HIV Prevention

Electron microscope image of HIV, seen as small spheres on the surface of white blood cells.

HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. CDC estimates that about 56,000 people in the United States contracted HIV in 2006.

There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise noted, the term “HIV” primarily refers to HIV-1.

Both types of HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.

Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting their bodies. All people with HIV should be seen on a regular basis by a health care provider experienced with treating HIV infection. Many people with HIV, including those who feel healthy, can benefit greatly from current medications used to treat HIV infection. These medications can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to transmit HIV. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer.  Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk behavior, and find needed services.

AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s.

No one should become complacent about HIV and AIDS. While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person’s life, need to be carefully monitored, and come with costs and potential side effects. At this time, there is no cure for HIV infection. Despite major advances in diagnosing and treating HIV infection, in 2007, 35,962 cases of AIDS were diagnosed and 14,110 deaths among people living with HIV were reported in the United States.

HIV is spread primarily by:

• Not using a condom when having sex with a person who has HIV. All unprotected sex with someone who has HIV contains some risk. However:
  • Unprotected anal sex is riskier than unprotected vaginal sex.
  • Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.
• Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex. Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex.
• Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection.
• Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breast-feeding.

Less common modes of transmission include:

• Being “stuck” with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare workers.
• Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV.  This risk is extremely remote due to the rigorous testing of the U.S. blood supply and donated organs/tissue.
• HIV may also be transmitted through unsafe or unsanitary injections or other medical or dental practices.  However, the risk is also remote with current safety standards in the U.S.
• Eating food that has been pre-chewed by an HIV-infected person.  The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing.  This appears to be a rare occurrence and has only been documented among infants whose caregiver gave them pre-chewed food. 
• Being bitten by a person with HIV. Each of the very small number of cases has included severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken. 
• Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare. 
• There is an extremely remote chance that HIV could be transmitted during “French” or deep, open-mouth kissing with an HIV-infected person if the HIV-infected person’s mouth or gums are bleeding.
• Tattooing or body piercing present a potential risk of HIV transmission, but no cases of HIV transmission from these activities have been documented. Only sterile equipment should be used for tattooing or body piercing.
• There have been a few documented cases in Europe and North Africa where infants have been infected by unsafe injections and then transmitted HIV to their mothers through breastfeeding.  There have been no documented cases of this mode of transmission in the U.S.

HIV cannot reproduce outside the human body. It is not spread by:

• Air or water.
• Insects, including mosquitoes. Studies conducted by CDC researchers and others have shown no evidence of HIV transmission from insects.
• Saliva, tears, or sweat.  There is no documented case of HIV being transmitted by spitting.
• Casual contact like shaking hands or sharing dishes.
• Closed-mouth or “social” kissing.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from CDC.

Because the most common ways HIV is transmitted is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV, it is important to take steps to reduce the risks associated with these. They include:

• Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once. If you are at increased risk for HIV, you should be tested for HIV at least once a year.
  • If you have HIV, you can get medical care, treatment, and supportive services to help you stay healthy and reduce your ability to transmit the virus to others.
  • If you are pregnant and find that you have HIV, treatments are available to reduce the chance that your baby will have HIV.
  Locate an HIV testing site.
• Abstain from sexual activity or be in a long-term mutually monogamous relationship with an uninfected partner.
• Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with HIV or another STD.
• Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually transmitted diseases. “Natural” or lambskin condoms do not provide sufficient protection against HIV infection.
• Get tested and treated for STDs and insist that your partners do too.
  
  Locate an STD testing site .
• Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex.
• Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop injecting drugs, use clean needles and works when injecting.
  
  Locate resources on substance abuse treatment .
• Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly. This is called post-exposure prophylaxis.
• Participate in risk reduction programs. Programs exist to help people make healthy decisions, such as negotiating condom use or discussing HIV status. Your health department can refer you to programs in your area.

Male Condoms 

Several studies have demonstrated that male condoms made of either latex or polyurethane are effective barriers against HIV. The theory behind using condoms is clear: they cover the penis and provide an effective barrier to secretions such as semen and vaginal fluids, thereby blocking sexual transmission of HIV infection. 

