HIV & AIDS | Transmission | Prevention | Testing | Legal Issues
What is HIV?
HIV (human immunodeficiency virus) is the name of the virus that
causes AIDS. Scientists have identified the virus as a "retrovirus,"
which is a virus in a very specific family of viruses. 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 babies during pregnancy, delivery, or breast-feeding.
People with HIV have what is called HIV infection. Most of these
people will develop AIDS as a result of their HIV infection.
These body fluids have been proven to spread HIV:
- blood
- semen
- vaginal fluid
- breast milk
- other body fluids containing blood
What is AIDS?
AIDS stands for acquired immunodeficiency syndrome. A person first
becomes HIV infected and later, in most cases, develops AIDS.
HIV can weaken the immune system to the point that it has difficulty
fighting off "opportunistic" infections (infections
that are usually controlled by a healthy immune system).
A person receives an AIDS diagnosis from a doctor after developing
one or more specific opportunistic infections, also known as AIDS
indicator illnesses. There are several illnesses including severe
pneumonia, several forms of cancer, damage to the brain and nervous
system, and extreme weight loss. An HIV-positive person who has
not had any serious illnesses also can receive an AIDS diagnosis
if blood tests indicate the person's T-cell count is 200 or below.
back to top
How is HIV passed from one person to another?
HIV can be transmitted 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.
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, making risk
of infection extremely low. Some health-care workers have become
infected after being stuck with needles containing HIV-infected
blood or, less frequently, after infected blood came in contact
with the worker's open cut or splashed into the worker's eyes
or their nose. In the United States, there has been only one instance
of 6 patients being infected by an HIV-positive dentist.
back to top
How do I prevent getting HIV?
To prevent the spread of HIV, avoid any behavior that might result
in contact with blood, semen, or vaginal secretions. Specifically:
- Do not have unprotected (without a condom) sex.
- Do not inject drugs by sharing needles or syringes.
The following prevention measures apply to personal sex practices
and injecting drug use:
- Abstaining from sex is the only way to be 100% sure that HIV
won't be transmitted sexually. For those who are sexually active,
latex condoms should be used consistently and correctly.
- Ask about the sexual history of current and future sex partners.
- Reduce the number of sex partners to minimize the risk of
HIV infection.
- Always use a condom from start to finish during any type of
sex (vaginal, anal, and oral).
- Use latex condoms rather than natural membrane condoms. If
used properly, latex condoms are highly effective against most
sexually transmitted diseases, including HIV. If either partner
is allergic to latex, plastic (polyurethane) condoms for either
males or females can be used. Use only water-based lubricants.
Do not use saliva or oil-based lubricants such as petroleum
jelly or vegetable shortening.
- Avoid anal or rough vaginal intercourse. Do not do anything
that could tear the skin or moist lining of the genitals, anus,
or mouth and cause bleeding.
- Avoid deep, wet, or "French" kissing with an infected
person. Possible trauma to the mouth may occur, which could
result in the exchange of blood. It is safe, however, to hug,
cuddle, rub, or dry kiss your partner.
- Avoid alcohol and illicit drugs. Alcohol and drugs can impair
your immune system and your judgment.
- If you use drugs, do not share "drug works" (needles,
syringes, or cookers).
- Do not share personal items such as toothbrushes, razors,
and devices used during sex that may be contaminated with blood,
semen, or vaginal fluids.
- If you are infected with HIV or have engaged in sex or needle-sharing
behaviors that lead to infection with HIV, do not donate blood,
plasma, sperm, body organs, or tissues.
Are condoms safe and effective?
Yes. Scientific evidence demonstrates that latex condoms are highly
effective in preventing the transmission of HIV and other STDs
(such as herpes simplex, hepatitis B, chlamydia, and gonorrhea)
when used consistently and correctly.
Although some people claim that condoms frequently slip off or
break, studies show that these problems are rare. When these problems
do occur, they are not typically caused by product error. They
tend to be caused by user errors, such as using a petroleum-based
lubricant, using out-of-date condoms, having rough sex, or storing
condoms at a high temperature over a long period of time, such
as in a car glove compartment or wallet.
back to top
Is there a test for HIV?
YES! The only way to know for sure if you are HIV positive is
to be tested! Since the virus attaches and hides itself within
the white blood cells and cannot be seen, the test (called an
HIV antibody test) will detect antibodies produced by your body
to combat the HIV virus. The HIV antibody test needs approximately
3-6 months to accurately detect the presence of these antibodies,
so it is advisable a person wait approximately three months after
possible HIV exposure to get tested. If the test is negative,
it is recommended that you return in another 3 months for a second
test, since sometimes it can take up to six months for HIV antibodies
to show up. It is urged that an individual abstain from any risky
behavior during these 3-6 months (called the window period) while
waiting to be tested and waiting for results.
What is an HIV antibody test?
When HIV enters the body, it begins to attack certain white blood
cells called T4 lymphocyte cells (helper cells). Your doctor may
also call them CD4 cells. The immune system then produces antibodies
to fight off the infection. Although these antibodies are ineffective
in destroying HIV, their presence is used to confirm HIV infection.
HIV tests look for the presence of HIV antibodies; they do not
test for the virus itself.
What blood tests detect the presence of HIV?
Two types of tests are commonly used to detect HIV infection.
