How to stay healthy

By Gus Cairns
Editor, HIV Treatment Update, NAM

Like a lot of risks in life, if you don’t know the facts about HIV transmission, it’s easy to panic about unlikely risks and yet ignore real ones. There are so many people whose lack of knowledge about how HIV is passed on makes them worry unnecessarily about getting infected.

Take the following example of this lady, who says:

“ I kissed this guy I met at a club – I mean, like, for an hour, we were really into each other – and then I found he had HIV! I’m sure I have got the virus, now.”

Not if all you did was kiss. You simply can’t catch HIV that way.

Lack of knowledge about transmission can also make some people do things that put them at risk. Another example:

“I had sex without a condom with this girl but she’s really fit and only 18. I knew just by looking at her she was clean?”

Most people with HIV are healthy, and they look healthy, too: You can’t rely on appearances only.

HIV transmission is mainly about what you do rather than who you do it with. The reason some acts are safe and others are not depends on how much HIV is in people’s body fluids (quantity); whether it’s infectious (quality); and whether it has a way in to your body (route).

Quantity
There has to be enough of the virus to establish an infection. This means very small amounts of the infectious body fluids (blood, sperm, vaginal and rectal secretions, breast milk) won’t be enough.

It also means that people who have recently been infected with HIV themselves and have a lot of virus in their fluids are very infectious, and people who have been on successful HIV treatment for over six months may hardly be infectious at all.

Quality
In general, HIV is a fragile virus that can’t survive for long outside the body. That’s why you can’t get it from, for example, breathing it in like flu. HIV can be found in saliva, but there are substances in saliva that weaken it and stop infection, which is why you can’t get HIV through kissing and only very rarefy through oral sex.

Route
The usual advice is that you can’t get HIV through broken skin, but in my experience people then start worrying about invisible cuts. In fact HIV can only get into the body at certain points:

• the lining of the vagina;
• the lining of the rectum;
• the lining or the urethra (tube you pee through) and in uncircumcised men the inside of the foreskin;
• for a baby, via breast milk – babies have not yet developed the defences against infection by mouth that adults have. This is why in a country like the UK which has clean water, women with HIV should bottle-feed their baby.

The reason HIV can only enter at these points is because HIV is a very lazy virus and these are the only parts of the body where special cells exist which actively carry it into the body. The only other way is via a direct injection such as a blood transfusion (in countries where blood is not screened), or by sharing needles.

Comparing the risks
It’s very difficult to estimate exactly how risky particular sex acts are because so many factors come into play. Some types of sex are more risky than others.

For example, most studies have shown that:

• female-to-male transmission happens about half as often as male-to-female transmission;
• Used correctly, the condom can reduce the risk of HIV infection by 90%;
• Oral sex is a lot safer than vaginal sex without the use of condoms.

However we also know that:

• If either partner has a sexually transmitted infection, the risk of HIV infection can be much higher;
• Someone who has just been infected (in the previous six weeks or so) is much more likely to pass HIV on to their partner than someone infected a long time ago;
• A partner with a HIV-related illness is also more infectious, if they’re not on effective HIV treatment, than someone who does not have an STI or is receiving antiretroviral treatment;

Useful services for people living with or affected by HIV:
HIV Health Support - contact NAM on 020 7840 0050
Fountain of Life Support Group - contact CAN on 0750 1459543
Ealing, Hammersmith and Fulham HIV Service Users Forum - contact 020 8749 9814
Organisation of Positive African Men (OPAM) 020 7923 4744

Posted On: 18 December 2009 at 11:53AM
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