HIV and AIDS
Part 2 - Transmission and Prevention

Who is at risk of HIV infection?

HIV does not discriminate against race, social groups, sexuality or on sexual preference. The virus can infect anyone. It is behaviour that puts a person at risk, not the type of person one is or has sex with.

However, because many factors contribute to health, in some countries, people from minority populations have been disproportionately affected.

How do you become infected?

As previously stated, HIV is the virus, which is transmitted, and AIDS is a later stage condition, which may result from HIV infection.

Transfer of blood or sexual fluids from an infected person into another person’s body (usually by injection or sexual intercourse) is the principal mode of transmission. Once outside the body, HIV is fragile and dies quickly in normal circumstances.

HIV is transmitted by three major means:

1. Blood to Blood transmission

• By sharing injection equipment, e.g. syringes, water, filters etc, which may contain blood from an infected person. Remember the blood may not be visible.
• By having a tattoo or piercing done where the tattoo/piercing equipment is not sterilised.
• By receiving infected blood via a blood transfusion or blood products. Note: In most countries, the blood supply has been tested for HIV antibodies, however, if a donation occurred during the window period, the test may not have detected HIV. To cover this, all blood donors have to sign a declaration, which states that they haven’t put themselves at risk of acquiring HIV. Today more sensitive testing can be done to further reduce the likelihood of this happening.
• A person may be at higher risk if they received a blood transfusion or blood products overseas.

2. Sexual Transmission

Unprotected sexual intercourse is considered a high risk activity for both partners.
Having vaginal or anal sexual intercourse without a condom, or any other sexual activity where blood, semen, or vaginal fluid from an infected person may pass into the blood stream of another person, can lead to infection. Breaks in the skin caused by eczema, sores, or ulcers, could increase risks by allowing infected semen, blood or vaginal fluid to enter the blood stream. Absorption can also occur through the mucous membranes lining of the female cervical canal, the rectum, the male urethra and under the foreskin.

3. Parent to Child Transmission

HIV can be transmitted to an unborn child through the placenta during pregnancy, during a natural delivery as the baby comes into contact with infected blood and vaginal secretions in the birth canal and through milk if breast-feeding.

To reduce the possibilities of having a HIV positive child the infected parent should be on HIV anti-retroviral medications with undetectable or very low levels of the HIV virus present in their blood. To prevent infection to the baby during birth, delivery should be by a caesarean section. And to prevent infection to the baby after birth breast feeding should not be done.

The risk of transmission from the infected individuals to the baby increases if in the later stages of HIV/AIDS or if a woman is infected during pregnancy.

Can HIV be transmitted through oral sex?

Oral sex is considered to be a low risk for the transmission of HIV. HIV is not transmitted by saliva (see below “Can you become infected by kissing?”) however having cuts, ulcers, or damage to the mouth and gums may allow infected blood, semen, or vaginal fluid into the bloodstream via the mouth.

There is virtually no risk of acquiring HIV from receiving oral sex as the exposure is only to saliva. However, you should remember that other STIs may be transmitted this way.

How infectious is pre-seminal fluid (pre-cum)?

Pre-seminal fluid has been found to contain HIV in infected persons.

For this reason any penetrative sex without a condom must be considered unsafe. This includes coitus interruptus (withdrawing the penis before ejaculation). Any pre-seminal fluid involved in oral sex would also pose a theoretical risk of infection, however the actual risk would seem to be low. Studies are presently being conducted to measure to levels of HIV virus in semen.

Can you become infected by kissing?

Although HIV has been detected in saliva in some HIV positive people, it is in much lower concentrations than in semen, blood or vaginal fluid and therefore is not considered a risk for transmission of HIV. It is believed that some of the proteins in saliva may partially inactivate HIV.

Can you become infected with HIV through mutual masturbation?

The skin is a very effective barrier that keeps things like blood and sexual fluid, and therefore HIV, out of the bloodstream. It is not possible for HIV to enter the bloodstream via intact skin.

Theoretically, infection with HIV through masturbation could only happen if there are open (meaning bleeding or fresh) cuts or abrasions on the fingers, hands or on the body that come into contact with sexual fluid or blood. There are no documented cases of HIV transmission in which mutual masturbation was the only risk factor.

Can a person become infected with HIV from receiving or giving a massage?

As stated in the previous question, there is no entry point to the blood stream through intact skin. Blood, sexual fluid or vaginal secretions would need to get into the bloodstream. Blood or sexual fluid would need to get into a significant area of skin loss (such as a bleeding wound), which is extremely unlikely from massaging or being massaged.

I have seen a sex worker and am now worried that I may have been exposed to HIV. Can I catch the virus by having sex with a sex worker?

As mentioned, it is not the "type" of person who you have sex with but the behaviour that puts a person at risk. The principles of HIV transmission apply to everyone who you have sex with and the type of sexual behaviour that has occurred.

If safe sex is practised, you will not be at risk.

Can other sexually transmitted infections make you more susceptible to HIV?

The presence of other STIs can make it easier for HIV to enter the blood stream during unprotected sex (or in/on the mouth of a person performing oral sex). Having a STI makes it easier to both infect another and become infected with HIV.

Can you get infected at the doctor's, dentists or by ear piercing, electrolysis, acupuncture or tattooing?

