To understand what HIV is, let’s break it down:
This particular virus can only infect human beings.
HIV weakens your immune system by destroying important cells that fight disease and infection. A “deficient” immune system can’t protect you.
A virus can only reproduce itself by taking over a cell in the body of its host.
Human Immunodeficiency Virus is a lot like other viruses, including those that cause the “flu” or the common cold. But there is an important difference – over time, your immune system can clear most viruses out of your body. That isn’t the case with HIV – the human immune system can’t seem to get rid of it. Scientists are still trying to figure out why.
We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them.
Over time, HIV can destroy so many of your CD4 cells that your body can’t fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS.
To understand what AIDS is, let’s break it down:
AIDS is not something you inherit from your parents. You acquire AIDS after birth.
Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.
Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs).
You will be diagnosed with AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.
For more information, see CDC’s Basic Information About HIV And AIDS.
HIV is found in specific human body fluids. If any of those fluids enter your body, you can become infected with HIV.
WHICH BODY FLUIDS CONTAIN HIV?
HIV lives and reproduces in blood and other body fluids. We know that the following fluids can contain high levels of HIV:
- Semen (cum)
- Pre-seminal fluid (pre-cum)
- Breast milk
- Vaginal fluids
- Rectal (anal) mucous
Other body fluids and waste products—like feces, nasal fluid, saliva, sweat, tears, urine, or vomit—don’t contain enough HIV to infect you, unless they have blood mixed in them and you have significant and direct contact with them.
Healthcare workers may be exposed to some other body fluids with high concentrations of HIV, including:
- Amniotic fluid
- Cerebrospinal fluid
- Synovial fluid
HOW IS HIV TRANSMITTED THROUGH BODY FLUIDS?
HIV is transmitted through body fluids in very specific ways:
During sexual contact: When you have anal, oral, or vaginal sex with a partner, you will usually have contact with your partner’s body fluids. If your partner has HIV, those body fluids can deliver the virus into your bloodstream through microscopic breaks or rips in the delicate linings of your vagina, vulva, penis, rectum, or mouth. Rips in these areas are very common and mostly unnoticeable. HIV can also enter through open sores, like those caused by herpes or syphilis, if infected body fluids get in them.
You need to know that it’s much easier to get HIV (or to give it to someone else), if you have a sexually transmitted disease (STD).
During pregnancy, childbirth, or breastfeeding: Babies have constant contact with their mother’s body fluids-including amniotic fluid and blood-throughout pregnancy and childbirth. After birth, infants can get HIV from drinking infected breast milk.
As a result of injection drug use: Injecting drugs puts you in contact with blood-your own and others, if you share needles and “works”. Needles or drugs that are contaminated with HIV-infected blood can deliver the virus directly into your body.
As a result of occupational exposure: Healthcare workers have the greatest risk for this type of HIV transmission. If you work in a healthcare setting, you can come into contact with infected blood or other fluids through needle sticks or cuts. A few healthcare workers have been infected when body fluids splashed into their eyes, mouth, or into an open sore or cut.
As a result of a blood transfusion with infected blood or an organ transplant from an infected donor: Screening requirements make both of these forms of HIV transmission very rare in the United States.
HOW DO YOU GET AIDS?
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.
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means sex (anal, oral, or vaginal) without barrier protection, like a condom.
Some of the ways to reduce your risk of getting HIV through sexual contact include:
Take a break from sex.
Sex (anal, oral, or vaginal) is the main way that HIV is transmitted. If you aren’t having sexual contact, you are 100% protected from getting HIV in that way.
Being monogamous means: 1) You are in a sexual relationship with only one person and 2) Both of you are having sex only with each other. Having only one sex partner reduces your risk of getting HIV—but monogamy won’t protect you completely unless you know for sure that both you and your partner are not infected with HIV.
Get tested and know your partner’s status.
Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status can be difficult or uncomfortable—but it’s important to start the discussion BEFORE you have sex.
Ask prospective sexual partners:
- Have you been tested for HIV?
- When was the last time you had an HIV test?
- What were the results of your HIV test?
