Know the Facts. It is your job to protect yourself

What Is HIV? (Back to the Top)

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Many of these people will develop AIDS as a result of their HIV infection.

These body fluids have been proven to spread HIV:  

• blood
• semen
• vaginal fluid
• breast milk
• other body fluids containing blood

These are additional body fluids that may transmit the virus that health care workers may come into contact with:  

• cerebrospinal fluid surrounding the brain and the spinal cord
• synovial fluid surrounding bone joints
• amniotic fluid surrounding a fetus

• What is HIV?

H - Human - because this virus can only infect human beings.

I - Immuno-deficiency - because the effect of the virus is to create a deficiency, a failure to work properly, within the body's immune system.

V - Virus - because this organism is a virus, which means one of its characteristics is that it is incapable of reproducing by itself. It reproduces by taking over the machinery of the human cell.

HIV is the virus most researchers believe causes AIDS. However, some controversial scientists remain unconvinced that HIV is the cause of AIDS. Others believe that HIV can cause AIDS only in the presence of a "co-factor" -- some other virus or condition which has not yet been identified.

Scientists reported recently the existence of cases of people with severe immunodeficiency but with no evidence of HIV infection. Several researchers suspect the existence of a different virus. Some others speculate that these patients' immunodeficiency is due to other causes. But more research is needed to explain these cases.

However, since the vast majority of researchers believe that HIV is either the sole, or a primary, cause of AIDS, we often refer to HIV as "the AIDS virus."

 

The Two Types of HIV  (Back to the Top)

• What is the difference between HIV-1 and HIV-2?

Two types of HIV are currently recognized: HIV-1 and HIV-2. Worldwide, the predominant virus is HIV-1. HIV-2 is only prevalent in Western Africa. Both types of virus are transmitted by sexual contact, through blood, and from mother to child, and they appear to cause clinically indistinguishable AIDS. Both HIV-1 and HIV-2 cause the body to produce antibodies within three to six months, although the period between initial infection and illness may be longer in the case of HIV-2.

• Do conventional AIDS tests detect all subtypes?

Within HIV-1, there are several sub-groups of virus. These are genetic cousins of each other. They each cause HIV disease, but the viruses in each sub-group are slightly different from each other.

The prevalent strain of HIV in the United States and western Europe is "M". Several other strains have been identified, but they have occurred only in Africa and Asia. The likelihood of exposure to one of these sub-types is extremely low in the United States. Routine HIV tests that are being used for blood screening and diagnostic purposes detect virtually all subtypes of HIV-1.

• HIV-2 Testing

When a request for HIV-2 is made, the practitioner will ask questions to verify if this test is really required since this form of HIV is very rare in the United States. Generally, if someone is from a west African country, has had unsafe sex or shared needles with someone from there, then they will have reason to be tested.

• What is HTLV?

HTLV-1 is human T cell leukemia virus. HTLV-1 is not HIV. HTLV-2 causes a progressive neurodegenerative disease. There may be some confusion with the term "HTLV" because in the earlier years, the virus we now call HIV was called HTLV-III.

 

Unique Features of HIV  (Back to the Top)

The thought of contracting HIV is frightening. And there is good reason for that fear -- the disease is presently incurable, it has a high mortality rate, it spreads quickly and there is no vaccine to protect against it. In today's world, that combination is rare. For example, small pox is often fatal, but the disease has been completely contained through vaccinations. Tuberculosis is often fatal but can usually be cured with antibiotics if caught early.

• AIDS has been able to infect and kill so many people because of its unique makeup. Let's look at some of the features that make this disease so unusual:
  • HIV spreads by intimate contact with an infected person. Forms of intimate contact that can transmit AIDS include sexual activity and any sort of situation that allows blood from one person to enter another. Especially when you compare it with the many viruses that spread through the air, it would seem like the intimacy involved in the transmission of AIDS would be a limiting factor. However…
  •  
  • A person can carry and transmit the HIV virus for many years before any symptoms show themselves. A person can be contagious for a decade or more before any visible signs of disease become apparent. In a decade, a promiscuous HIV carrier can potentially infect dozens of people, who each can infect dozens of people, and so on.
  •  
  • HIV invades the cells of our immune system and reprograms the cells to become HIV-producing factories. Slowly, the number of immune cells in the body dwindles and AIDS develops. Once AIDS manifests, a person is susceptible to many different infections, because the immune system has been weakened so much by the HIV it can no longer fight back effectively. HIV has also shown the ability to mutate, which makes treating the virus nearly impossible.

The last feature in this list is the one that is truly unique. HIV invades and destroys the immune system -- the system that would normally protect the body from a virus. HIV corrupts and disables the system that should be guarding against HIV.

 

 

What Is AIDS? What Causes AIDS? (Back to the Top)

AIDS stands for acquired immunodeficiency syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses. An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g., AIDS indicator illnesses).

Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness.

Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care.

• What is AIDS?

