HIV and Sex
On this page you will find answers to the following questions:
• What exactly is HIV/AIDS?
• Which body fluids can transmit the HIV virus, and which ones don't?
• How is HIV passed from one person to another?
• Can I get HIV from oral sex?
• Can I get HIV from anal sex?
• Can I get HIV from vaginal sex?
• Can you get HIV or another STD from a person who is not infected?
• Does anal sex "make" the HIV virus?
• Why is injecting drugs a risk for HIV?
• Should I get tested for HIV?
• If I test HIV negative, does that mean that my partner is HIV negative also?
• What if I test positive for HIV?
Adapted from www.thebody.org
What exactly is HIV/AIDS?
AIDS is a disease caused by a virus called HIV (human immunodeficiency virus). AIDS stands for acquired immunodeficiency syndrome. HIV damages the immune system, so the body is no longer able to fight off diseases that normally it would be able to fight off. HIV infects and destroys a specific type of cell in your immune system called a CD4 cell. CD4 cells are the generals of the immune-system army. The CD4 cells tell other immune-system cells what to do when an invading organism, germ or cancer cell is found in the body. Basically HIV kills off the CD4 cells (that is, it kills off the generals of the army). When the generals of the immune-system army are killed off, the rest of the immune system won't know what to do to fight off invaders. This is how HIV damages the immune system.
When HIV first enters the body, your immune system immediately attacks the virus, and keeps it under control for a number of years. During this time, the virus is at constant battle with your immune system. Your body tries to get rid of the virus, but can only keep it under control. After a number of years, your immune system starts to lose its battle against HIV. After an average of 10 years of fighting HIV, your immune system starts to weaken, and this is when full-blown AIDS begins. During this 10-year period, a person may have no symptoms at all, and feel fine and look fine. During this time, the person is considered HIV positive, but does not yet have full-blown AIDS.
The definition of full-blown AIDS is a very specific one. In order to be diagnosed with AIDS, a person must meet the following requirements:
First, a person must be diagnosed with HIV. Second, in addition to having HIV, a person must have at least one of the following:
1. A CD4 cell count less than 200.
2. An opportunistic disease as defined by the U.S. Centers for Disease Control and Prevention (CDC).
Once a person is diagnosed with AIDS, they will always be considered to have AIDS, regardless of clinical changes later on. For example, if a person has HIV, and a CD4 cell count below 200, they are considered to have AIDS. If their CD4 cell count later goes back above 200, they are still considered to have AIDS.
Which body fluids can transmit the HIV virus, and which ones don't?
Blood, pre-cum, semen, vaginal secretions, and breast milk all contain high concentrations of HIV, and all have been linked to transmission of the virus.
Saliva, tears, sweat and urine can have the virus in them, but in such small concentrations that nobody has ever been infected through them. However, if any body fluid is visibly contaminated with blood, the risk of transmission exists.
How is HIV passed from one person to another?
HIV transmission can occur when blood, semen (cum), pre-seminal fluid (pre-cum), vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.
HIV can enter the body through a vein (e.g., injection drug use), the lining of the anus or rectum, the lining of the vagina and/or cervix, the opening to the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), or cuts and sores. Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.
These are the most common ways that HIV is transmitted from one person to another:
• by having sex (anal, vaginal, or oral) with an HIV-infected person;
• by sharing needles or injection equipment with someone who is infected with HIV; or
• from HIV-infected women to their babies before or during birth, or through breast-feeding after birth.
HIV also can be transmitted through receipt of infected blood or blood clotting factors. However, since 1985, all donated blood in the United States has been tested for HIV.
Can I get HIV from oral sex?
Yes, it is possible for either partner to become infected with HIV through performing or receiving oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.
If the person performing oral sex has HIV, blood from their mouth may enter the body of the person receiving oral sex through
• the lining of the urethra (the opening at the tip of the penis);
• the lining of the vagina or cervix;
• the lining of the anus; or
• directly into the body through small cuts or open sores.
If the person receiving oral sex has HIV, their blood, semen (cum), pre-seminal fluid (pre-cum), or vaginal fluid may contain the virus. Cells lining the mouth of the person performing oral sex may allow HIV to enter their body.
The risk of HIV transmission increases
• if the person performing oral sex has cuts or sores around or in their mouth or throat;
• if the person receiving oral sex ejaculates in the mouth of the person performing oral sex;
• if the person receiving oral sex has another sexually transmitted disease (STD).
Not having (abstaining from) sex is the most effective way to avoid HIV.
If you choose to perform oral sex, and your partner is male,
• use a latex condom on the penis; or
• if you or your partner is allergic to latex, plastic (polyurethane) condoms can be used.
Can I get HIV from anal sex?
Yes. In fact, unprotected (without a condom) anal sex (intercourse) is considered to be very risky behavior. It is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.
Not having (abstaining from) sex is the most effective way to avoid HIV. If people choose to have anal sex, they should use a latex condom. Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use generous amounts of water-based lubricant in addition to the condom to reduce the chances of the condom breaking.
Can I get HIV from vaginal sex?
Yes, it is possible for either partner to become infected with HIV through vaginal sex. In fact, it is the most common way the virus is transmitted in much of the world. HIV can be found in the blood, semen (cum), pre-seminal fluid (pre-cum) or vaginal fluid of a person infected with the virus.
In women, the lining of the vagina can sometimes tear and possibly allow HIV to enter the body. HIV can also be directly absorbed through the mucous membranes that line the vagina and cervix.
In men, HIV can enter the body through the urethra (the opening at the tip of the penis) or through small cuts or open sores on the penis.
Not having (abstaining from) sex is the most effective way to avoid HIV. If you choose to have vaginal sex, use a latex condom to help protect both you and your partner from HIV and other STDs. Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.
