Transmission of HIV

Where can HIV be found? Which body fluids contain HIV?

HIV is present in infectious quantities in:

During invasive surgical procedures health care workers may also come into contact with the following body fluids, which contain significant amounts of HIV:

In HIV+ persons, HIV is either not present or present in very minute amounts in:

Finding a small amount of HIV in a body fluid does not necessarily mean that H IV can be transmitted by that body fluid. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

How is HIV transmitted?
The main routes of HIV transmission are through:

For HIV transmission to occur the following criteria must be met:
1) HIV must be present
2) There must be a sufficient quantity of HIV present
3) It must be able to enter the bloodstream of the next person.

HIV cannot enter the body through healthy, intact skin.
The virus can however enter the body through cuts, and wounds, but also through the so called mucous membranes or soft tissues of the body. These soft and fragile tissues we find inside the vagina, on the tip/opening of the penis, the anus, the eyes and the mouth, and to some extent the inside of the foreskin on the penis.

Who is at risk?
You are, at high risk:

If you have sex without condoms

If you have many sex partners and do not use condoms

If your sex partner(s) has/have sex with other persons without using condoms

If you have shared unsterilized needles for intravenous drug use

How can I protect myself?
Abstinence or no sex is the only complete safe way of protection against sexually transmitted HIV infection.

This does not necessarily mean you can not have sex your entire life. It can also mean not to have sexual intercourse until you are in a monogamous (one person with one person only) sexual relationship, where both partners are tested and found not infected with HIV. This will only hold truth for as long as none of the partners goes outside this relationship and both stay faithful to each other.

In all other circumstances it is advisable to use condoms, correctly and consistently (every time you have sex). There are “male condoms” and “female condoms”. Both can protect you against HIV and most other sexually transmitted infections.

Will a condom protect me from getting HIV the AIDS virus?

Used correctly, and consistently a condom will protect you from contracting HIV-infection/AIDS. A condom is the best barrier that is now available to prevent the transmission of HIV and other sexually transmitted infections, during sexual intercourse.

There are “male condoms”, and “female condoms”. Both are sold on St. Maarten in many different varieties. Lambskin condoms are not safe to use for protection against infection. Only latex and polyurethane condoms are protective.

Most condoms come with lubrication. If you prefer to use additional lubrication, always use so called “water-based” lubricants like KY-jelly. Never use Vaseline, oil or creams for additional lubrication, because they will weaken the condom so it can break more easily.

Using the condom

1) Carefully remove condom from package. Avoid using teeth or nails as this can burst the condom.

2) Hold the tip of condom to squeeze out air and place on erect penis.

3) Unroll the condom down the shaft to base of penis.

4) Do not use grease (Vaseline).This can cause the condom to burst. Use a water based lubricant (such as KY) which is available at the drugstore.

5) After you ejaculate (cum, break) withdraw while still hard and while holding the base of the condom to prevent it from slipping.

6) Wrap condom and dispose of safely.
There are also ‘female condoms’Instructions on how to use a female condom are included in the package.

When you plan to use condoms for the first time, it makes sense to practice putting them on before actually using them during sex. When you feel more comfortable putting them on, you will be more bound to use them correctly during intercourse.

How safe is oral sex?
It is possible to become infected with HIV through oral sex; however the risk of becoming infected in this way is lower than for unprotected sexual intercourse with a man or woman.

When giving oral sex to a man (sucking or licking a man's penis) a person could become infected with HIV if infected semen or pre-cum gets into any cuts, sores or (receding) gums in the mouth.

Giving oral sex to a woman (licking a woman's clitoris or vagina) is considered low risk (but not zero risk). Transmission could take place if infected fluids from a woman get into the mouth of her partner. The likelihood of infection might be increased if there is menstrual blood involved or if the woman is infected with another STI, which causes breaks in the skin, therefore increasing exposure to blood.

What are the chances of becoming infected with HIV if he doesn't come inside me?

Whilst research suggests that high concentrations of HIV can sometimes be detected in pre cum, it is difficult to judge whether HIV is present in sufficient quantities for infection to occur. To guard against the possibility of infection with HIV or any other STI it is best to practice safer sex i.e. sex with a condom from start to finish.

Co-infection of HIV and other sexually transmitted diseases.
When a person has both HIV infection and another sexually transmittable disease, the amount of HIV in the body fluids (blood, semen, vaginal fluids) is greatly increased. This makes it more likely that HIV is transmitted during sex.

Also, having a sexually transmittable disease will make you more susceptible to become infected with HIV, especially when such a disease has caused wounds, blisters, and ulcerations of the genitals.

Is deep kissing a route of HIV transmission?
Deep or open mouthed kissing is a very low risk activity in terms of HIV transmission. There has been only one documented case of someone becoming infected with HIV through kissing; a result of exposure to infected blood during open mouthed kissing.

If you or your partners have open wounds in your mouth you should avoid kissing until the wound has healed.

Can I become infected with HIV through normal social contact or activities such as shaking hands, kissing, using toilet seats and swimming pools, sharing cutlery, or exposure to sneezes and coughs?
No. This is because HIV is not an air borne, water borne or food borne virus. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.