A - Acquired - because it's a condition one must acquire or get infected with, not something transmitted through the genes

I - Immune - because it affects the body's immune system, the part of the body which usually works to fight off germs such as bacteria and viruses

D - Deficiency - because it makes the immune system deficient (makes it not work properly)

S - Syndrome - because someone with AIDS may experience a wide range of different diseases and opportunistic infections

The CDC's definition of AIDS has changed several times since the beginning of the AIDS epidemic. The changes have taken place as scientists learned more about the disease and thus were able to include more people with HIV who develop symptoms or immunodeficiency. The current AIDS definition includes the following conditions:

• HIV positive, AND

• CD4 (T-cell) count below 200 OR presence of one or more

  • Pneumocystis Carinii Pneumonia (PCP)
  • Kaposi's Sarcoma (KS)
  • HIV wasting syndrome
  • Non-Hodgkin's lymphoma
  • Cryptococcosis, extrapulmonary
  • HIV encephalopathy (AIDS Dementia)
  • Mycobacterium Avium Intracellulare (MAC or MAI)
  • Candidiasis of the esophagus, trachea, bronchi, or lungs
  • Cryptosporidiosis, chronic intestinal
  • Cytomegalovirus disease (CMV)
  • Tuberculosis (outside of the lungs)
  • Herpes simplex virus infection
  • Progressive Multifocal Leukoencephalopathy (PML)
  • Primary lymphoma of the brain
  • Toxoplasmosis of the brain
  • Histoplasmosis
  • Isoporiasis, chronic intestinal
  • Coccidioidomycosis
  • Salmonella septicemia
  • Bacterial infections, recurrent, <13 years
  • Lymphoid interstitial pneumonia/pulmonary lymphoid hyperplasia, <13 years.
  • Pulmonary tuberculosis
  • Recurrent bacterial pneumonia (two or more episodes in one year)
  • Invasive cervical cancer

  Note that more recent definitions finally include illnesses specific to women with HIV. Although this list has been revised several times since it was first developed, it does not include all of the illnesses experienced by people with HIV-related immune suppression.

 

 

The Origin of the AIDS Virus (Back to the Top)

August 1999 Rick Sowadsky

From time to time, new diseases are discovered. In the past 20 or so years we have seen new diseases like hantavirus, ebola virus, Legionnaires' disease, lyme disease, chronic fatigue syndrome and toxic shock syndrome. Among these new diseases, AIDS has become the most notorious.

In 1980 and 1981, doctors in the United States discovered that young gay men and IV-drug users, were mysteriously getting diseases most often seen when the immune system is damaged. As the months progressed, more and more people in these groups began to die from diseases associated with a damaged immune system. This trend was also beginning to be seen in Western Europe. As the numbers began to dramatically increase, it became clear that a new disease was upon us. AIDS was identified as a new disease in 1981. Human immunodeficiency virus (HIV) was co-discovered several years later by Luc Montagnier and Robert Gallo.

AIDS is caused by HIV. HIV is believed to have originated in Africa sometime between the late 1940s and the early 1950s. The earliest known case was in a man from the Belgian Congo (now known as the Democratic Republic of Congo) in 1959 (his blood -- stored since 1959 -- was recently tested for HIV).

HIV is believed to have evolved from the simian immunodeficiency virus (SIV) found in monkeys. The hypothesis that HIV evolved from SIV is based on the many similarities between these two viruses, especially at the genetic level. The two viruses are genetically very similar and are transmitted the same way. However HIV only causes AIDS in humans, and SIV only causes AIDS in monkeys. The SIV virus, like HIV, is found in blood. From what we can tell, HIV entered man via monkey blood. This could have been possible by either drinking the blood of monkeys, eating raw monkeys or perhaps another direct exposure of monkey blood into humans.

Once HIV entered humans, over time it spread person-to-person primarily through heterosexual contact. In fact, even today, most of the worlds HIV/AIDS cases are spread by heterosexual contact, not by homosexual contact or by needle sharing.

Throughout the centuries, when a new disease spread in one community, it took many months, years or even decades to spread around the world. With the use of airplanes in the 20th century, new diseases can spread around the world faster than ever before. A person can now fly from the United States to Africa in about one day. Before airplanes were invented, it would have taken months or years to make this same journey. As people fly around the world in a matter of hours, they can bring new diseases with them.

In fact, some of the early AIDS cases in the United States were linked to a male flight attendant who flew all around the world (including Africa). This man had literally thousands of sexual partners. As he flew around the world, he spread HIV when he had sex with his numerous sexual partners. At that time it still took years for HIV to spread from Africa to the United States, since there were very few people traveling then between Africa and North America.

There is absolutely no evidence that HIV was man-made. This is especially true when you look at our level of technology back in the 1940s and 1950s. In those years, we did not have the technical tools it would have taken to "invent" a virus. Even today, we do not have the technology to invent a new virus. To a limited extent, we can now alter viruses, as well as look at them under a microscope, and study their genetic make-up.

However, these capabilities were not in existence in the 1940s and 1950s. In fact, the genetic make-up of this virus is so complex, that even today, we do not have a total understanding of how the virus works at the genetic level. There was talk that the virus was spread in a polio vaccine years ago, however this theory was later disproven.

