Which body fluids can transmit HIV?

HIV spreads when blood or some body fluids from an infected person enter another person. Do you know which body fluids can transmit HIV infection? Pick the correct choices from this list:

• Blood
• Semen and pre-ejaculatory fluid
• Vaginal fluid
• Breast milk
• Urine
• Saliva
• Tears
• All

Well, the correct choices are A, B, C, and D. HIV is present in high concentrations in the blood and sexual fluids of infected persons. Breast milk can transmit the infection to the baby. Urine, saliva and tears have minimal concentration of HIV and are not known to transmit the infection.

What's Safe, What's Not

When it comes to HIV, the paranoid are worried if it’s even safe to shake hands with an infected person. The reckless on the other hand refuse to accept proven modes of transmission as risky. Here is a list of ways through which HIV can and cannot be transmitted.

• Vaginal sex without condom. Single contact can cause infection.
• Anal sex without condoms. Risky even with condoms as chances of condom tearing are high. Condom with adequate lubrication is advised to increase protection.
• Sharing needles and the "works' (syringes, spoons, filters and blood-contaminated water) used to inject drugs. Considered three times as risky as unprotected sex.
D. Oral sex. The risk is much lower but infection is possible.

Some other circumstances in which HIV is transmitted are:

• From infected mother to baby. If a woman knows she is infected with HIV, there are drugs she can take to greatly reduce the chances of her child becoming infected.
• From infected patients to healthcare workers such as doctors and nurses if adequate precautions are not taken or an accidental injury occurs.

Circumstances in which there is a potential risk of infection, but the actual instances in which transmission has occurred are rare:

• Receiving blood transfusion. Blood banks are required by law to screen all donated blood for HIV, so the actual chances of receiving infected blood are negligible.
• While undergoing surgical procedures or receiving injections at a clinic. Sterile precautions taken in a healthcare setting minimize the risk of infection.

What's Safe

• Kissing. The quantity of virus present in saliva is insufficient to cause infection unless you have large sores in your mouth or severely bleeding gums.
• Hugging, shaking hands, working together, sharing cups
• Sitting next to a sneezing, coughing, spitting infected individual
• Swimming pools, toilet seats, showers used by an infected person. Except under laboratory circumstances HIV does not survive well in the open air, therefore the risk of infection through contaminated surfaces is very low.
• Playing sports. Unless a lot of bleeding and rubbing together of skin is expected! There is no evidence of such a case occurring so far.
• Protected sex. If used correctly and consistently, condoms are highly effective at preventing HIV transmission.

Can I get HIV from a barber's shop?

Theoretically, yes. Even though there are hardly any documented cases of HIV transmission through this route, the possibility of HIV transmission through accidental cuts from infected razors at a barber’s shop cannot be ruled out. Other procedures such as tattooing, ear piercing, and acupuncture also carry similar potential risk. The best way to protect yourself is to see that your barber or tattoo artist uses a new/ sterilized blades and needles. Boiling for twenty minutes is an acceptable method of sterilization. Disinfecting with surgical spirit should be used if other methods are not feasible.

Can mosquitoes transmit HIV?

No. Since HIV is transmitted through blood, it is natural to worry that biting or bloodsucking insects might spread HIV. Thankfully, studies from areas with high HIV prevalence and lots of mosquitoes show no evidence to support this fear. This is so because when insects bite, they do not inject the blood of the person they have last bitten. Besides, the HIV can survive for a very short period inside an insect.

How common is HIV in India?

Though HIV is not as rampant in India as in some countries of Sub-Saharan Africa (where about 5% population is infected), it is certainly not a rare infection. Currently, the overall HIV prevalence in India is 0.3%. The rates are much higher among people attending STD clinics (3.6%), female sex workers (5.1%), injecting drug users (7.2%) and men who have sex with men (7.4%). Moreover, the picture is not uniform across the country. The highest HIV prevalence rates are found in Andhra Pradesh (1%), Maharashtra (0.5%), and Karnataka (0.5%) in the south; and Manipur (0.75%) and Nagaland (0.6%) in the north-east. A prevalence of 0.5% means that every 1 in 200 persons is infected. More than 17% female sex workers in Maharashtra are infected. In Mumbai the figure approaches 30% which means approximately 1 in 3 and it is very high.

