What is HIV?
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.

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:
· Cerebrospinal fluid surrounding the brain and the spinal cord
· Synovial fluid surrounding bone joints
· Amniotic fluid surrounding a fetus

What is AIDS? What causes AIDS?
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 preventive care. How is HIV passed from one person to another?

HIV transmission can occur when blood, semen (including pre-seminal fluid, or “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 anus or rectum, the vagina, 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 sexual intercourse (anal, vaginal, or oral sex) with an HIV-infected person
· By sharing needles or injection equipment with an injection drug user who is infected with HIV
· From HIV-infected women to babies before or during birth, or through breast-feeding after birth
· HIV also can be transmitted through transfusions of infected blood or blood clotting factors. (However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world.)

How effective are latex condoms in preventing HIV?
Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently and correctly. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected.

What are the factors that determine my risk of getting infected or reinfected with HIV?

Five main factors determine risk of HIV transmission:
1. Prevalence of HIV in the community. If HIV infection is very rare in the population of people with whom you have sex, it is pretty unlikely that you’ll get infected. But if HIV is common in the community (as it now is in almost all urban gay communities…about 1 in 7 urban men who have sex with men have HIV), then it’s easy to get infected.
2. Number of Partners. If you have sex with very few people, your chances of getting HIV are lower than if you have sex with many.
3. Number of encounters with each partner. HIV doesn’t get transmitted every time you have sex, even if one person is HIV+ and one is HIV-. But if you have sex many times with a person who is infected, that increases the risk. It’s like Russian Roulette.
4. Level of risk in each specific behavior. Different sex acts have different risks of transmission. We have no way of knowing the absolute risk for a specific behavior, but we can rank different behaviors based on the risk relative to each other (a risk continuum or risk hierarchy). For example, as we all know, getting fucked without a condom is very high risk, but jerking off is very low risk on risk continuum.
5. Presence of genital ulcers. STDs that give you rashes or ulcers (syphilis, herpes, chancroid) act as doorways for HIV infection. Look before you lick or engage in other sexual activities. This factor is related to #4 – if you avoid activities that carry a high level of risk, potential contact with genital ulcers is minimized.

Can I get HIV from anal sex?
Yes, 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.

Having unprotected (without a condom) anal sex is considered to be a very risky behavior. 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 a water-based lubricant in addition to the condom to reduce the chances of the condom breaking.

Can I get HIV from open-mouth, deep kissing?
Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner and then enter the body through cuts or sores in the mouth. Because of this possible risk, the CDC recommends against open-mouth kissing with an infected partner.

Can I get HIV from performing oral sex?
Yes, it is possible for you to become infected with HIV through performing 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.

Blood, semen, pre-seminal fluid, and vaginal fluid all may contain the virus. Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. The risk increases:
· if you have cuts or sores around or in your mouth or throat;
· if your partner ejaculates in your mouth; or
· if your partner has another sexually transmitted disease (STD).

So how can we get people to use latex condoms (or dental dams) during oral sex? Truth is, most folks won’t. So how can you give a blow-job safely? Actually, there are ways of reducing your risk of infection while giving oral sex:
1. Let’s start off with making condoms taste better. First of all, always use unlubricated condoms for oral sex. Lubricants were never made to be ingested. There are flavored condoms on the market which don’t taste so bad. Kiss of Mint brand is probably the best example. But what if you can’t find Kiss of Mint? What if you hate the taste of mint? Well, all you have to do is use any food item that isn’t oil based, and put it on a latex condom. You can use any food item that will cover the awful taste of latex, as long as it isn’t oil-based. Using food for sex can also eroticize things with your partner.
2. You can use plastic condoms. These condoms, sold under the brand name Avanti are made out of a type of plastic called polyurethane. Since they’re not made out of latex, they don’t have that awful taste. But studies are still being done to see how well they protect against HIV and other STDs.
3. If you don’t want to use condoms at all, at the very least, don’t let the guy cum in your mouth. The less you allow pre-cum and semen to get in your mouth, the less your chance of infection.
4. And finally, “look before you lick.” If you see any type of lesions, growths or discharge on the guy’s penis, that’s nature’s way of telling you to hold off. These symptoms can be due to numerous STDs, and physical contact with them can lead to infection. A guy can have a disease and have no symptoms at all, but if you see something that doesn’t belong there, don’t touch it!