If you have more than one sex partner, the CDC recommends that you be tested for HIV and other sexually transmitted infections (STIs) every 3-6 months.
Use condoms consistently and correctly.
To reduce your risk of getting HIV or other STIs, you must use a new condom with every act of anal, oral, or vaginal sex. You also have to use condoms correctly, to keep them from slipping off or breaking.
You have to use the right kind of condom too. Latex condoms are highly effective against HIV. (If you are allergic to latex, you can use polyurethane or polyisoprene condoms.) Lambskin condoms will NOT protect you from HIV, because the virus is small enough to slip through lambskin.
You should always use a water-based lubricant when you use a condom for anal or vaginal sex. Lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (like petroleum jelly, hand lotion, or cooking oil). Oil-based lubricants can damage condoms and make them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. To learn more about how to use a condom correctly, see the U.S. Department of Veterans Affairs’ Tips For Using Condoms And Dental Dams.
Condoms do not provide 100% protection against all STIs—but you are ALWAYS safer using a condom! You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom. But condoms lessen the risk of infection even for those types of STIs.
Condoms with the spermicide Nonoxynol-9 are NOT recommended for STI/HIV prevention. Nonoxynol-9 (N9) irritates rectal and vaginal walls, which increases the chance of HIV infection if infected body fluids do come in contact with them.
All sexual practices can be made “safer”—meaning you can lower your risk of transmitting/contracting STIs and HIV—but some activities are much safer than others. Here’s a list of sexual activities and the risks they pose for transmitting HIV or other STIs:
Receptive Anal Sex (Bottoming)
The odds of getting HIV from “bottoming” without a condom are higher than any other sexual behavior.
HIV has been found in pre-cum (pre-ejaculatory fluid), so having your partner pull out before he cums (ejaculates) may not decrease your risk.
Do not douche before sex. Douching irritates the lining of your rectum and this can increase your risk for getting HIV. If you are concerned about cleanliness, clean the rectum gently, with a soapy finger and water.
If you are bottoming, always use plenty of water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize damage to the rectum during sex and to prevent the transmission of STIs (including HIV).
Insertive Anal Sex (Topping)
“Topping” without a condom is considered a high-risk behavior for transmission of HIV and other STIs.
Your partner may have sores or other signs of infection in his/her rectum that you can’t see. If you have tears or cuts on your penis, HIV can enter your body this way.
It is possible for blood and other fluids containing HIV to infect the cells in the urethra of your penis.
Receptive Vaginal Sex (Risks For Women)
Vaginal sex without a condom is considered a high-risk behavior for HIV infection.
During vaginal sex, HIV is transmitted from men to women much more easily than from women to men.
The risk for transmission is increased if you currently have another STI or vaginal infection. Many STIs and vaginal infections are “silent”—meaning you don’t have any symptoms, so you may not be aware that you are infected.
Many barrier methods that are used to prevent pregnancy (diaphragm, cervical cap, etc.) DO NOT protect against STIs or HIV infection because they still allow infected semen to come in contact with the lining of your vagina.
Oral or hormonal contraceptives (i.e., birth control pills) DO NOT protect against STIs or HIV infection.
Female condoms DO prevent against HIV infection, if you use them correctly and consistently.
Insertive Vaginal Sex (Risks For Men)
Unprotected vaginal sex is less risky for the male partner than the female partner—but there is still a risk that the male partner can contract HIV and other STIs.
Some STIs are “silent,” meaning that a woman may have an STI but not have any symptoms. Your partner may not know she has an infection, so it is important to use a condom.
Use a new condom with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.
Performing Oral Sex On A Man
You can get HIV by performing oral sex on your male partner, although the risk is not as great as it is with unprotected anal or vaginal sex.
You are also at risk for getting other STIs, like chlamydia and gonorrhea.
Your risk of contracting HIV is reduced if your male partner does not ejaculate (cum) in your mouth.
Your risk of HIV is reduced if you do not have open sores or cuts in your mouth.
Using condoms for oral sex reduces your risk of getting HIV or other STIs.