Can you get HIV or another STD from a person who is not infected? Does anal sex "make" the HIV virus?
Many people incorrectly believe that just having sex (anal intercourse, vaginal intercourse, oral sex, etc.) will give you a disease like HIV/AIDS. The fact is, sex by itself is not what gives you an infectious disease. It is having unprotected sex with an infected person that makes sex risky, as far as HIV and other STDs are concerned. If you have unprotected sex with a person who is not infected, you are at no risk whatsoever for HIV and other STDs. A person cannot give you a disease that they do not have. Also, if you have sex by yourself (solo masturbation), you are at no risk whatsoever for HIV and other STDs. You cannot give HIV (or any other STD) to yourself.
But, if you have unprotected sex with a person who is infected with HIV or another STD, then you would be at risk of infection. If there is any possibility at all that your partner may have HIV or another STD, I strongly encourage the use of condoms every time you have sex. But if your partner is not infected, you are at no risk at all of getting infected. And if you are not infected, you are not putting yourself (or anybody else) at any risk.
Remember, it is not the sex itself that makes a person get infected with HIV or any other STD. It is having unprotected sex with an infected person, that poses a risk of infection.
Why is injecting drugs a risk for HIV?
At the start of every intravenous injection, blood is introduced into the needle and syringe. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing") carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream.
Sharing drug equipment (or "works") can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by
• using blood-contaminated syringes to prepare drugs;
• reusing water;
• reusing bottle caps, spoons, or other containers ("spoons" and "cookers") used to dissolve drugs in water and to heat drug solutions; or
• reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.
"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. For this reason, people who continue to inject drugs should obtain syringes from reliable sources of sterile syringes, such as pharmacies.
It is important to know that sharing a needle or syringe for any use, including skin popping and injecting steroids, can put one at risk for HIV and other blood-borne infections.
Should I get tested for HIV?
The following are behaviors that increase your chances of getting HIV. If you answer yes to any of them, you should definitely get an HIV test. If you continue with any of these behaviors, you should be tested every year. Talk to a health care provider about an HIV testing schedule that is right for you.
• Have you injected drugs or steroids or shared equipment (such as needles, syringes, works) with others?
• Have you had unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners, or anonymous partners?
• Have you exchanged sex for drugs or money?
• Have you been diagnosed with or treated for hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD), like syphilis?
• Have you had unprotected sex with someone who could answer yes to any of the above questions?
If you have had sex with someone whose history of sex partners and/or drug use is unknown to you or if you or your partner has had many sex partners, then you have more of a chance of being infected with HIV. Both you and your new partner should get tested for HIV, and learn the results, before having sex for the first time.
For women who plan to become pregnant, testing is even more important. If a woman is infected with HIV, medical care and certain drugs given during pregnancy can lower the chance of passing HIV to her baby. All women who are pregnant should be tested during each pregnancy.
When taking an HIV test, what does a negative, positive or indeterminate test result mean?
When a person gets an antibody test for HIV, the first test that is done is the ELISA test. If the ELISA test is negative, this is considered a negative result, and confirmatory tests are not necessary. A negative result means that no antibodies were found.
If the ELISA test is repeatedly positive, it must be confirmed with a confirmatory test (usually a Western Blot or an IFA test). This second test can be done from the same tube of blood. You must test positive on both the ELISA test and the confirmatory test, to be considered HIV positive. If both the ELISA test and the confirmatory test are positive, this is considered a positive result. This means that antibodies were found, and the person is infected with HIV.
If the ELISA test is repeatedly positive but the confirmatory test is negative, this is considered a negative result overall, and this means that no antibodies were found.
ELISA tests are either positive or negative. Western Blot tests however, can be positive, negative or indeterminate. An indeterminate test means that the test could not determine whether a person is infected or not. This can be due to two things. Either a person was so recently infected that they are just starting to produce antibodies, or something else is cross-reacting on the test. If an indeterminate test result occurs, the person is usually re-tested in four to six weeks to determine whether they are infected or not.
The ELISA test is very good at picking up infections, but sometimes gives false positive readings (which is why confirmatory testing is always done on positive ELISA results). The Western Blot is very good at ruling out false-positive ELISA tests.
If I test HIV negative, does that mean that my partner is HIV negative also?
No. Your HIV test result reveals only your HIV status. Your negative test result does not indicate whether or not your partner has HIV. HIV is not necessarily transmitted every time you have sex. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected.
Ask your partner if he or she has been tested for HIV and what risk behaviors he or she has engaged in, both currently and in the past. Think about getting tested together.
What if I test positive for HIV?
If you test positive for HIV, the sooner you take steps to protect your health, the better. Early medical treatment and a healthy lifestyle can help you stay well. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. There are a number of important steps you can take immediately to protect your health:
• See a licensed health care provider, even if you do not feel sick. Try to find a health care provider who has experience treating HIV. There are now many medications to treat HIV infection and help you maintain your health. It is never too early to start thinking about treatment possibilities.
• Have a TB (tuberculosis) test. You may be infected with TB and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early.
• Smoking cigarettes, drinking too much alcohol, or using illegal drugs (such as methamphetamines) can weaken your immune system. There are programs available that can help you stop or reduce your use of these substances.
• Get screened for other sexually transmitted diseases (STDs). Undetected STDs can cause serious health problems. It is also important to practice safe-sex behaviors so you can avoid getting STDs.
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There is much you can do to stay healthy. Learn all that you can about maintaining good health.
Not having (abstaining from) sex is the most effective way to avoid transmitting HIV to others. If you choose to have sex, use a latex condom to help protect your partner from HIV and other STDs. Studies have shown that latex condoms are very effective, though not 100%, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.