For a better understanding of the history of the early years of the AIDS epidemic, read the book And the Band Played On: Politics, People, and the AIDS Epidemic, written by Randy Shilts.

As humans encroach upon the rain forests and jungles of the world, it would not be surprising if we become exposed to still other new diseases. Diseases are a part of nature. However, we must do our best to prevent spread of new diseases, and to educate people about prevention of the diseases that are already around us.

 

 

The HIV Antibody Test. What is it? (Back to the Top)

A test is available that detects antibodies to HIV. Antibodies are special cells the body produces to fight bacteria and viruses. If you think you may have been exposed to HIV, then you should consider having the test. HIV antibody testing is confidential and free in many places.

A negative antibody test result means: you have not been infected with HIV OR you may have been infected with HIV but have yet to develop antibodies to the virus (it can take up to 6 months for your body to develop antibodies to HIV), so take a second test 6 months after possible exposure.

A positive antibody test result means: you have been infected with HIV, HIV can be transmitted to others if you have unsafe sex or share injecting equipment, it's time for you to begin regular health check-ups.

 

 

Where did the HIV Virus Come From? (Back to the Top)

We do not know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasha, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

We do know that the virus has existed in the United States since at least the mid- to late 1970s. From 1979-1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems.

In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. Formal tracking (surveillance) of AIDS cases began that year in the United States.

The cause of AIDS is a virus that scientists isolated in 1983. The virus was at first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus).

 

Requirements For Transmission To Occur  (Back to the Top)

Three conditions must be met for HIV transmission to occur:

• HIV must be present;

Infection can only happen if one of the persons involved is infected with HIV. Some people assume that certain behaviors (such as anal sex) cause AIDS, even if HIV is not present. This is not true.

• In sufficient quantity;

The concentration of HIV determines whether infection may happen. In blood, for example, the virus is very concentrated. A small amount of blood is enough to infect someone. A much larger amount of other fluids would be needed for HIV transmission.

• And it must get into the bloodstream.

It is not enough to be in contact with an infected fluid to become infected. Healthy, unbroken skin does not allow HIV to get into the body; it is an excellent barrier to HIV infection. HIV can only enter through an open cut or sore, or through contact with the mucous membranes in the anus and rectum, the genitals, the mouth, and the eyes.

 

 

HIV Survival Outside The Body  (Back to the Top)

Generally, when people ask the question, "How long can HIV survive outside the body?" they have come into contact with some body fluid that they think might contain HIV, and are worried about transmission. Almost always these questions are about casual contact, and we know the virus is not transmitted except during unprotected sex, sharing needles, or through significant and direct exposure to infected blood.

• Length of time

The length of time HIV can survive outside the body depends on:

• the amount of HIV present in the body fluid;
• what conditions the fluid is subjected to

In a laboratory, HIV has been kept viable (able to infect) for up to 15 days, and even after the body fluid containing it had dried. However, these experiments involved an extremely high concentration of the virus which was kept at a stable temperature and humidity. These conditions are very unlikely to exist outside of a laboratory. HIV is very fragile, and many common substances, including hot water, soap, bleach and alcohol, will kill it.

• Risk of transmission

The chances of becoming infected with HIV by handling a body fluid are extremely small, because that fluid will rarely have access to a person's bloodstream. However, anyone handling blood, semen or vaginal fluids should be careful to avoid touching them with broken skin or getting them into mucous membranes (such as those around the eye). Spills of blood should be mopped up, cleaned with soap and water, then cleaned with bleach. For maximum safety, the person cleaning the spill should also wear latex gloves, and should wash the hands thoroughly after the cleanup.

• Exposure to air

Air does not "kill" HIV, but exposure to air dries the fluid that contained the virus, and that will destroy or break up much of the virus very quickly. The CDC reports that drying HIV reduces viral amount by 90-99 percent within several hours.

• Needles

HIV can survive for several days in the small amount of blood that remains in a needle after use, so used needles are very risky for HIV transmission; they provide a direct path into the bloodstream.  Ideally, used needles should never be reused, but if they are, they should always be cleaned with bleach or alcohol before re-use.

 

Where is HIV Found in the Body?  (Back to the Top)

Looking at the first two conditions for HIV transmission (HIV present and in sufficient quantity), let's examine some of the so-called "bodily fluids" that can contain HIV.

• Infectious "bodily fluids"

HIV can be transmitted from an infected person to another through:

• Blood (including menstrual blood)
• Semen
• Vaginal secretions
• Breast milk

Blood contains the highest concentration of the virus, followed by semen, followed by vaginal fluids. Breast milk can also contain a high concentration of the virus, but in this situation, transmissibility depends on WHO and HOW. An adult can ingest a small amount of breast milk at no probable risk. But an infant, with its very small body and newly forming immune system, consumes vast quantities of breast milk relative to its body weight. Therefore an infant is at risk from breast milk, whereas an adult may not be.

