HIV and AIDS.

1. What are the main routes of HIV transmission?
These are the main ways in which someone can become infected with HIV:
Unprotected penetrative sex with someone who is infected.
Injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected.
From a mother who is infected to her baby; this can occur during pregnancy, at birth and through breastfeeding.
Sharing unsterilised injection equipment that has previously been used by someone who is infected.

2. Can I be infected if my partner doesn't have HIV?
No. Like all sexually transmitted infections, HIV cannot be created, only passed on. If you are sure that your partner does not have HIV, then there is no risk of contracting it even if you do have unprotected sex (whether it be vaginal, anal or oral). However, pregnancy and other sexually transmitted diseases remain a risk, so you should still use a condom or other suitable form of birth control wherever possible.

3.How safe is oral sex?
Answer: Although it is possible to become infected with HIV through oral sex, the risk of becoming infected in this way is much lower than the risk of infection via unprotected sexual intercourse with a man or woman.
When giving oral sex to a man (sucking or licking a man's penis) a person could become infected with HIV if infected semen got into any cuts, sores or receding gums they might have in their mouth.
Giving oral sex to a woman (licking a woman's vulva or vagina) is also considered relatively low risk. Transmission could take place if infected sexual fluids from a woman got into the mouth of her partner. The likelihood of infection might be increased if there is menstrual blood involved or if the woman is infected with another sexually transmitted disease.
The likelihood of either a man or a woman becoming infected with HIV as a result of receiving oral sex is extremely low.

4.What are the chances of becoming infected with HIV if he doesn't come inside me?
Answer: Whilst research suggests that high concentrations of HIV can sometimes be detected in pre-cum, it is difficult to judge whether HIV is present in sufficient quantities for infection to occur. To guard against the possibility of infection with HIV or any other STD it is best to practise safer sex, i.e. sex with a condom.

5.Is deep kissing a route of HIV transmission?
Answer: Deep or open-mouthed kissing is a very low risk activity in terms of HIV transmission. HIV is only present in saliva in very minute amounts, insufficient to cause infection with HIV.
There has been only one documented case of someone becoming infected with HIV through kissing; a result of exposure to infected blood during open-mouthed kissing. If you or your partner have blood in your mouth, you should avoid kissing until the bleeding stops.

6.Are lesbians or other women who have sex with women at risk for HIV?
Answer: Lesbians/bisexual women are not at high risk of contracting HIV through woman-to-woman sex. Very few women are known to have passed HIV on to other women sexually.

7.Is unprotected anal intercourse more of an HIV risk than vaginal or oral sex?
Answer: Unprotected anal intercourse does carry a higher risk than most other forms of sexual activity. The lining of the rectum has fewer cells than that of the vagina, and therefore can be damaged and cause bleeding during intercourse. This can then be a route into the bloodstream for infected sexual fluids or blood. There is also a risk to the insertive partner during anal intercourse, though this is lower than the risk to the receptive partner.

8.Does 'fingering' during sex carry a risk of HIV transmission?
Inserting a finger into someone's anus or vagina would only be an HIV risk if the finger had cuts or sores on it and if there was direct contact with HIV infected blood, vaginal fluids or semen from the other person.

9.Is there a connection between HIV and other STDs (sexually transmitted diseases)?
Answer: HIV and other STDs can impact upon each other. The presence of STDs in an HIV infected person can increase the risk of HIV transmission. This can be through a genital ulcer which could bleed or through genital discharge.
An HIV negative person who has an STD can be at increased risk of becoming infected with HIV through sex. This can happen if the STD causes breaks in the skin (e.g. syphilis or herpes), or if it stimulates an immune response in the genital area (e.g. chlamydia or gonorrhoea). Nevertheless, HIV transmission is more likely in those with ulcerative STDs than non-ulcerative.
Using condoms during sex is the best way to prevent the sexual transmission of diseases, including HIV.

10.Can I become infected with HIV through normal social contact/activities such as shaking hands/toilet seats/swimming pools/sharing cutlery/kissing/sneezes and coughs?
Answer: No. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.

11.Can I become infected with HIV from needles on movie/cinema seats?
Answer: There have been a number of stories circulating via the Internet and e-mail, about people becoming infected from needles left on cinema seats and in coin return slots. These rumours appear to have no factual basis.
For HIV infection to take place in this way the needle would need to contain infected blood with a high level of infectious virus. If a person was then pricked with an infected needle, they could become infected, but there is still only a 0.4% chance of this happening.
Although discarded needles can transfer blood and blood-borne illnesses such as Hepatitis B, Hepatitis C and HIV, the risk of infection taking place in this way is extremely low.