Of course having oral sex without protection will still have some element of risk, but looking before you lick and not letting the guy cum in your mouth will significantly reduce your risk. So if you love going down on a guy, but hate the taste of latex, you now have four ways of having safer sex.

Can I get HIV from someone performing oral sex on me?
Yes, it is possible for you to become infected with HIV through receiving oral sex, but the risk is extremely low. If your partner has HIV, blood from their mouth may enter the urethra (the opening at the tip of the penis), the vagina, the anus, or directly into the body through small cuts or open sores.

Is there a connection between HIV and other sexually transmitted diseases?
Yes. Having a sexually transmitted disease (STD) can increase a person’s risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person also is infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:
· Engaging in sex that does not involve vaginal, anal, or oral sex
· Having intercourse with only one uninfected partner
· Using latex condoms every time you have sex

Can I get HIV as a Bareback Top?
The HIV risk associated with receptive anal sex is greater than for the person doing the fucking, but you can still catch HIV from being the top in anal sex. HIV can enter your urethra during sex and cause infection. If you are uncircumcised, your foreskin can also trap the HIV virus and allow it to enter your body. If you think you’ve been exposed to HIV, you should get tested.

Is Precum Dangerous?
In HIV positive people both precum and semen can contain the HIV virus. The more body fluids you are exposed to, the greater the risk of HIV infection. As a result, semen is riskier than precum because there tends to be more of it. But you can become infected with HIV and other sexually transmitted diseases (STDs) if you are exposed to precum. As with semen, your risk of catching HIV or other STDs from precum depends on the sex act – from sucking and fucking to hand jobs.

If you have unprotected anal sex, precum containing HIV can enter your body and infect you. While HIV risk is much less from oral sex, precum from an infected partner in your mouth can also infect you. To be completely safe a partner should use a condom during oral and anal sex, even if he plans to pull out before ejaculation.

It is also important to keep in mind, that you don’t need to be exposed to precum or semen to catch certain STDs including herpes, gonorrhea and human papillomavirus (HPV). These and many others are just spread by skin-to-skin contact. They can pass between partners on fingers, toys or from close physical contact.

Any risks associated with lube?
There are studies which document that nonoxynol-9 (a spermicide) found in some lubricants can irritate the colon and actually increase the risk of HIV transmission during anal sex.

A good lubricant should be water soluble. Oil based lubricants can clog anal glands and damage latex condoms. If you choose a lube with flavoring or dyes, there is a chance that you could be allergic. Most men tolerate these types of lubricants without any problems. You should try different lubricants to see which one works best for you and then keep a good supply available. You can also buy small packets of many lubricants to keep in your pocket if you are going out for the night. Above all, please don’t reach for hand creams or vaseline.

There are no reported problems with silicone-based lubricants like Eros. Some people enjoy them more than water-based lubricants. The silicone-based lubricants are also safe for use with condoms

Allergic to latex condoms. Alternatives?
Many people are allergic to latex condoms, and there are safe alternatives available. First and foremost, you cannot use a natural membrane condom (like lamb intestines), as they are porous enough to let HIV through. Although they will protect a woman from pregnancy, they won’t protect anyone from HIV. Avanti makes a non-latex condom out of a thin plastic (polyurethane) and it is safe for men with latex allergies. It will also protect you from HIV. The female condom is also another safe and effective alternative, but it has not been tested or approved for anal sex.

How can I maintain my erection with a condom on?
This complaint is very common. Many men lose their erections when they put on condoms. It may be caused by decreased sensation. Or the condom may not fit correctly – the condom might be too tight and you may need a larger size.

A cock ring might also help keep your erection up, but be sure it is properly sized. Consider one that can snap on and off so that there is no chance of it getting stuck. You may want to try a Reality female condom, which you can insert into your partner’s anus. It looks like a small plastic bag. But it is important to note that the female condom has a higher rate of semen exposure and there are more reported user problems, according to study results presented by the Centers for Disease Control and Prevention.

If the problem results from a loss of excitement during the time that you put on the condom, perhaps have your partner put it on for you. Try and maintain stimulation while you unroll it.

Two condoms safer than one?
It is not safer to wear two latex condoms and there is even evidence that says it might be worse. Two condoms may actually increase the chances of breakage because they rub against each other. The fit is often suboptimal with vacuum pockets forming.