• Possibly infectious "bodily fluids"

HIV might be transmitted from an infected person to another from:

• Pre-seminal fluid (pre-cum)

Although it is difficult for researchers to analyze definitively, it is thought that HIV may be transmitted through pre-cum (this is a clear fluid that lubricates the urethra for semen).  Pre-seminal fluid can contain semen or white blood cells, both of which have HIV in an infected person. So going back to conditions required for transmission, HIV can be present, but it is present in a relatively small amount, compared to semen or blood. Therefore, pre-seminal fluid presents a much lower risk for HIV transmission than ejaculate, but there is some risk, depending on where this fluid is going (as in all transmission situations).

• Non-infectious "bodily fluids"

  • Saliva
  • Tears
  • Sweat
  • Feces
  • Urine

 

Activities That Allow HIV Transmission  (Back to the Top)

Looking at the third condition for transmission (it must get into the bloodstream), there are three primary ways in which this can happen:

• Unprotected sexual contact
• Direct blood contact, including injection drug needles, blood transfusions, accidents in health care settings or certain blood products
• Mother to baby (before or during birth, or through breast milk)

• Sexual Routes Of Transmission

• Sexual intercourse (vaginal and anal): In the genitals and the rectum, HIV may infect the mucous membranes directly or enter through cuts and sores caused during intercourse (many of which would be unnoticed).
• Oral sex (mouth-penis, mouth-vagina): The mouth is an inhospitable environment for HIV (in semen, vaginal fluid or blood), meaning the risk of HIV transmission through the throat, gums, and oral membranes is lower than through vaginal or anal membranes. There are however, documented cases where HIV was transmitted orally, so we can't say that getting HIV-infected semen, vaginal fluid or blood in the mouth is without risk.
• Heterosexual transmission studies: It is evident, from epidemiological studies as well as common sense, that AIDS can be transmitted sexually between men and women. Several studies, usually with the female partners of hemophiliacs who have been infected, show that male to female sexual transmission does occur. This conclusion is supported by the statistics of women who have AIDS, whose only risk factor was sex with a man with AIDS or a man at risk for AIDS. Female to male sexual transmission seems to be less efficient, but it certainly does occur.

• Non-Sexual Routes Of Transmission

• Sharing injection needles: An injection needle can pass blood directly from one person's bloodstream to another. It is a very efficient way to transmit a blood-borne virus.

• Needle sticks: A study of over 2,000 health care workers has been underway for several years to assess the risk of their exposure to people with AIDS. Over 1,000 of these workers had a needle stick accident with a needle that had been used on a person living with AIDS. The rest had some sort of mucous membrane exposure, such as being splashed in the face with blood or vomit.
  
  Of all these people, only 21 show signs of being infected with HIV (as determined by the antibody test). One of these people was a nurse who had multiple needle stick accidents, including one where she tripped and fell on the depressor of a syringe full of blood, and the entire contents entered her body. Another was a lab worker who was working with a test tube of infected blood which broke and cut his finger, exposing the infected blood to his bloodstream. This study shows that AIDS is a difficult disease to get, and even the intimate exposure of these health care workers was not enough to infect them, except in the most extreme cases.

• Blood transfusions: Since March 1985, all blood in the U.S. has been screened with the HIV antibody test. This practice has almost eliminated the risk of getting HIV through a blood transfusion. BUT NOTE, PEOPLE BECOME HIV+ THROUGH BLOOD PRODUCTS EVERY YEAR. THE NUMBERS ARE SMALL, BUT IT IS STILL A PROBLEM.

• Hemophilia treatments: Hemophilia is a genetic disease in which people (almost all men) lack the ability to clot blood. To control the condition, hemophiliacs take Factor VIII, a clotting factor. Each dose of Factor VIII comes from the pooled blood of many donors. Currently, over 90% of hemophiliacs in the U.S. have been infected with HIV because of receiving contaminated Factor VIII. Factor VIII is now heat-treated to kill the virus. In addition, there are new synthetic products that do not pose any risk for HIV and which accomplish the same function.
  
   

• Other blood products: Besides whole blood, platelets (red blood cells) have transmitted the virus. Current blood screening, however, should prevent all but a very, very few cases. No other blood products are suspected of transmitting HIV. Gamma globulin or hepatitis B vaccine do not transmit HIV. Gamma globulin, however, can temporarily transmit HIV antibodies, although not the virus itself. These antibodies will disappear within a few months.
   

• Mother to Child: It is possible for an HIV-infected mother to pass the virus directly before or during birth, or through breast milk. Approximately 20% of babies born to HIV-positive women who undertake no transmission-reduction measures will be infected with HIV. Taking AZT during the later stages of pregnancy and delivery reduces this probability to 5% - 8%. Recent studies presented at the 12th World AIDS Conference indicate that transmission is reduced to less than 2% if a caesarian section (c-section) is performed prior to labor, incombination with AZT therapy. Other studies are being conducted to determine whether vaginal cleansing and use of antiviral vaginal suppositories prior to birth are effective in reducing mother-to-child, or "perinatal," transmission.
  