Receiving Oral Sex If You Are A Man
There is less associated risk for HIV infection with this sexual activity.
Your risk of HIV is reduced if you do not have open sores or cuts on your penis.
There is a risk of contracting other STIs, including herpes.
Performing Oral Sex On A Woman
HIV has been found in vaginal secretions, so there is a risk of contracting HIV from this activity.
It is possible to contract other STIs from this activity.
There are effective barriers you can use to protect you from contact with your partner’s vaginal fluids. You can cut open an unlubricated condom and lay it over your partner’s vulva. You can also use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (Plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)
Receiving Oral Sex If You Are A Woman
The risk for contracting HIV this way is significantly lower than for unprotected vaginal sex.
There is still a risk of contracting other STIs, like herpes, and bacterial infections.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.
Oral-Anal Contact (Rimming)
The risk of getting HIV by rimming is very low—but this kind of sexual contact comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.
Digital Stimulation (Fingering)
There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
Use medical-grade gloves and lots of water-based lubricant to eliminate this risk.
Using sex toys can be a safe practice, as long as you do not share your toys with your partner.
If you share your toy with your partner, use a condom on the toy, if possible, and change the condom before your partner uses it.
Clean your toys with soap and water, or a stronger disinfectant if indicated on the cleaning instructions. It is important to do this after each use!
These activities carry no risk of HIV transmission:
- Non-sexual massage
- Casual or dry kissing
- Masturbation (without your partner’s body fluids)
- Frottage—also known as “dry humping” or body-to-body rubbing
You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.
Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method in which people who do not have HIV infection take a pill daily to reduce their risk of becoming infected. The pill, called Truvada®, contains two of the many medications that can be used to treat people who already have HIV. These medications prevent HIV from making copies of itself and turning into an infection that’s spread throughout your body. In this way PrEP medicines can help keep the virus from establishing a permanent infection. So, PrEP is a way for people who are at very high risk of getting HIV to lower their risk by taking a daily pill. PrEP is only meant for people at very high risk for getting HIV because they may often be exposed to the virus—for example, someone who is HIV-negative but has an HIV-positive partner and doesn’t consistently use condoms.
In 2012, the U.S. Food and Drug Administration (FDA) approved the use of the drug Truvada® as PrEP to be taken once daily and used in combination with safer sex practices to reduce the risk of sexually acquired HIV infection in adults who do not have HIV but are at high risk of becoming infected.
Taking medicine before exposure to a germ or a virus is nothing new. For example, public health officials often advise travelers to take a medication before they visit areas where malaria is common. However, the use of medication to prevent HIV infection has only recently been studied.
DOES PrEP WORK?
Studies have shown that PrEP provides a high level of protection against getting HIV for gay and bisexual men, heterosexual men and women, and injection drug users, if the daily medication is taken consistently.
Results from two studies of PrEP, released in July 2011 (the TDF2 study and the Partners PrEP study) showed that daily oral doses of two specific antiretroviral drugs can be used to prevent transmission of HIV from men to women and from women to men. This follows findings of the iPrEx study among men who have sex with men (MSM), reported in November 2010, which found that daily oral doses of the same two antiretroviral drugs taken by HIV-negative study participants reduced, but did not eliminate, the risk of getting HIV.
In addition, in June 2013, published results from the Bangkok Tenofovir Study showed that daily oral doses of one of the two antiretroviral drugs used in other PrEP studies reduced the risk of getting HIV among injecting drug users.
In all of these studies, people who took the drugs consistently—enough that regular blood tests showed detectable levels of the drug in their systems—had much higher levels of protection than those who did not.
- iPrEx: PrEP reduced the risk of getting HIV by 44% among all the study participants, and by more than 90% among men with detectable levels of the drug in their blood.
- Partners PrEP: PrEP reduced the risk of getting HIV by 75% overall, and by 90% in people with detectable levels of the drug in their blood.
- Bangkok Tenofovir Study: PrEP reduced risk of getting HIV by 49% overall, and by 75% in participants with detectable levels of the drug in their blood.
WHAT MEDICATIONS ARE USED IN PrEP?