12.Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?
Answer: If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. However, people who carry out body piercing or tattooing should follow procedures called 'universal precautions', which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.
When visiting the barbers there is no risk of infection unless the skin is cut and infected blood gets into the wound. Traditional 'cut-throat' razors used by barbers now have disposable blades, which should only be used once, thus eliminating the risk from blood-borne infections such as Hepatitis and HIV.

13.Are healthcare workers at risk from HIV through contact with HIV positive patients?
Answer: The risk to healthcare workers being exposed to HIV is extremely low, especially if they follow universal healthcare precautions. Everyday casual contact does not expose anyone, including healthcare workers, to HIV. The main risk is through accidental injuries from needles and other sharp objects that may be contaminated with HIV.
It has been estimated that the risk of infection from a needlestick injury is less than 1 percent. In the UK for instance, there have been five documented cases of HIV transmission through occupational exposure in the healthcare setting, and twelve possible/probable cases. In the US, there were 56 documented cases of occupational HIV transmission up to June 2000.
The risk posed by a needlestick injury may be higher if it is a deep injury; if it is made with a hollow bore needle; if the source patient has a high viral load; or if the sharp instrument is visibly contaminated with.

14.Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
Answer: Transmission of HIV in a healthcare setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and healthcare professionals from the transmission of blood-borne diseases such as Hepatitis B and HIV.

15.If blood splashes into my eye can I become infected with HIV?
Answer: Research suggests that the risk of HIV infection in this way is extremely small. A very small number of people - usually in a healthcare setting - have become infected with HIV as a result of blood splashes in the eye.

16.Can I become infected with HIV through biting?
Infection with HIV in this way is unusual. There have only been a couple of documented cases of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.

17.Can I be infected with HIV through contact with animals such as dogs and cats?
Answer: No. HIV is a Human Immunodeficiency Virus. It only affects humans. There are some other types of immunodeficiency viruses that specifically affect cats and other primates, namely the Feline Immunodeficiency Virus (FIV) and Simian Immunodeficiency Virus (SIV). These viruses are of no risk to humans.

18.Can I get HIV from a mosquito?
Answer: No, it is not possible to get HIV from mosquitoes. When taking blood from someone mosquitoes do not inject blood from any previous person. The only thing that a mosquito injects is saliva, which acts as a lubricant and enables it to feed more efficiently.

19.Can HIV be transmitted in household settings?
HIV is overwhelmingly transmitted through sexual contact, through intravenous drug use, through infected blood donations and from mother to child during pregnancy, birth and breastfeeding. HIV is not transmitted through everyday social contact. There have however been a few cases in which it is thought that family members have infected each other through ways other than those stated above.

20.Can I become infected with HIV if I inject drugs and share the needles with someone else, without sterilising them?
Answer:There is a possibility of becoming infected with HIV if you share injecting equipment with someone who has the virus. If HIV infected blood remains within the bore (inside) of the needle or in the syringe and someone else then uses it to inject themselves, that blood can be flushed into the bloodstream. Sharing needles, syringes, spoons, filters or water can pass on the virus. Disinfecting equipment between uses can reduce the likelihood of transmission, but does not eliminate it.

21.Can I transmit HIV to my baby during pregnancy or breastfeeding?
Answer: An HIV-infected pregnant woman can pass the virus on to her unborn baby either before or during birth. HIV can also be passed on during breastfeeding. If a woman knows that she is infected with HIV, there are drugs she can take to greatly reduce the chances of her child becoming infected. Other ways to lower the risk include choosing to have a caesarean section delivery and not breastfeeding.

22.Does donating blood or having a blood transfusion mean that I am putting myself at risk from HIV?
Answer: Some people have been infected through a transfusion of infected blood. In most countries, however, all the blood used for transfusions is now tested for HIV. In those countries where the blood has been tested, HIV infection through blood transfusions is now extremely rare. Blood products, such as those used by people with haemophilia, are now heat-treated to make them safe.

23.Can HIV be transmitted outside of the body?
Answer: Whilst HIV may live for some time outside of the body, HIV transmission has not been reported as a result of contact with spillages of blood, semen or other bodily fluids. Just because someone comes into contact with tiny quantities of HIV in dried blood, it does not follow that infection will occur.Scientists agree that HIV does not survive well in the environment, making the chance of environmental transmission remote. To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these concentrations of HIV can be kept alive for days or even weeks under controlled conditions, studies have shown that drying of these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours.Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed, essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have unnecessarily alarmed some people.

24.Does circumcision protect against HIV?
Answer: There is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen.