The most commonly used initial test is an enzyme immune assay
(EIA) or the enzyme-linked immunosorbent assay (ELISA). If EIA
test results show a reaction, the test is repeated on the same
blood sample. If the sample is repeatedly reactive, the results
are "confirmed" using a second test such as the Western
blot. This more specific (and more expensive) test can tell the
difference between HIV antibodies and other antibodies that can
react to the EIA and cause false positive results. False positive
EIA results are uncommon, but can occur. A person is considered
infected following a repeatedly reactive result from the EIA,
confirmed by the Western blot test.
In addition to the EIA or ELISA and Western blot, other tests
now available include:
- Radioimmunoprecipitation assay (RIPA): A confirmatory blood
test that may be used when antibody levels are very low or difficult
to detect, or when Western blot test results are uncertain.
An expensive test, the RIPA requires time and expertise to perform.
- Dot-blot immunobinding assay: A rapid-screening blood test
that is cost-effective and that may become an alternative to
standard EIA and Western blot testing.
- Polymerase chain reaction (PCR): A specialized blood test
that looks for HIV genetic information. Although expensive and
labor-intensive, the test can detect the virus even in someone
only recently infected.
Are there HIV tests that don't involve drawing blood?
Yes. Urine and oral-fluid HIV tests offer alternatives for anyone
reluctant to have blood drawn.
Urine testing for HIV antibodies is not as sensitive or specific
as blood testing. Available urine tests include an EIA and a Western
blot test that can confirm EIA results. A physician must order
these tests, and the results are reported to the ordering physician
or his or her assistant.
Orasure© is currently the only federally approved oral-fluid
test. It collects fluids from inside the mouth, and analyzes them
using an EIA test and supplemental Western blot test if necessary.
Oral fluid tests are offered at many HIV testing locations. Contact
a location near you to find out if this test is available.
What are rapid HIV tests?
A rapid HIV test is a test that usually produces results in 5
to 30 minutes. In comparison, results from the commonly used HIV-antibody
screening test, the EIA, are not available for 1-2 weeks.
The only rapid HIV test currently licensed for use in the United
States is the Single Use Diagnostic System for HIV-1 (SUDS™),
manufactured by Murex. The availability of this test may differ
from one place to another. The rapid HIV test is considered to
be just as accurate as the EIA. As is true for all screening tests
(including the EIA), a positive test result must be confirmed
before a diagnosis of infection can be given. There are several
new rapid tests currently being researched for possible use.
Are HIV tests as accurate on young children as adults?
Diagnosis of infants is hampered because babies born to HIV-infected
mothers can test positive for antibodies acquired from their mothers
for as long as 15 months after birth. Without treatment, only
a portion of these infants (current estimates range from 16 percent
to 25 percent in North America and Europe) are actually infected
with HIV. In these cases, a positive antibody test alone is not
sufficient to confirm that the infant is infected with HIV.
What is the difference between confidential and anonymous
HIV antibody testing?
For a confidential HIV antibody test you give your name and contact
information to a test counselor, health care provider or doctor
and the test result is entered into your medical records. If the
HIV antibody test results are positive, the health care provider
must send your name and information to the State Department of
Health (DOH); the State DOH then sends it to your local DOH. The
local DOH will possibly contact you for more information about
past partners to notify them to be tested as they may have been
exposed. Your name will not be used in the correspondence to past
partners for your anonymity and safety. For more information about
the Partner Notification Law passed in June 2000, please go to
GMHC.org (see testing info).
For an anonymous HIV antibody test, you do not give your name
or contact information. People tested are given a code number,
which they use to get their test results when they return. An
anonymous test result is NOT recorded in a person's medical record
and may not be used for accessing HIV related services. However,
if you test HIV positive, when you go for health care a confidential
record will be set up for you.
Who should be tested?
- People who have had unprotected sex with a person who's HIV
status is unknown
- Pregnant women
- People who have or have had a sexually transmitted disease
- People who use unclean needles
- Sex partners and needle-sharing partners of needle users
- Any person who thinks they may have been exposed to the virus
How long does it take to get test results?
Results from the most commonly used HIV antibody screening test,
the ELISA, can be available within several days to several weeks.
How do I interpret HIV test results?
A positive result on an HIV test means that HIV antibodies are
present and you are HIV positive.
A negative result on an HIV test means that HIV antibodies were
not detected.
As stated above, you should return in another 3 months to have
a second test done and abstain from any risky behavior during
this period.
back to top
Are people with AIDS considered handicapped?
The Americans with Disabilities Act (ADA) was signed into law
on July 26, 1990. The ADA extends federal protection against discrimination
for persons with disabilities in the private workplace and in
places of public accommodation. The Act considers any form of
HIV disease to be a disability covered under the law.
For more information, you may find it helpful to contact:
ADA Education Project
c/o ACLU AIDS Project
132 W. 43rd Street
New York, New York 10036
Equal Employment Opportunity Commission
National Office
1801 L. Street NW
Washington, DC 20507
1-800-669-3362
President's Commission on Employment of
People with Disabilities
1331 F. Street NW
Washington, DC 20004-1107
(202) 376-6200
What are the laws regarding knowingly infecting someone
with HIV?
In some states, persons who are aware of their infection but who
knowingly put their sex partners at risk or intentionally attempt
to infect someone are subject to criminal penalties.
For more information regarding the laws in your state, you may
wish to contact your state health department.
What are the laws regarding privacy for persons with
HIV?
Virtually every state has passed laws dealing directly with HIV
or AIDS. These states have enacted statutes, regulations, or policies
that protect HIV-related information either directly or indirectly.
Laws regarding obtaining HIV/AIDS information, how it is protected,
and under what circumstances confidential medical information
is releasable varies among states.
For more information regarding the laws in your state, you may
wish to contact your state health department.
back to top
