May 12, 2009
I am very honored to be a regular contributor on the HIV Prevention Forum here at MH. The forum is very busy, and we often get the same inquiries over and over. I figured that putting together a journal entry covering the most popular topics, and just laying out the facts may be helpful. I also invite Lizzie Lou and Teak to share their thoughts, and to cover anything I may have missed.
First of all, sadly, there is a very overlinflated view of HIV among a large portion of the general population. I feel this is related to a lot of the "hype" and media around the virus. The FACT is, HIV is a very difficult virus to transmit. Comparable to other viruses (ie influenza), it is a very WEAK and unstable virus that succombs to the environment rapidly. It needs basically a set of near perfect circumstances to allow for infection. Therefore, a person CANNOT get HIV from environmental surfaces, like toilet seats, manicure/barber equipment, shower stalls, drinking glasses, toothbrushes, etc etc. The virus quickly becomes inactive when it is outside of its host (the body). This is why infection from inanimate objects is impossible. This is also why mutual masturbation with exposure to a partner's gential fluids is also NOT a risk in any way. This also is the case with cuts, abrasions, cracked cuticles, etc. Those things make no difference when it comes to risk, as the virus is outside of its host, rendering it inactive.
"Delayed Seroconversion". We have all heard horror stories of people who test negative for YEARS, even decades, somehow being infected without having a POS HIV test. This is a bunch of "you know what". It doesn't happen, it is an urban myth. If a person has transmitted the virus, they will test pos, actually quite rapidly (usually within 6 weeks of exposure). 3 months will give a person with an exposure a conclusive result. If a person does not test POS for HIV 3 months after an exposure, then they did not contract HIV. The ONLY exception to this is people who have literally NO immune system who may take longer to produce antibodies. This would include an extremely small portion of the population, and would include situations such as....a person taking anti-rejection meds post an organ transplant, a person on aggressive chemotherapy, or a person with terminal, end stage cancer, again...people who have NO immunity. Even this "delayed" seroconversion among this small population is highly debated among medical professionals. Even people in these categories usually test POS within the 3 month window period, but as a precaution, it is recommended that people with severely compromised immune systems test to 6 months post an exposure. NO ONE ELSE NEEDS TO TEST BEYOND 3 MONTHS. If a person was prescribed PEP ("Post Exposure Prophylaxis), then they need to test 3 months after their LAST dose of PEP.
"Autoimmune Disorders". This is often confused with what I discussed above. Autoimmune disorders (ie rheumatoid arthritis) are completely different from a person with a severely compromised immune system, from chemo, etc. The presence of an autoimmune disorder does NOT change the testing guidelines whatsoever, and it will not affect the test results.
"Blood to Blood Exposures". We get questions about this all the time. HIV is classified as a "blood borne pathogen", which is where a lot of this fear comes from. It basically means that the virus has to reach the bloodstream. In sexual exposures, it does this through the mucous membranes of the vagina or anus, which are VERY vascular, with very easy access to the vascular system. In a needle sharing scenario, a person is injecting infected blood DIRECTLY into their bloodstream. These situations are VERY different from a superficial skin "exposure":
Someone has a cut and was exposed to someone else's cut. This does not pose a risk for many reasons. First, the skin serves as an EXCELLENT barrier to the virus. The skin is comprised of several layers, and injuries, like paper cuts, etc...begin healing IMMEDIATELY from the inside out. Therefore, even if there IS a superficial abrasion/laceration, it will not allow the virus to penetrate deep enough to reach the bloodstream, which is what has to happen for infection. In a VERY severe scenario, there may be a risk....for example, two people being in a car accident with large major hemorrhaging injuries where there is HUGE exposure to the other person's blood through a very significant (deep) injury. However, again...being exposed to someone else's blood in small amounts, even with a small cut, will NOT place you at risk.
The Great ORAL Debate. This is probably our most common question. Unprotected oral sex. Is it a risk? The short answer: NO. The long answer....
There is often a difference in the answers given by the docs in the expert forum vs us. People have to understand that medical professionals and the CDC have a responsibility to be ULTRA conservative when discussing risks. Therefore, there is a MINUTE "theoretical" risk assigned to oral sex. If oral sex was TRULY a "real" risk, there would be new cases all the time of HIV being transmitted in this manner. There absolutely is NOT. And a "theoretical" risk is VERY different from an actual risk. The docs have BOTH said time and time again in the expert forum that neither of them, in their combined DECADES of being specialists dealing with HIV have EVER seen a case of HIV as a result of oral sex, nor have they READ any convincing cases. There is a physiological reason for that. First, the virus isn't present in the saliva, making infection impossible for the receptive partner (the person receiving oral sex). Secondly, for the person GIVING oral sex, THEIR saliva contains enzymes that inhibit the virus, should they be exposed to infected genital secretions. Secondly, again, the virus has been exposed to the air and elements, rendering it inactive in an oral situation. This debate will continue, but again, for anyone worrying about an oral "exposure"...think of the facts. If it was truly a risk, there would be newly reported cases ALL the time.