  Breast milk contains HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is a viable means of transmission to infants. The United Nations presented a recommendation at the 12th World AIDS Conference suggesting that infected mothers not breast feed their infants. Despite use of AZT by the mother, approximately 5% of vertical transmission occurs via breast milk.
   

• Donor insemination: Donor semen is checked for HIV antibodies when the semen is collected. The semen is then frozen. The donor is required to come back after six months for a second HIV test, to confirm the initial HIV screening. The semen is not used before the procedure is completed.
   

 

 

HIV Is NOT Transmitted By  (Back to the Top)

• Insect bites

HIV is not transmitted by mosquitoes, flies, ticks, fleas, bees or wasps. If a bloodsucking insect bites someone with HIV, the virus dies almost instantly in the insect's stomach (as it digests the blood). HIV can only live in human cells.

Mosquitoes cannot transmit HIV for two reasons:

• The mosquito draws blood and injects saliva. The blood from one person is not injected into the mosquito's next victim.
• HIV dies in the mosquito's body. People sometimes are confused because malaria actually reproduces inside the mosquito's digestive track, using the insect as part of its life cycle. HIV does not.

These facts are confirmed by looking at infection patterns. In areas where mosquitoes are common and where HIV is prevalent, the distribution of AIDS cases in the population is not different from other areas. If mosquitoes transmitted HIV, we would be seeing a disproportionate number of children and elderly infected in those areas.

 

• Casual Contact/Sharing dishes or food

HIV is not transmitted through casual, every day contact. Since HIV is not transmitted by saliva, it is impossible to get it through sharing a glass, a fork, a sandwich, or fruit.

Three studies of household contacts, in the U.S., Europe, and Africa, have shown that AIDS is not casually transmitted by normal activities, even when people are in close living arrangements. All the studies examined households where someone had AIDS to see if any of the other members in that household had become infected (sexual contact was excluded). Many of these households included a small child as the one who has AIDS. These children continued to play with siblings in the manner that children play: wrestling, fighting, spitting, sharing food and clothes, and many other activities. No other member of any of the households shows any sign of being infected. This study shows that AIDS is a difficult disease to get, and that even the intimate exposure common among small children living together is not sufficient to transmit the virus.

 

• Donating blood

Sterilized needles are always used in taking blood from donors, so HIV is not spread in this manner.

• Swimming pools and hot tubs

The chemicals used in swimming pools and hot tubs would instantly kill any HIV, if the hot water hadn't killed it already.

• Pets

Humans are the only animals that can harbor HIV. People sometimes think they can get HIV from pets, because some animals carry viruses that produce similar immune deficiencies in their own species, e.g. FIV, feline immunodeficiency virus, in cats, and SIV, simian immunodeficiency virus, in some types of monkeys. However, FIV cannot be transmitted to people, nor can HIV be transmitted from humans to pets such as cats and dogs. (An exception is chimpanzees used in research that have been infected with HIV. Their blood poses a risk to researchers working with them). There have been two reported cases of transmission of SIV to researchers, but no one knows if the virus will cause disease in them.

• Contact with saliva, tears, sweat, feces or urine

Transmission can only occur when a sufficient amount of HIV enters the bloodstream, through cuts or mucous membranes. These "bodily fluids" either contain no HIV or it exists in a quantity too small to result in transmission.

HIV is not transmitted by saliva. There is a great deal of evidence to support this fact. In a study of 79 men with AIDS, the virus could be found in the saliva of only one. This man had PCP, thrush, and other mouth and throat lesions. Even in this man, the level of virus found in his saliva was 10,000 times less than the level in his blood. To this study we can add the evidence of the countless numbers of people who have had saliva contact with people with AIDS or others who have been infected. This contact has occurred through kissing, sharing food, sharing joints, and many other means. We can find no evidence that these activities have transmitted the virus even a single time. Recent findings suggest that saliva contains an enzyme which kills HIV. Certainly there is a lot at work in the mouth combining to make the mouth an inhospitable site for the virus: acids, enzymes, friction, dilution, air, and more.

 

 

Transmission Through Tattooing, Piercing, Acupuncture, Electrolysis, and Shaving  (Back to the Top)

• What is the risk?

Any procedure in which a needle or razor is used on more than one person involves a theoretical risk of HIV transmission because of the possibility of infected blood on the instrument. However, the risk can be reduced or eliminated through routine sterilization procedures. There are no documented cases in the United States of someone becoming infected through tattooing or piercing.

• Universal precautions

Tattoo artists, piercers, hairdressers and barbers, massage therapists, manicurists and pedicurists, and acupuncturists are all defined by the Centers for Disease Control (CDC) as "personal service workers" (PSWs). The CDC has established universal precautions for PSWs, similar to those for health care workers, which are designed to protect both the workers and their customers from HIV and other blood-borne illnesses such as hepatitis. The guidelines state that any instruments designed to penetrate the skin such as tattoo or acupuncture needles either should be used only once and discarded, or should be thoroughly cleaned and sterilized after each use.

