The Real Deal on HIV Transmission

By Elisabeth Long

From PHN Issue 38, Fall 2018

The Human Immunodeficiency Virus (HIV) is not spread easily. There are a lot of myths about how people get HIV—from mosquito bites to sharing utensils to toilet seats to coughing and sneezing. None of these are true. The reality is that HIV is only transmitted when a body fluid that carries a high concentration of HIV gets into the bloodstream. Mainly, HIV transmission occurs through unprotected sex and sharing drug use equipment. Fortunately, the risk of HIV transmission can be reduced in
a number of ways.

What Body Fluids Carry HIV?

HIV is only transmitted through four body fluids:

  • Blood
  • Semen and Pre-ejaculate (pre-cum)
  • Vaginal Fluids (wetness)
  • Breast Milk

HIV cannot be transmitted through other body fluids, such as saliva (spit), sweat, tears, urine, feces and snot. Therefore, HIV transmission does not occur through sharing utensils or coughing and sneezing. You cannot get HIV from skin-to-skin contact (including hand jobs) or sharing a cell, telephone, toilet, or shower with someone who is living with HIV. In order for HIV to be transmitted, one of the four body fluids above must have HIV in it and get into the bloodstream.

How Does HIV Get Into the Bloodstream?

HIV cannot pass through unbroken skin—it must have an entry point into the bloodstream. HIV can get into the bloodstream through:

  • Mucus membranes (“pink parts”) such as the inside of the vagina or anus, gums in the mouth, and the urethra on the tip of the penis
  • Punctures, scratches or rips in the skin (usually via needles)
  • Any open sore, inflammation on or place that bleeds

HIV gets into the bloodstream through activities that provide access to an entry point. HIV is most commonly transmitted through shared drug use equipment (including needles used for hormones) and unprotected sex, which includes oral, vaginal, and anal sex.

Other activities that carry risk include sharing tattoo and body piercing equipment and sharing razors. HIV can also be transmitted to a baby during pregnancy, childbirth or breast-feeding.

What Can You Do to Reduce the Risk of HIV Transmission?

HIV transmission can only be prevented through abstinence, which means not engaging in any of the activities above. However, that’s not realistic for most folks. Luckily, there are many ways to reduce the risk of HIV transmission.

Risk reduction starts with awareness and communication. Get tested if and when you can. Know your status and talk to your sexual partners about theirs. Think through safer sex, drug use and other activities that put you or others at risk. Decide how much risk you’re willing to take. Communicate that with your partners.

Protect yourself by doing what you can to make sure that blood or sexual fluids don’t get into your body. For anal or vaginal sex, use a condom or an insertive “female” condom. For oral sex, use a condom or dental dam. Use water-based lubricant, when possible, to reduce the risk of vaginal and anal tears (entry points). But make sure to avoid Vaseline or creams or oils like cocoa butter or baby oil, because they damage condoms. Avoid sex when other sexually transmitted infections (STIs) are present, because STIs often cause inflammation, open cuts and sores (entry points). Avoid sex during menstruation. Have your partner pull out instead of ejaculating inside of you. If you’re using drugs, use a clean needle and works every time!

If you know that you are going to engage in an activity that puts you or your partner at risk, you can reduce your risk by choosing a less risky option. For example, if you are going to have unprotected sex, choose oral sex instead of anal or vaginal sex. If you know that you are going to be sharing needles or razors with someone, rinse with cold water, clean with bleach, and then rinse again. If you don’t have access to bleach, rinse with cold water. (Rinsing with water doesn’t work well at reducing risk, but it’s better than nothing.)

If you don’t have HIV but know that you’re getting out soon and considering activities that include a high risk of HIV transmission, talk to a health-care provider about PrEP, a daily pill that provides a high level of protection against HIV. If you are HIV-positive and pregnant, work closely with your doctor. Take antiretroviral treatment as prescribed by your doctor, which can reduce your risk of transmitting HIV to your baby to less than 1%. Keep your delivery time as short as possible, and use infant formula instead of breast-feeding.

Finally, if you test positive for HIV, remember that HIV is not a death sentence— people living with HIV are able to live long, healthy, full and rewarding lives. HIV medication is what makes that possible, so start treatment as soon as you can. By taking HIV medication as prescribed, most people can have undetectable viral loads (very low level of HIV in your blood). A person has effectively no risk of transmitting HIV when they’re taking treatment as prescribed and their viral load is undetectable. Connect with other people living with HIV and educate yourself. For more information and support, contact the resources on page 14.

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