HIV

How is HIV spread?
In the United States, HIV is spread mainly by

• Having sex with someone who has HIV. In general:
  • Anal sex is the highest-risk sexual behavior. Receptive anal sex (bottoming) is riskier than insertive anal sex (topping).
  • Vaginal sex is the second highest-risk sexual behavior.
  • Having multiple sex partners or having other sexually transmitted infections can increase the risk of infection through sex.
• Sharing needles, syringes, rinse water, or other equipment (works) used to prepare injection drugs with someone who has HIV.

Only certain fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from an HIV-infected person can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to possibly occur. Mucous membranes can be found inside the rectum, the vagina, the opening of the penis, and the mouth.

Less commonly, HIV may be spread by

• Being born to an infected mother. HIV can be passed from mother to child during pregnancy, birth, or breastfeeding.
• Being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.
• Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely small because of rigorous testing of the US blood supply and donated organs and tissues.
• Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing, and is very rare.
• Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.
• Oral sex—using the mouth to stimulate the penis, vagina, or anus (fellatio, cunnilingus, and rimming). Giving fellatio (mouth to penis oral sex) and having the person ejaculate (cum) in your mouth is riskier than other types of oral sex.
• Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare.
• Deep, open-mouth kissing if the person with HIV has sores or bleeding gums and blood is exchanged. HIV is not spread through saliva. Transmission through kissing alone is extremely rare.

Are You at Risk for HIV?
Anyone can acquire HIV. Although HIV risk factors and routes of transmission apply to everyone equally, some people are at higher risk because of where they live and who their sex partners are.
The percentage of people living with HIV (prevalence) in the Coachella Valley is more than twice the national rate, so people who live or visit here are more likely to encounter an HIV-positive person among their possible sex partners. In the same way, because the prevalence of HIV is higher among gay and bisexual men and among black and Latino men and women, members of these groups are more likely to encounter partners who are living with HIV.

How to Avoid Getting HIV
Today, there are many tools available to prevent HIV, including:

• Limiting your number of sexual partners;
• Never sharing needles;
• Using condoms and lubricant correctly and consistently;
• Choosing less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming). Sexual activities that do not involve the potential exchange of bodily fluids carry no risk for getting HIV (e.g., touching).
• When having oral sex, avoid having your partner ejaculate in your mouth, and use barriers such as condoms, natural rubber latex sheets, or dental dams between your mouth and your partners’ genitals.
• Getting tested and treated for sexually transmitted diseases (STDs) and encouraging your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others.
• Talking to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicine daily to prevent HIV infection, if you are at substantial risk for HIV. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you are not in an exclusive relationship with a recently tested, HIV-negative partner and are a:
  • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or
  • heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).
• Talking to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable. Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV.
• If your partner is HIV-positive, encourage your partner to get and stay on treatment. ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.
• If you have HIV, you can avoid spreading the virus to others by making sure they do not come into contact with your body fluids.

The more of these actions you take, the safer you can be.

What Are the Symptoms of HIV?
The only way to know if you are infected with HIV is to be tested. You cannot rely on symptoms to know whether you have HIV. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. Some people who are infected with HIV report having flu-like symptoms (often described as “the worst flu ever”) 2 to 4 weeks after exposure. Symptoms can include:

• Fever
• Enlarged lymph nodes
• Sore throat
• Rash

These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.

However, you should not assume you have HIV if you have any of these symptoms. Each of these symptoms can be caused by other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection. If you test positive for HIV, you should see your doctor as soon as possible to begin treatment.

How Testing is Done for HIV
HIV testing is done in a number of different ways. At The DOCK, we provide free rapid oral swab testing that is quick and easy, with no pain and no blood. This antibody screening test (immunoassay) uses oral fluid to look for antibodies to HIV and produces results in 20 minutes.

For all rapid tests that are positive, we conduct a follow-up blood test to confirm the result.

Keep in mind that if an HIV test is conducted during the window period (i.e., the period after exposure but before the test can find antibodies), the test may not find antibodies and may give a false-negative result – making it important to get tested again.

The immune system usually takes 2 to 8 weeks to make antibodies against HIV (the average is 25 days).
A few people will have a longer window period, so if you get a negative test result in the first 3 months after possible exposure, you should get a repeat test after 3 months.

Ninety-seven percent of people will develop antibodies in the first 3 months after they are infected. In very rare cases, it can take up to 6 months to develop antibodies to HIV.

(For further details on HIV testing, visit www.cdc.gov/hiv/basics/testing.html.)

How Often to Get Tested for HIV 
The CDC recommends that adolescents and adults get tested for HIV at least once. They also estimate that one in eight people who has HIV is unaware they have it. So if you’ve never had an HIV test, you should get an HIV test now.

If you are having sex with multiple partners and/or if you think you were exposed to someone with HIV, consider being tested for HIV and other STDs every 3 to 6 months. Discuss this with your doctor.

If you have ever shared needles for any reason (e.g., drugs, steroids, hormones) and have never had an HIV test, you should get tested for HIV now. You should also talk to your doctor about your current needle-sharing practices to learn how frequently you should get tested going forward.

How is HIV Be Treated?
HIV is treated with medication called antiretroviral therapy (ART). It’s very important to take HIV medicines exactly as directed. Not taking medications correctly may lower the level of immune system defenders called CD4 cells and cause the level of virus in your blood (viral load) to go up. The medicines then become less effective when taken. Some people report not feeling well as a reason for stopping their medication or not taking it as prescribed. Tell your doctor if your medicines are making you sick. He or she may be able to help you deal with side effects so you can feel better. Don’t just stop taking your medicines, because your health depends on it.

Protect your partners by keeping yourself healthy. Take all of your medicines and get tested and treated for other STDs. If you have HIV plus another STD or hepatitis, you are 3 to 5 times more likely to spread HIV than if you only have HIV.

What Happens If You Don’t Get Treated for HIV
Untreated, HIV is almost universally fatal because it eventually overwhelms the immune system—resulting in acquired immunodeficiency syndrome (AIDS). HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next.

Be sure that your partner or partners know that you have HIV. Then they will know it’s important to use condoms for all sexual activity and to be tested often for HIV.

(Updated 6/7/17)