A combination of two medications (tenofovir and emtricitabine) sold under the name Truvada® is approved by the FDA for daily use as PrEP for people at very high risk of getting HIV infection through sexual exposures. The same combination of medications is also recommended for people at very high risk of getting HIV through needle-sharing injection drug use. PrEP can only be prescribed by a health care provider and must be taken as directed to work.
CAN ANYONE USE PrEP?
For some individuals at very high risk for HIV, PrEP may represent a much-needed additional prevention method—but it will not be right for everyone. PrEP is an intensive approach that requires strict adherence to daily medication and regular HIV testing. You and your healthcare provider should consider the following factors in deciding whether PrEP is right for you:
- Only people who are HIV-negative should use PrEP. An HIV test is required before starting PrEP and then every 3 months while taking PrEP.
- PrEP should never be seen as the first line of defense against HIV.
- PrEP is most effective when combined with other prevention efforts like consistent condom use and safer injection practices.
- PrEP involves taking daily medication consistently and frequent visits to a healthcare provider.
- PrEP medications can cause side effects like nausea in some people. These side effects can be treated and are not life threatening.
- PrEP may also be an option for HIV-negative women whose partners have HIV infection during conception, pregnancy, or breastfeeding.
WHERE CAN I GET PrEP?
You can seek PrEP from your doctor or a local HIV clinic. Your local public health department can refer you to healthcare providers that specialize in treating and preventing HIV.
WHO PAYS FOR PrEP?
Private and public health insurance plans often cover the cost of PrEP. Alternatively, if you are eligible, your healthcare provider may be able to get Truvada for you at no cost from the drug’s manufacturer through its PrEP-specific medication assistance program. To be eligible, you must be a U.S. resident (you need not be a citizen or current visa holder) who meets the low-income cutoff and has no health insurance or no PrEP coverage under your health insurance. Your local health department may also be able to direct you to other kinds of medication assistance programs.
There are two types of PEP:
- occupational PEP (sometimes called “oPEP”), taken when someone working in a healthcare setting is potentially exposed to material infected with HIV, and
- non-occupational PEP (sometimes called “nPEP”), taken when someone is potentially exposed to HIV outside the workplace (e.g., from sexual assault, or during episodes of unprotected sex or needle-sharing injection drug use).
To be effective, PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in your body. PEP consists of 2-3 antiretroviral medications and should be taken for 28 days. Your doctor will determine what treatment is right for you based on how you were exposed to HIV. PEP is safe but may cause side effects like nausea in some people. These side effects can be treated and are not life threatening. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV.
WHO NEEDS PEP?
PEP is used for anyone who may have been exposed to HIV during a single event.
Healthcare workers are evaluated for PEP if they are exposed after:
- Getting cut or stuck with a needle that was used to draw blood from a person who may have HIV infection
- Getting blood or other body fluids that may have lots of HIV in their eyes or mouth
- Getting blood or other body fluids that may have lots of HIV on their skin when it is chapped, scraped, or affected by certain rashes
The risk of getting HIV infection in these ways is extremely low—fewer than 1 in 100 for all exposures.
PEP can also be used to treat people who may have been exposed to HIV during a single event unrelated to work (e.g., during episodes of unprotected sex, needle-sharing injection drug use, or sexual assault).
Keep in mind that PEP should only be used in uncommon situations right after a potential HIV exposure. It is not a substitute for other proven HIV prevention methods, such as correct and consistent condom use or use of sterile injection equipment.
Because PEP is not 100% effective, you should continue to use condoms with sex partners while taking PEP and should not use injection equipment that has been used by others. This will help avoid spreading the virus to others if you become infected.
WHEN SHOULD I TAKE PEP IF I’VE BEEN EXPOSED?
To be effective, PEP must begin as soon as possible, but always within 72 hours of exposure. Your healthcare provider will consider whether PEP is right for you based on how you might have been exposed and whether you know if the person whose fluids you were exposed to might be HIV-positive. You will be asked to return for more HIV testing at 4 to 6 weeks, 3 months, and 6 months after the potential exposure to HIV. (Talk to your healthcare provider about the recommended follow-up schedule for you.)