Not if professional infection control guidelines are followed. If you have any procedure, which pierces the skin, ask how equipment is sterilised between clients. All professional service providers are required to follow strict infection control guidelines. If you have any doubts, check that your practitioners use either disposable or sterile equipment for each client, and that they follow infection control procedures.

Can you become infected by pricking yourself on a hypodermic needle by standing on it or otherwise piercing the skin?

The risk of acquiring HIV from a discarded needle and syringe is very low. To date there is no documented cases of this happening. The reasons for this low risk of transmission are:

• The used needle and syringe is usually very small, therefore holding no or very little potential infectious fluid.
• It may be some time since the needle was used, therefore any viral matter present has died.
• There may be no blood in the syringe.
• If there is blood in the syringe, it would have congealed and could not be injected out of the needle.
• The injury from the needle may not be deep.

Other blood borne viruses are more easily transmitted than HIV, such as Hepatitis B and C; even so, there are still only two documented cases of transmission of any of these viruses (one Hepatitis-B and one Hepatitis-C) occurring from discarded needles. Seek medical advice if you are concerned.

If infected blood is spilt, how can the area be disinfected?

Even though skin is a good barrier to HIV infection, it is recommended that you wear gloves to clean up the spill. Use paper towels if possible. Then wash the area with detergent, clean the cloth in the normal way and put gloves and paper towels into a plastic bag for disposal.

Can you get infected by household contact such as kissing or hugging, coughing or sneezing, or by sharing toilet seats, glasses, cutlery, towels, books or other implements?

You cannot become infected with HIV through general social contact. It would be unwise, however, to share razor blades or toothbrushes as blood might be present and able to pass through cuts or breaks in your skin, which may be a risk for other blood-borne diseases.

Can you get infected in swimming pools, spas, hot tubs or saunas?

Chlorine or salt water will destroy the virus. In water, the virus would also be diluted which means there will be no risk of transmission.

How do children get HIV/AIDS?

If the parents are infected, infants can become infected during pregnancy or at birth. Also, the virus can be transmitted through breast milk. Children are not at risk during normal home, school, or playground activities even when HIV infected children are present. Children should be made aware of the risks of contact with blood and should be instructed not to touch or play with discarded needles or syringes. Games such as "blood brothers" are not advised.

In the past (before 1985) children have become infected during transfusions of blood products (such as Factor 8 to treat haemophilia). This is unlikely to occur today as blood banks test all blood donations and heat process some blood products such as Factor 8 to inactivate the virus.

What is "safe sex"?

Safe sex is any sexual practice, which does not allow infected blood, semen, or vaginal or anal secretions to pass into the blood stream of another person.

Wearing a condom during sexual intercourse is the most effective protection. Condom breakage can occur if not used properly. Remember to squeeze the air out of the tip of the condom to leave room for the ejaculate. Always use water-based lubricants (e.g. wet stuff, KY). NEVER use oil based lubricants, (such as moisturisers, baby oil, or Vaseline), since these lubricants weaken the condom's latex and increase risk of breakage. If a condom does break, douching (flushing the area with water) is not advised as this may increase the risk of infection by weakening the lining of the rectum or vagina. Condoms should be stored as recommended and used before the expiry date, which is printed on the wrapper. Store condoms away from direct sunlight preferably in a cool place.

How long does the virus stay active outside the body?

We know that the virus is fragile and cannot survive long outside the human body in normal conditions. An exact time cannot be given as it depends on the environmental conditions, but HIV is extremely sensitive to changes in external temperatures, dilution and drying out.

Can I be infected by a HIV positive person?

Yes, but by specific means only, such as unprotected sexual intercourse or sharing needles with them You cannot become infected by casual social contact, such as: kissing, hugging, sharing food or cutlery/crockery, toilet seats, swimming pools, coughing or sneezing.

Is transmission of HIV by HIV positive people automatic?

There are recorded cases of one partner remaining uninfected despite regular sexual contact. However, the risk of transmission is high without appropriate precautions and avoidance of contact with blood, semen, vaginal or anal secretions is strongly recommended. It is not always clear why sometimes an infection occurs when on other occasions it has not.

Can you tell when people are HIV positive?

Most HIV positive people are healthy. The only way to tell someone has HIV is by a specific blood test. Therefore, if you do not know the status of your sexual partner, it is wise to take precautions and always use condoms.

Are HIV positive people a danger in the workplace?

The virus is mainly transmitted by sexual contact or sharing needles. HIV positive people can work in all professions and do not need to inform their employer. It is unlawful in Australia for an employer to ask an employee their HIV status.

Some people are required to know their status and change their practices if they are HIV positive. This is only for people who in the course of their job perform "exposure prone procedures", such as specific types of surgery or dentistry. It does not relate to all health care workers. Standard infection control precautions should be in place to prevent contact with blood or body fluids in every workplace regardless of whether employees are known to be HIV positive or not.

Do I report people with HIV/AIDS?

Doctors have the responsibility to make such legal notifications as necessary while maintaining patients' confidentiality. (Legal requirements for doctors to notify health authorities may vary from country to country) However, in Australia, all notifications of a new HIV diagnosis is coded in such a way as to not divulge the identity of the client.

People living with HIV have the same right to confidentiality as anyone.

Is there a Vaccine for HIV?

Despite many years of research, a vaccine has not been successfully developed, although one was recently being trialled but that trial has since ceased.

This information was taken from a booklet created by the NSW HIV/AIDS Information Line