If you are worried about the risks of such procedures, you should discuss infection control precautions with the provider. In the case of tattoos and acupuncture, you may also provide your own fresh needles to ensure sterility.

 

How long does it take for HIV to cause AIDS? (Back to the Top)

Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure AIDS itself. As with other diseases, early detection offers more options for treatment and preventative health care.

 

 

The Stages of HIV  (Back to the Top)

Provided by the San Francisco AIDS Foundation December 15, 1998

• HIV Is a Continuum

Most of us are used to thinking of disease in very simple terms: if you feel sick, you are sick; if you feel healthy, you are healthy. However, because HIV may be causing subtle changes in the immune system long before an infected person feels sick, most doctors have adopted the term "HIV Disease" to cover the entire HIV spectrum, from initial infection to full-blown AIDS (which can also be called "Advanced HIV Disease").

The continuum that follows and its stages are representative of the experience of many people with HIV. The time that it takes for each individual person to go through these stages is varied. For most people, however, the process of HIV disease is fairly slow, taking several years from infection to the development of severe immunodeficiency.

• Infection

HIV enters the bloodstream and begins to take up residence in the cells. People with HIV are considered to be infectious immediately after infection with the virus. Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV-infected people to find out what their level of infectivity is.

A person with HIV is infectious at all times. Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if a person is infected is by taking an HIV antibody test.

• Primary Infection (or Acute Infection)

Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by the body (usually 6-12 weeks). Within the first 72 hours after exposure, post-exposure prevention (PEP) may be possible.

Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms. These symptoms, which usually last no more than a few days, might include fevers, chills, night sweats and rashes (not cold-like symptoms). The remaining percentage of people either do not experience "acute infection," or have symptoms so mild that they may not notice them.

Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection.

The important thing to do is call an AIDS hotline to discuss whether you were in a situation that put you at risk for HIV and whether you should consider taking an HIV test. call the CDC National AIDS Hotline toll free at 1-800-342-AIDS.

During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively reproduces and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load." However, people with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV.

Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment.

Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS. Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression. Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti-HIV treatment should be continued indefinitely once it is started.

• Seroconversion

This term refers to the time when the body begins producing antibodies to the virus. About 95% of the people infected with HIV will develop antibodies within three months after infection. Nearly all people will develop antibodies within six months after infection.

Most people develop antibodies within three months and some can take up to six months. People who get tested need to wait at least three months for the test. If their first result is negative, they should come back for a second test three months later.

 

• Immune System Decline

The virus appears to slowly damage the immune system for a number of years after infection (perhaps because the body is able to keep it in check during this time). In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. This damage can be seen in blood tests, such as lowered T-cell counts, before any actual symptoms are experienced.

People who are HIV-positive should see a doctor to monitor their immune systems. By getting lab indicators (such as the viral load test) and observing how they are changing over time, they can get a better sense of whether HIV has already caused any damage to their immune systems. As mentioned above, a development in the last couple of years in the treatment of HIV disease is what doctors call "Early Intervention" or "Early Care." The principle behind this concept is that early rather than late medical care may give people better chances of survival and better quality of life. It is extremely important that people with HIV learn that they have to see a doctor even if they feel fine at the moment because the virus could be already damaging their immune systems.

Understanding that HIV Disease begins immediately after infection enables us to begin treating infected persons before symptoms appear. This important medical advance has significantly extended the lifespan -- and the hope -- of HIV-infected people.

 

• Mild, Non-Specific Symptoms

Once the immune system is damaged, many people will begin to experience some mild symptoms (skin rashes, fatigue, slight weight loss, night sweats, thrush in the mouth, etc.). Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one's prognosis varies greatly depending on one's ability to access support, services and preventative treatment, it is generally believed that it takes the average person five to seven years to experience their first mild symptom.

These symptoms are not specific to AIDS. However, they should be of concern to people who have tested positive to HIV. Usually, symptoms occur when the virus has already caused considerable damage to the immune system. For that reason, people with HIV should not wait until symptoms appear to get medical treatment. Also, people with high risk for HIV should not wait to get symptoms to take the HIV-antibody test.

If you are a person with HIV experiencing any symptoms, we suggest that you have them checked by a health care worker.

 

• More Severe Symptoms; Opportunistic Infections and Diseases

When immune system damage is more severe, people may experience opportunistic infections (called "opportunistic" because they are caused by organisms which cannot induce disease in people with normal immune systems, but take the "opportunity" to flourish in people with HIV). Most of these more severe infections, diseases and symptoms fall under the Centers for Disease Control's definition of full-blown "AIDS." In a San Francisco study of gay men, the median time to receive an AIDS diagnosis among HIV-infected men is 10-11 years. (Again, this statistic predates the advent of more powerful anti-HIV drugs.)

Receiving an AIDS diagnosis does not necessarily mean that the person will die soon. Some people have lived many years after their diagnosis. However, it is extremely important that people in this stage of HIV disease get adequate care for any symptoms or conditions that develop.