How can I tell if a person is HIV positive?

Apparently normal and healthy looking people may be HIV infected. A large number of people with HIV do not even know that they are infected. It is impossible to guess anyone’s HIV status without testing. Likewise, it is irrational to think that someone has HIV because they look too thin, pale, tired, or fall ill too often. Unprotected intercourse outside a mutually faithful monogamous relationship or sharing needles should be avoided without relying on your hunch about someone’s HIV status.

Should I get tested for HIV?

If you answer yes to any of the questions below, you should definitely get an HIV test.

• Have you had unprotected sex with someone whose history of sex partners and/or drug use is unknown to you?
• Have you had unprotected sex in exchange for drugs or money?
• Have you had unprotected sex with men who have sex with men, multiple partners, or anonymous partners?
• Have you had a sexually transmitted infection (STI)?
• Have you shared needles to inject recreational drugs or steroids or to pierce your skin?
• Have you had a blood transfusion before April, 1985 (before the routine screening of blood for HIV started)?
• Have you had unprotected sex with someone who could answer yes to any of the above questions?

For women who plan to become pregnant, testing is recommended as medical care and certain drugs given during pregnancy can lower the chance of passing HIV to the baby. All women who are pregnant should be tested during each pregnancy.

If you are worried, get tested. A negative result will put your mind at rest.  However, a negative test does not indicate immunity against the virus. People who remain negative after repeated exposure can still get infected if they continue high risk behavior.

When should I get tested?

The commonly used HIV tests (antibody tests) cannot detect HIV immediately after you get infected. The test becomes positive only after six weeks to three months of infection. This is known as the "window period". Hence, it is recommended that you get tested after three months of last exposure to a possible source of infection. A person with last possible exposure on Dec 1st should get tested after March 1st. In extremely rare cases the test becomes positive only after 6 months of infection. So if you want to be extra sure get a repeat test at 6 months.

Precautions during the window period

Even though the antibody tests cannot detect HIV in the window period, the infected person can transmit the disease to other people. If you suspect that you may be infected and are waiting to get yourself tested, it is necessary to have protected sex so that you do not pass the infection to your partner. Also take all measures to avoid further exposure to HIV because a negative test result at 3 months will not be meaningful in that case.

A prescription drug called Metformin has also been shown to prevent the development of Diabetes in people with preDiabetes. However, weight loss, diet modification and exercise are more effective at reducing the risk compared to Metformin.

Is HIV the same as AIDS?

Every HIV positive person does not have AIDS. Being HIV positive means that the virus is present in the body. AIDS is a stage of HIV where the immune system is considerably weakened and the person is highly prone to develop many infections that otherwise do not affect healthy individuals. Each person’s body reacts differently to HIV and the time taken for HIV to cause AIDS varies from months to several years.

Modern medicine can cure HIV, right?

Alas, it is a misconception that advanced treatment, although costly, can cure HIV. HIV is incurable.

So is HIV the Death Sentence?

No, HIV does not mean a death sentence. Antiretroviral medicines for HIV can prolong life and help individuals get on normally with day to day activities. Some patients can even go on to have a life span similar to an uninfected person.

Why don't we have an HIV vaccine?

Scientists are working very hard to make HIV vaccine a reality. More money has been spent on finding an HIV vaccine than on any other vaccine in history. Some reasons why developing an HIV vaccine is a challenge are:

• The HIV virus makes copies of itself very rapidly.
• Many types of HIV exist, and new types continue to arise.
• The virus is very efficient at outsmarting the body's immune response.
• Scientists are yet to understand the complete immunology of fighting HIV.