Consumer reports published the results in June, 1999, where they tested 30 different brands of condoms for breakage. They found that the condoms were all very good
except for Durex Pure Protection Spermicidally-Lubricated and Trojan Plus 2 Spermicidal, which failed the minimum inflation pressures.

The key to preventing breakage is to use a water-soluble lubricant, and the condom should be fresh and properly stored. The package will give an expiration date as well as proper storage instructions. Most doctors feel that men who have sex with men should not use Nonoxynol-9 lubricated condoms as that might actually increase risk of HIV if the condom breaks.

Do two “virgins” need to use condoms?
Although you may be virgins as far as anal sex is concerned, you and your partner may have had other sexual experiences (oral sex, mutual masturbation, etc.) with other people. While your risk of catching HIV from these types of sex is very low, it does exist. Additionally, other STDs can be spread during these types of sex. At the very least, get an HIV test and get screened for STDs before having unprotected anal sex. Remember: How do you know what you know?

Please remember that if you choose not to use condoms for anal sex, you must be committed to your monogamous relationship. If one of you cheats on the other, you must be honest and tell your partner right away, so that you can begin using condoms for sex. If you cheat on your partner, and resume having unprotected sex without telling him, you may put him at risk for HIV and STDs. The same is true if your partner cheats on you and does not tell you.

HIV and STDs from Water Sports?
The urine stream from a partner will carry out any infections that he has inside his urethra. It is possible therefore to urinate HIV, Syphilis, gonorrhea and other infections from one partner to another. If your partner urinates into your mouth or anus, any STDs he has will be carried out in his urine and into your body. If he urinates on you and you
don’t have open cuts, it is very safe. So if you are just urinating on each other then there is probably almost no risk for HIV infection, but you may get another type of infection, and if you drink a partner’s urine or it goes into your body then the risk increases.

Can HIV be transmitted via contact with feces?
Exposure to feces does not pose a risk for infection with HIV, unless there is blood present in the feces and that comes into contact with your mucous membranes or bloodstream. Contact with feces alone has never been documented as a vehicle for HIV transmission. It is as important to remember that there is no evidence that HIV is transmitted through contact with objects in your day-to-day environment (like the toilet seat in the bathroom). Contact with feces does pose a risk for infection with hepatitis A virus, parasites, and bacteria, so it is important to be aware of any feces coming into contact with your mouth. Getting a hepatitis A/B vaccine is a good idea if you are sexually active (especially for gay men) or in a region where hepatitis A/B is prevalent.

Shot in the Eye: Possible HIV Transmission?
The lining inside of the eye socket consists of mucous membranes. Therefore, HIV infected fluids coming into contact with the eye does pose a theoretical risk (infected fluids coming into contact with mucous membranes). It is important to remember that transmission is highly unlikely when getting a drop of semen in your eye. We know this because sexual transmission of HIV is known to occur through vaginal, anal and oral sex. There is evidence that healthcare workers have been infected when getting HIV infected blood in their eye, but there is no evidence that people have been infected through getting semen in their eye.

Can HIV be transmitted if viral load is undetectable?
We know that several factors complicate the relationship between serum viral load and degree of infectiousness. The correlation of HIV viral load in blood and in the genital tract is relatively weak. There is an overall effect, averaged across people, that antiretroviral therapy reduces blood and genital (semen, vaginal fluid) viral load. But there is not a one-to-one correspondence! Some individuals have relatively high viral loads in their semen while having relatively low viral loads in their blood, and vice versa. There also seems to be greater variation of the concentration of HIV in the genital tract than in the blood, both from one person to another and within one person at different times.

Other infections localized to the genital tract may increase the amount of HIV there. For instance, while a herpes infection or flare-up in one’s system might generally increase the amount of circulating HIV, a genital herpes infection with many sores (and therefore an increase of T-cells in the area to help fight them) might mean that the increase of HIV in the semen or vaginal fluids is much greater than the increase in the blood.

For many individuals, there is probably some real reduction in transmission risk from a given unprotected contact. The problem is, we have no way as yet of knowing for whom this is true and for whom it is not!

This information was compiled from the Centers for Disease Control and Prevention www.cdc.gov and The Body www.thebody.com. The information provided is designed to support, not replace, the relationship that exists between a person and his/her existing health care provider.

June 27th, 2006 | HIV/STD, Patients, Gay Men .