People with an AIDS diagnosis have coined the term "living with AIDS" to describe their experience. We prefer this term over others because it implies empowerment which may be crucial in maintaining a positive frame of mind and possibly even in surviving longer. As the term "HIV-disease" becomes more common, many people are also using the term "living with HIV" to refer to anyone who has the virus.

Does everyone who has HIV eventually get sick? Nobody knows.

Many researchers believe that, in some small percentage of people with HIV, the immune system may be able to defeat the virus. As existing treatments are used earlier in the course of HIV disease and new treatments are developed, these, too, will postpone, and possibly prevent, illness. Unfortunately, however, studies show that the majority of untreated people do eventually become ill from HIV. Long-term studies of San Francisco gay men infected with HIV between 1978 and 1980 have shown that by 1992, 85% had developed AIDS, and 15% remained symptom-free.

No one knows whether these men will eventually develop AIDS, or what percentage of the symptom-free men will develop AIDS in the years to come. Some long-term survivors may do so well because of their unique body chemistry, or access to a combination of medical, emotional and spiritual support, or something yet unknown to us. Others may find their health declining even with access to all of these things. We don't really know the answer yet, although you can be sure scientists and researchers are searching for the common thread that links long-term survivors together.

 

What is AIDS?

AIDS stands for acquired immunodeficiency syndrome. A diagnosis of AIDS is made by a physician using certain clinical or laboratory standards.

What causes AIDS?

AIDS is caused by infection with a virus called human immunodeficiency virus (HIV). This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their babies during pregnancy or delivery, as well as through breast feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection.

What body fluids transmit HIV?

These body fluids have been proven to spread HIV:

• blood
• semen
• vaginal fluid
• breast milk
• other body fluids containing blood

 

These are additional body fluids that may transmit the virus that health care workers may come into contact with:

• fluid surrounding the brain and the spinal cord
• fluid surrounding bone joints
• fluid surrounding an unborn baby

 

Questions and Answers: HIV is the Cause of AIDS (Back to the Top)

• How does HIV cause AIDS?

HIV destroys a certain kind of blood cells--CD4+ T cells (helper cells)--which are crucial to the normal function of the human immune system. In fact, loss of these cells in people with HIV is an extremely powerful predictor of the development of AIDS. Studies of thousands of people have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for AIDS to develop. However, recently developed sensitive tests have shown a strong connection between the amount of HIV in the blood and the decline in CD4+ T cell numbers and the development of AIDS. Reducing the amount of virus in the body with anti-HIV drugs can slow this immune destruction.

• An author indicated in a recently published book that AIDS is caused by HHV-6 rather than HIV. Is this true?

No, this is not true. Both HHV-6 and HIV infect the same kind of cells in a person's body. These cells are called CD4+ T cells (helper cells). However, AIDS will not develop in someone who is not infected with HIV. Infection with HHV-6 does not lead to infection with HIV. HHV-6, one of the eight known human herpesviruses, is common throughout the world, with over 90% of adults in many populations being infected. Most people are infected with HHV-6 between the ages of 6 months and 2 years old, soon after they lose their mother's antibodies. HHV-6 is the cause of roseola [ro ZEE o la], a usually mild childhood disease that is also called exanthem subitum [eg ZAN them SUBI tum] or sixth disease. Approximately 30% of all children get roseola, usually before 2 years of age.

• Why do some people make statements that HIV does not cause AIDS?

The epidemic of HIV and AIDS has attracted much attention both within and outside the medical and scientific communities. Much of this attention comes from the many social issues--homosexuality, drug use, poverty--related to this disease. Although the scientific evidence is overwhelming and compelling that HIV is the cause of AIDS, the disease process is not yet completely understood.. This incomplete understanding has led some persons to make statements that AIDS is not caused by an infectious agent or is caused by a virus that is not HIV. This is not only misleading, but may have dangerous consequences. Before the discovery of HIV, evidence from epidemiologic studies involving tracing of patients’ sex partners and cases occurring in persons receiving transfusions of blood or blood clotting products had clearly indicated that the underlying cause of the condition was an infectious agent. Infection with HIV has been the sole common factor shared by AIDS cases throughout the world among homosexual men, transfusion recipients, persons with hemophilia, sex partners of infected persons, children born to infected women, and occupationally exposed health care workers. Recommendations to prevent HIV involve guidance to avoid or modify behaviors that pose a risk of transmitting the virus as well as the use of tests to screen donors of blood and organs.

The inescapable conclusion of more than 15 years of scientific research is that people, if exposed to HIV through sexual contact or injecting drug use, may become infected with HIV. If they become infected, most will eventually develop AIDS.