Studies have also demonstrated that other common sexually transmitted viral infections, such as herpes simplex virus (HSV) and hepatitis B virus (HBV), can be prevented with the use of latex or polyurethane condoms. While condoms can help prevent the transmission of human papillomavirus (HPV), a virus that can cause cervical and penile warts, lesions and cancer, there is still a risk of infection.

Condoms made of "natural" materials—such as lambskin—are not a consistently effective barrier against many viruses. This is because they contain microscopic holes through which HIV can pass. 

The key to effective protection is consistent and correct use of condoms. To learn more about correct condom use, click here. 

Incorrect use of condoms can increase the risk of condom slippage or breakage, which diminishes their protective effect. Inconsistent use—for example, failure to use condoms with every act of vaginal or anal intercourse—can lead to HIV transmission. 

A word about polyurethane condoms: They are an effective alternative to latex condoms, especially for people with an allergy to latex. However, some studies have found that polyurethane condoms are more likely to break than latex condoms. Still, if used consistently and correctly, they are considered to be a highly effective barrier against the sexual transmission of HIV. 

Female Condoms 

The female condom, approved in 1993 for use in the United States, is a polyurethane pouch with flexible polyurethane rings at each end. It is inserted deep in the vagina, much like a diaphragm. The ring at the closed end holds the pouch in the vagina. The ring at the open end stays outside the vulva (vaginal opening). If inserted properly, it lines the vagina and the cervix, which helps to prevent pregnancy, along with HIV and other sexually transmitted infections. 

While female condoms are not approved for use during anal intercourse, some men and women have reported using them for anal sex. However, at least one study has uncovered problems for the receptive partner using the female condom, during anal sex, including difficulty inserting the condom, discomfort and rectal bleeding (removing the inner ring may alleviate some of the problems experienced during anal insertion and removal). 

A Word About Lubricants 

Only water-based and silicone-based lubricants should be used with latex condoms. K-Y Jelly, Wet and Astroglide are three examples of water-based lubricants that can be used with latex condoms. Examples of silicone-based lubricants include Millennium ID and Eros Bodyglide. 

Never use oil-based lubricants, including hand or body lotion, baby oil, vegetable oil or shortening, massage oil, mineral oil, or petroleum jelly (e.g., Vaseline) with latex condoms. Oil-based lubricants can damage latex and cause latex condoms to tear more easily. If you must use an oil-based lubricant, it should only be used with polyurethane condoms. 

Some pre-lubricated condoms and separately sold lubricants contain a chemical called nonoxynol-9. While nonoxynol-9 has been shown to kill sperm (and potentially reduce the risk of pregnancy) and various sexually transmitted infections, some men and women are allergic to this chemical. This can cause irritation inside the vagina and anus, which can increase the risk of HIV transmission if the condom breaks.

Safer Sex 

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. However, researchers have also confirmed that some sexual practices are associated with a higher risk of HIV transmission than others. 

POZ.com believes everybody-regardless of their HIV status-should enjoy sex to the fullest. Though the facts about HIV transmission are the same for HIV positive and HIV negative men and women, even the tiniest bit of misunderstanding about how HIV is (and isn't) spread can lead to a lot of confusion when it comes to making important decisions about safer sex. 

There are a few basic facts to consider:

• Abstinence is the only 100-percent way to avoid HIV and other sexually transmitted infections.
• If you have a partner who has tested negative for HIV, does not inject drugs and is having sexual contact only with you, there is minimal risk of being infected with the virus.
• Being infected with a sexually transmitted infection (STI) can increase an HIV-positive person's chance of transmitting HIV, just as it can increase an HIV-negative person's chance of acquiring HIV.
• An HIV-positive person with a detectable viral load is more infectious-more likely to transmit the virus to somebody else-that an HIV-positive person who is receiving antiretroviral treatment and has an undetectable viral load.
• Safer sex practices, including correct and consistent use ofcondoms for vaginal or anal sex, can reduce the spread of HIV and other STIs.
• Getting intoxicated or high on drugs, including alcohol, can impair judgment and cause people to forget to take care of themselves-or their sexual partners.
• Safer sex is not just about vaginal, anal or oral intercourse. Masturbation (alone or with someone else), body rubbing, erotic massage and kissing-they're all fun, no-risk activities.

Safer Injecting