syringe to prepare and inject drugs.

If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).

Use a new or disinfected container ("cooker") and a new filter ("cotton") to prepare drugs.

Clean the injection site prior to injection with a new alcohol swab.

Safely dispose of syringes after one use.

If new, sterile syringes and other drug preparation and injection equipment are not available, then previously used equipment should be boiled in water or disinfected with bleach before reuse.

Injection drug users and their sex partners also should take precautions, such as using condoms consistently and correctly, to reduce risks of sexual transmission of HIV.

Is there a connection between HIV and other sexually transmitted diseases?

Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person is also infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid STD's, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

Engaging in sex that does not involve vaginal, anal, or oral sex

Having intercourse with only one uninfected partner

Using latex condoms every time you have sex

Are women at risk?

Women remain the fastest growing group to be infected with HIV. In fact, today one out of every three people found to have HIV infection in the U.S. is a woman. Yet there are many gaps in our medical knowledge about women and HIV disease. There seem to be complex gender differences in both symptoms and drug side effects, as well as gynecological complications.

In 1997, women comprised 22% of all AIDS cases in the US. Heterosexual contact is the leading risk exposure category for all women (38%), and 29% of those are due to sex with an injection drug user (IDU). Injection drug use accounts for 32% of all cases. The majority of women who have sex with women (WSW) acquired HIV via drug use or sex with a man, although a few women have been identified as being infected via same-sex contact.

The number of AIDS cases among women increases steadily each year. Women under 30 made up 22% of AIDS cases among women in 1996. Because the time from HIV infection to developing AIDS can be long, many of these women acquired HIV in their teens.

African American and Hispanic women have been disproportionately affected by AIDS. AIDS rates for African American and Hispanic women are 17 and 6 times higher than for white women. In 1997, African American women made up 60% of all female AIDS cases, Hispanics 20% and Whites 19%.

What places women at risk?

Male-to-female transmission is estimated to be eight times more likely than female-to-male. There are two reasons for this: there are more men than women in the US infected with HIV, which increases the likelihood that women would have an infected sex partner; and HIV is more easily transmitted from men to women due to the greater exposed surface area in the female genital tract.

Sexually transmitted diseases (STDs) other than HIV can increase the risk of new HIV infections. Genital ulcers and immune response associated with STDs make it easier for HIV to enter the body. There are an estimated 12 million new cases of STDs every year, and populations at highest risk for HIV infection also have disproportionately high rates of other STDs. Treatment of STDs can be an effective HIV prevention strategy.

Injection and non-injection drug use puts women at increased risk for HIV infection and is strongly linked to unsafe sex. In one study, female IDUs reported sharing needles 32% of the time, and obtained used needles from their regular sex partner 71% of the time. Women who smoke crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection via sexual transmission.

Sexual abuse and coercion places many women at risk. In one study, physical and sexual abuse were "disturbingly common" throughout life among women at high risk for HIV infection. Childhood sexual abuse and physical abuse were also common. Women who have been abused are more likely to use crack cocaine and have multiple sex partners.