 

Talking With Kids About HIV and AIDS (Back to the Top)

As upsetting and confusing as it can be to bring up the subject of AIDS with young children, it's essential to do so. By the time they reach third grade, research shows that as many as 93 percent of children have already heard about the illness. Yet, while kids are hearing about HIV/AIDS early on, what they are learning is often inaccurate and frightening. You can set the record straight -- if you know the facts yourself. HIV is transmitted from person to person through contact with blood, semen, vaginal fluid, or breast milk. HIV can be prevented by using latex condoms during sex, not sharing "drug needles," and avoiding contact with another person's bodily fluids. So stay informed. Sharing this information with your youngster can keep her safe and calm her fears. Finally, talking with your child about AIDS lays the groundwork for any future conversations about AIDS-preventative behavior. Here are some tips on how to get started:

Initiate discussion

Use a "talk opportunity" to introduce the subject of AIDS to your child. For example, try tying a discussion into something your child sees or hears, such as a commercial about AIDS. After you and your child watch the ad, say something like, "Have you heard about AIDS before? Well, what do you think AIDS is?" This way, you can figure out what she already understands and work from there.

Present the facts

Offer honest, accurate information that's appropriate to a child's age and development. To an 8-year-old you might say, "AIDS is a disease that makes people very sick. It's caused by a virus, called HIV, which is a tiny germ." An older child can absorb more detailed information: "Your body is made up of billions of cells. Some of these cells, called T-cells, help your body stay healthy by fighting off disease. But if you get a virus called HIV, that virus kills the T- cells. Over time, the body can't fight disease any more and that person has AIDS." Pre-teens should also understand how condoms could help protect people from getting AIDS and that the disease can be transmitted between persons who share drug needles. (If you have already explained sexual intercourse to your children, you might add, "During sexual intercourse, the semen from the man's body goes into the woman's body. That semen can carry HIV." If you have not yet talked about sex, don't bring it up during initial discussions about AIDS. It's not a good idea for your child's first information about sex to be associated with such a serious disease.)

Set them straight

Children's misconceptions about AIDS can be pretty scary, so it's important to correct them as soon as possible. Suppose your 8-year-old comes home from school one day, tearful because she fell down on the playground, scraped her knee and started bleeding -- and the other kids told her she would get AIDS. As a parent, you might explain, "No, you don't have AIDS. You're fine. You can't get AIDS from scraping your knee. The way you can get AIDS is when the fluids from your body mix with those of someone who has AIDS. Do you understand?" After such a discussion, it's also wise to check back with your child and see what she remembers. Understanding AIDS, particularly for young children, takes more than a single conversation.

Foster self-esteem

Praising our children frequently, setting realistic goals and keeping up with their interests are an effective way to build self-esteem. And that's important, because when kids feel good about themselves, they are much more likely to withstand peer pressure to have sex before they are ready, or to not do drugs. In short, they are less likely to engage in behavior that could put them at risk for AIDS.

Put Your Child's Safety First

Some adults mistakenly believe that AIDS is only a disease of homosexuals. Whatever your beliefs, try not to let your opinions or feelings prevent you from giving your child the facts about AIDS and its transmission -- it's information that's essential to their health and safety.

Be prepared to discuss death

When talking with your kids about AIDS, questions about death may come up. So get ready to answer them by reading books (see Readings for Children and Parents) available at libraries or bookstores. In the meantime, here are three helpful tips:

• Explain death in simple terms. Explain that when someone dies, they don't breathe, or eat, or feel hungry or cold, and you won't see them again. Although very young children won't be able to understand such finality, that's okay. Just be patient and repeat the message whenever appropriate.
• Never explain death in terms of sleep. It may make your child worry that if he falls asleep, he'll never wake up.
• Offer reassurance. If appropriate, tell your child that you are not going to die from AIDS and that he won't either. Stress that while AIDS is serious, it is preventable.

Questions & Answers

What is AIDS?

AIDS is a very serious disease that is caused by a tiny germ called a virus. When you are healthy, your body can fight off diseases, like Superman fighting the bad guys. Even if you do get sick, your body can fight the germs and make you well again. But when you have AIDS, your body cannot protect you. That's why people with AIDS get very sick.

How do you get AIDS?

You can get AIDS when the fluids from your body mix with those of someone who has AIDS. You can't catch it like the flu and you can't get it just by touching or being near someone with AIDS, so you and I don_t have to worry about getting it. (NOTE: If you have already talked with your child about sex, you should also add, "You can also get AIDS by having unprotected sexual intercourse with someone who has the HIV virus.")

Can kids get AIDS?

Very few children get AIDS. But if they were born to a mommy who had AIDS, they could get AIDS when they were born. A long time ago, some kids who had hemophilia -- a disease that means their blood doesn't have enough good cells, so they need to get blood from other people -- got AIDS when they got blood. But that doesn't happen anymore. AIDS is mostly a disease of grownups. (NOTE: If your child already knows about the link between sex and AIDS, and IV drug use and AIDS, you might also add, "Sometimes teenagers who have unprotected sex or who share drug needles get AIDS." But you should still emphasize that "AIDS is mostly a disease of grown-ups.")

How can you tell from looking at someone if they have AIDS?

You can't. Anyone, regardless of what they look like, can have AIDS. People find out if they have AIDS after being tested by a doctor. Therefore, the only way to know if someone has AIDS is to ask him if he has been tested and if the test results were positive for HIV/AIDS.

Do all gay people get AIDS?

No. Homosexuals get AIDS the same way that heterosexuals do. And they can protect themselves the same way, too.

(Back to the Top)