How long can HIV survive outside the human body?
Generally the fragile nature of the virus prevents it from surviving for a substantial amount of time in the open air. The length of time HIV can survive outside the body is dependent on the amount of HIV present in the body fluid and the conditions the fluid is subjected to.

Note that HIV is fragile and many common substances such as hot liquid, soap, bleach, alcohol, and the gastric juices found within your stomach can destroy the virus.

Your skin is a 100% proof barrier against HIV. The virus cannot enter your skin unless there is an open bleeding wound. If you get blood on your skin, simply wash with water and soap. There is no need to scrub because this might damage the skin.

It is good practice to be careful with any blood spill, because one can never tell if the person it came from has HIV or other blood borne infections. You can safely clean such blood spills with water and Clorox.

Is there a risk of HIV transmission when having a tattoo, during body piercing or while visiting the barber or hairdresser?
When visiting the barber there is no risk of infection unless the skin is cut (which may occur if the barber accidentally cuts you) and if there is a transfer of infected blood. If the instruments are contaminated with infected blood and are not sterilized between clients there is a risk of HIV transmission.

To reduce the risk of blood borne infections such as hepatitis and HIV ensure that the razor/instruments used are new (disposable) or have been properly sterilized.

Persons who carry out body-piercing, tattoos should follow procedures called "universal precautions", which are designed to prevent the transmission of blood borne infections such as HIV and hepatitis B.

What are universal precautions?
These are a set of guidelines that were designed to protect both workers and their customers from HIV and other blood borne illnesses such as hepatitis. The guidelines state that any instrument 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.

I at risk of becoming infected with HIV when visiting the doctor or dentist?

Transmission of HIV in a health care setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and health care professionals from the transmission of blood borne diseases such as hepatitis B and HIV.

If I have sex with a commercial sex worker (prostitute) will I get HIV?

Unprotected sex (sex without a condom) places you at a high risk of contracting the virus whether it is with a commercial sex worker or another person. Statistics from the Caribbean and several other parts of the world have shown that there is a higher prevalence or occurrence of HIV in commercial sex workers (prostitutes). Therefore by having unprotected sex with a commercial sex worker the risk of contracting HIV is high.

Can I infect my unborn child if I am positive?

Women with HIV can transmit the virus to their fetus. The use of special drugs, during pregnancy and at birth, can help reduce the transmission of HIV from mother to child.

For this reason it is important that every pregnant woman does a HIV antibody-test. Medicines that reduce the chance of infection for the child are available for all pregnant women that are HIV infected and live on St. Maarten. It does not matter if you are insured, non-insured, legal or illegal on the island.

For additional information you can check with your doctor or Dr. van Osch at Union Road Medical Clinic.

Can the virus be transmitted through breast feeding?

Yes, HIV is present in infectious amounts in breast milk. HIV can be passed from an HIV infected mother to her baby through breastfeeding. Most HIV+ children in the Caribbean got infected through mother to child transmission of HIV.

This can be prevented when an HIV infected mother does not breastfeed her baby and uses other alternate milk recommended by her doctor.

All pregnant women are advised to take a blood test for HIV as early as possible in their pregnancy. Sometimes it is advised to repeat this test later during the pregnancy. If a pregnant woman is HIV infected her baby does not have to get HIV. Ask your doctor more about pregnancy and HIV prevention.

Can I get HIV from a mosquito?

No, it is not possible to get HIV from mosquitoes or other biting and bloodsucking insects. The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person's or animal's blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant so the insect can feed efficiently.

Diseases, such as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect. Unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another insect, the insect does not become infected and cannot transmit HIV to the next human it bites.

There is also no reason to fear that a mosquito or other insect could transmit HIV from one person to another through HIV infected blood left on its mouth parts. Several reasons help explain why this is so.

1) Infected people do not have constantly high levels of HIV in their blood streams.

2) Insect mouth parts retain no (or too small amounts of) blood on their surfaces.

3) Finally, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest the blood meal.

Also epidemiological studies (that look at statistics on where and how HIV spreads) have shown no relationship at all between HIV and the existence of mosquito’s or mosquito bites

Am I at higher risk if I have sex with a member of the same sex?

HIV is transmitted sexually regardless of your sexual preference. Note however, that world wide there is a higher prevalence of the virus in certain groups because of their sexual practices and therefore having unsafe sex with someone from one of these groups places you at a higher risk of contracting the virus. Men who have sex with men, commercial sex workers, and people who have a sexually transmitted infection are examples of such groups.

By following safe sexual practices (using a condom every time) you can reduce your chances of becoming infected.

A member of my family or close friend of mine has HIV; am I also at risk?

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare.

These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions should be taken in all settings including the home to prevent exposure to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown.

For example, gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, faces, or vomit.

Cuts, sores, or breaks on both the caregivers' and patients~ exposed skin should be covered with bandages. Hands and other parts of the body should be washed immediately after contact with blood or other body fluids.

Surfaces soiled with blood should be disinfected appropriately. Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided.

Needles and other sharp instruments should be used only when necessary and handled according to recommendations for health care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture proof containers out of the reach of children and visitors).