HIV is classified as an STD, which means, basically, one has to have SEX to be at risk. This leads me to the primary REAL risks of becoming infected. They are UNPROTECTED VAGINAL OR ANAL SEX, sharing IV drug works, and from mother to infant. Sexually, there are certainly higher risks. Homosexual men having sex with other men still remains a higher risk, with a "bottom" anal sex partner having unprotected sex being about the highest risk factor. HOWEVER...despite this information....HIV is still on the rise among heterosexual partners. While it is less of a risk, it is still a risk! And, despite the "odds" out there, it IS possible to get HIV from only ONE episode of unprotected hetero sex. Who wants to take those kinds of chances? Therefore, remember to protect yourself at all costs. ONE moment of pleasure for a lifetime of dealing with a chronic illness? Seems like one heck of an exchange!
Protection. HIV is a 100% preventable disease. Condoms work. Therefore, condoms used consistently and correctly will almost guarantee a future free of HIV. Whether a person chooses to use condoms for oral sex is a personal decision. It certainly is adviseable to protect against other STD's, which are far more prevalent, and easier to transmit via oral sex. When engaging in a sexual relationship, follow a few rules. First, have open conversations with a prospective partner about their history, and flat out ask their history, whether they have been tested, etc. ANYone who is evasive about their answer, or refuses to answer....walk away. UNLESS you have been mutually tested with a monogamous partner...unprotected intercourse should NEVER be an option. Men, choose condoms that are the right fit, and use only ONE condom at a time. Some people think that 2 condoms at a time offers double protection. To the contrary, they increase the risk of condom failure. Use plenty of WATER based lubrication, like KY jelly, and if you question the quality of a condom, use another one. Make sure the condoms are not expired, as that also increases the risk of condom breakage. When condoms break, they do so CATASTROPHICALLY. There is no doubt. Therefore, if you use a condom, and it is WHOLE after the act, the condom worked. Always remember to hold onto the condom on withdrawl, this will prevent slippage, which overall isn't a risk for HIV, but may expose you to other STD's. The fact that HIV virus can penetrate an intact condom is also an urban myth. The ONLY exception to this is lambskin condoms...they are not efficient against HIV. Use latex or polyurethane condoms only to protect against HIV.
Medical Exposures. You cannot and will not EVER be infected by a medical procedure, like having your blood drawn, or an IV inserted. Medical professionals do NOT re-use needles, period. Mainly because if they did, they would be placing themselves at risk for all kinds of infections, and they simply wouldn't do that. Secondly, most of the needle products out there today allow for a ONE time use only, and have safeguards in place to prevent re-use. If you are worried about this...put it out of your mind, it is irrational.
Lastly, if you feel you've had a risk, then get tested. There is NO reason not to. Anxiety is NO excuse not to get tested. "Not knowing" doesn't change your test result...it just delays possible life-saving treatment, not to mention, may keep you from the likely relief of a negative result. HIV education is vital....and in this day and age, not ONE more person should be getting infected. It is completely avoidable.
If you have been tested, and your result is NEG at 3 months, you do NOT have HIV, despite any "symptoms" you are sure you have. One can NEVER EVER gauge a risk by physical symptoms. Newly infected people many times do not experience any ARS symptoms, not to mention that ARS symptoms are also VERY consistent with thousands of other common, non-HIV illnesses, infections. If you have had a NO RISK situation, or have tested NEGATIVE at 3 months, or both...and you simply CANNOT move on, cannot convince yourself that you do not have HIV, then it is time to seek professional help for yourself. HIV phobias/anxiety is sadly pretty common. One can see that by reading either of the HIV forums here on MH. Continuing to search the internet is the absolute WORST thing you could do in that situation. That would be synonomous with a person with a severe snake phobia throwing themselves into a snake pit day after day.. Doesn't make much sense, does it?
The "HIV Prevention" forum here at MH is to help people assess a risk. The forum has rules in place because of the nature of the high levels of anxiety related to the subject. People get a little upset with us when we tell posters to "move on", but it is absolutely a necessity. We HAVE to maintain order in the forum, and once we have advised a poster that they have not had a risk, or they are conclusively negative, there isn't much more we can tell them. There are hundreds, thousands of posts to search. We cannot provide constant emotional support, that just isn't whay the forum is there. Of course we recognize that people coming to us are highly anxious and of course we are compassionate, but there comes a time when enough is enough. No one else would get their ?'s answered if we allowed every person to continue on and on, asking the same question in a different way. Therefore, it deserves mention...if YOU are one of these people, be courteous to the other posters in the forum, and please follow the rules. Again, the search option is available to you, you can review MANY threads discussing the same topic.
Hopefully, this information will help those who are looking for some insight into HIV and its risks.