25.If I am taking antiretroviral drugs and have an 'undetectable' viral load, am I still infectious?
Answer: Even if your tests show that you have very low levels of HIV in your blood, the virus will not have been totally eradicated and you are still capable of infecting others. Some drugs do not penetrate the genitals and do not disable HIV as effectively there as they do in the blood. This means that while you may have little active virus showing up on blood tests, there may still be quite a lot of HIV in your semen or vaginal fluids. Transmission may be less likely when you have a low viral load, but it is still possible so you should always take appropriate precautions.

26.How can HIV be transmitted during oral sex?
Answer: HIV (and indeed hepatitis B, which is more infectious) can pose a small risk for both the active (person giving the oral stimulation) and receptive (person receiving oral stimulation) partner.Transmission from an HIV positive receptive partner to an HIV negative active partner may occur when the active partner gets sexual fluid (semen or vaginal fluid) or blood (from menstruation or a wound somewhere in the genital or anal region) into a cut, sore, ulcer or area of inflammation somewhere in their mouth or throat. The linings of the mouth and throat are very resistant to viral infections such as HIV, so infection is unlikely if they are healthy.Transmission from an HIV positive active partner to an HIV negative receptive partner is generally believed to be less common. This is because HIV it is normally only present in saliva in very low levels that are not sufficient to cause infection. The only risk in this scenario would be from bleeding wounds or gums in the HIV positive person’s mouth or on their lips, which may transfer blood onto the mucous membranes of the other person’s genitals or anus, or into any cuts or sores they may have. Hepatitis C can also be transmitted this way.

27.What is the risk of HIV transmission via oral sex?
Answer: The risk of HIV transmission from an infected partner through oral sex is much smaller than the risk of HIV transmission from anal or vaginal sex. Because of this, measuring the exact risk of HIV transmission as a result of oral sex is very difficult. In addition, since most sexually active individuals practice oral sex in addition to other forms of sex (such as vaginal and/or anal sex) when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors can increase the risk of HIV transmission through oral sex, including oral ulcers and wounds, bleeding gums, genital sores, genital or oral piercings, and the presence of other STDs.When scientists describe the risk of transmitting an infectious disease, like HIV, the term "theoretical risk" is often used. Very simply, "theoretical risk" means that passing an infection from one person to another is possible, even though there may not yet be any actual documented cases. "Theoretical risk" is not the same as likelihood. In other words, stating that HIV infection is "theoretically possible" does not necessarily mean it is likely to happen - only that it might. Documented risk, on the other hand, is used to describe transmission that has actually occurred, been investigated, and documented in the scientific literature.Various scientific studies have been performed around the world to try and document and study instances of HIV transmission through oral sex. A programme in San Francisco studied 198 people, nearly all gay or bisexual men. The subjects stated that they had only had oral sex for a year, from six months preceding the six-month study to its end. 20 per cent of the study participants (39 people) reported performing oral sex on partners they knew to be HIV positive. 35 of those did not use a condom and 16 reported swallowing cum. No one became HIV positive during the study, although the small number of participants performing oral sex on HIV positive partners meant the researchers could only say that there was a less than 2.8 per cent chance of infection through oral sex over a year.1 In 2000, a different San Francisco study of gay men who had recently acquired HIV infection found that 7.8 per cent of these infections were attributed to oral sex.2 However, the results of the study have since been called into question due to the reliability of the participants' data.In June 2002, a study conducted amongst 135 HIV negative Spanish heterosexuals, who were in a sexual relationship with a person who was HIV positive, reported that over 19,000 instances of unprotected oral sex had not led to any cases of HIV transmission.3 The study also looked at contributing factors that could affect the potential transmission of HIV through oral sex. They monitored viral load and asked questions such as whether ejaculation in the mouth occurred and how good oral health was. Amongst HIV positive men, 34 per cent had ejaculated into the mouths of their partners. Viral load levels were available for 60 people in the study, 10 per cent of whom had levels over 10,000 copies. Nearly 16 per cent of the HIV positive people had CD4 counts below 200. The study, conducted over a ten year period between 1990 and 2000, adds to the growing number of studies which suggest varying levels of risk of HIV transmission from oral sex when compared to anal or vaginal intercourse.At the 4th International Oral AIDS Conference held in South Africa, the risk of transmission through oral sex was estimated to be approximately 0.04 per cent per contact.4 This percentage figure is a lot lower than the two American figures, because this figure is a risk per contact percentage, whereas the other figures are percentage risks over much longer time periods. Oral sex is still regarded as a low-risk sexual activity in terms of HIV transmission, but only when more work is done will we be clearer as to the risks of oral sex.

28.Are there any individual documented cases of HIV transmission during oral sex?
Answer: While it is very difficult to ever know how HIV transmission occurred, according to a factsheet on oral sex produced by the CDC in 2000, there have been a few of documented cases of transmission during oral sex. These have occurred in both receptive and active partners during fellatio, cunnilingus and anilingus.