WHERE CAN I GET PEP?
Some of the places you can go to seek treatment include your doctor’s office, emergency rooms, urgent care clinics, or a local HIV clinic.
WHO PAYS FOR PEP?
Antiretroviral medications are expensive, and many people cannot pay for them out of pocket. If you are a healthcare worker who was exposed to HIV on the job, your workplace health insurance or workers’ compensation will usually pay for oPEP. If you are prescribed nPEP after sexual assault, you may qualify for partial or total reimbursement for medications and clinical care costs through the Office for Victims of Crime funded by the U.S. Department of Justice (see the contact information for each state). If you are prescribed nPEP for another reason, and you cannot get insurance coverage (private, employer-based, Medicaid, or Medicare), your healthcare provider can help you apply for free antiretroviral medications through the patient assistance programs of the drug manufacturers. Online applications can be faxed to the company, or some companies have special phone lines. These can be handled urgently in many cases to avoid delay in accessing medication.
Being HIV-positive means that it is possible for you to pass the virus along to others, including your sexual partners. If you are female, you could also pass it along to your unborn child.
Once you have been infected with HIV, you will always carry it in your body. There is no cure for HIV. It is a serious, infectious disease that can lead to death if it isn’t treated.
But many scientific and technological advances have made HIV a chronic manageable disease. Many people with HIV lead healthy, happy, and productive lives and learn how to cope with the disease.
This is why it is so important to know your HIV status. Knowing that you are HIV-positive gives you the ability to protect your own health and the health of your partners and children.
Being HIV-positive does NOT mean you have AIDS. AIDS is the most advanced stage of HIV disease. Proper treatment can keep you from developing AIDS.
Being diagnosed with HIV can be a scary thing to face. You may have a lot of unanswered questions and concerns. This checklist will help you take the first steps toward managing a new HIV diagnosis.
- Don’t panic—just breathe. This is life-changing news but you have life-enhancing options.
- Make a list of all your questions. You will probably have some time between when you are diagnosed and when you have your first visit with an HIV specialist or healthcare provider. This might be a good time to sit down and write out a list of questions about your new diagnosis.Making a list is a good way to organize your thoughts. No question is too vague, too detailed, or unimportant. You may find the answers to some of these questions through your own research, and some may need to be answered by your healthcare provider.
- Understand your diagnosis. After you have listed your questions, take some time to understand what it means to be “HIV-positive.” You can visit government and private websites, read printed materials (from the testing center or local library), talk with healthcare providers, or take advantage of community resources.
- Find a support system. This is one of the most important pieces of managing a new HIV diagnosis. You can find support among friends, family, or members of your community.If you are not ready to tell other people about your HIV diagnosis, that’s ok. Look to community resources and professional organizations that offer support groups for newly diagnosed people, one-on-one counseling, peer counselors, or health educators.
- Find a care provider. Your care provider will be the person who partners with you to manage your HIV care. That person will be responsible for monitoring your laboratory results, working with you to develop a proper treatment plan, advising you on health-related matters, and caring for your general health and well-being.This clinician, usually a doctor or nurse practitioner, will be your partner in your healthcare. It is important to maintain an open and honest dialogue with your care provider. Sometimes a care provider will be recommended to you at the time of your diagnosis, or you will receive a referral from the place that conducted your HIV test. In some cases, you may need or want to find a provider on your own.
- Prepare for your first appointment. Your first appointment with your HIV specialist can cause anxiety. Remember to bring your list of questions and be open and honest with your clinician. Take some time to research the medical tests that your clinician may want to run during your first visit.
- Begin thinking about who you want to tell. Disclosing can be one of the hardest parts about managing a new diagnosis of HIV. It’s important to remember that you do not need to tell everyone all at once, and that there are systems in place to help you.At this time it is important to disclose your HIV status to your healthcare providers, sexual partners, and anyone who may be at high risk for exposure. Please see the section entitled Talking to Others About Your HIV Status.
information provided by www.aids.gov