HOW DOES HIV SPREAD DURING SEX? UNSAFE ACTIVITIES SAFER ACTIVITIES SAFE ACTIVITIES WHAT IF BOTH PEOPLE ARE ALREADY INFECTED? KNOW WHAT YOU’RE DOING SET YOUR LIMITS THE BOTTOM LINE HOW DOES HIV SPREAD DURING SEX? To spread HIV during sex, HIV infection in blood or sexual fluids must be transmitted to someone. Sexual fluids come from a man’s penis or from a woman’s vagina, before, during, or after orgasm. HIV can be transmitted when infected fluid gets into someone’s body. You can’t spread HIV if there is no HIV infection. If you and your partners are not infected with HIV, there is no risk. An “undetectable viral load does NOT mean “no HIV infection.” If there is no contact with blood or sexual fluids, there is no risk. HIV needs to get into the body for infection to occur. Safer sex guidelines are ways to reduce the risk of spreading HIV during sexual activity. UNSAFE ACTIVITIES Unsafe sex has a high risk of spreading HIV. The greatest risk is when blood or sexual fluid touches the soft, moist areas (mucous membrane) inside the rectum, vagina, mouth, nose, or at the tip of the penis. These can be damaged easily, which gives HIV a way to get into the body. Vaginal or rectal intercourse without protection is very unsafe. Sexual fluids enter the body, and wherever a man’s penis is inserted, it can cause small tears that make HIV infection more likely. The receptive partner is more likely to be infected, although HIV might be able to enter the penis, especially if it has contact with HIV-infected blood or vaginal fluids for a long time or if it has any open sores. SAFER ACTIVITIES Most sexual activity carries some risk of spreading HIV. To reduce the risk, make it more difficult for blood or sexual fluid to get into your body. Be aware of your body and your partner’s. Cuts, sores, or bleeding gums increase the risk of spreading HIV. Rough physical activity also increases the risk. Even small injuries give HIV a way to get into the body. Use a barrier to prevent contact with blood or sexual fluid. Remember that the body’s natural barrier is the skin. If you don’t have any cuts or sores, your skin will protect you against infection. However, in rare cases HIV can get into the body through healthy mucous membranes. The risk of infection is much higher if the membranes are damaged. The most common artificial barrier is a condom for men. You can also use a female condom to protect the vagina or rectum during intercourse. Fact Sheet 153 has more information on condoms. Lubricants can increase sexual stimulation. They also reduce the chance that condoms or other barriers will break. Oil-based lubricants like Vaseline, oils, or creams can damage condoms and other latex barriers. Be sure to use water-based lubricants. Oral sex has some risk of transmitting HIV, especially if sexual fluids get in the mouth and if there are bleeding gums or sores in the mouth. Pieces of latex or plastic wrap over the vagina, or condoms over the penis, can be used as barriers during oral sex. Condoms without lubricants are best for oral sex. Most lubricants taste awful. SAFE ACTIVITIES Safe activities have no risk for spreading HIV. Abstinence (never having sex) is totally safe. Sex with just one partner is safe as long as neither one of you is infected and if neither one of you ever has sex or shares needles (see Fact Sheet 154) with anyone else. Fantasy, masturbation, or hand jobs (where you keep your fluids to yourself), sexy talk, and non-sexual massage are also safe. These activities avoid contact with blood or sexual fluids, so there is no risk of transmitting HIV. To be safe, assume that your sex partners are infected with HIV. You can’t tell if people are infected by how they look. They could be lying if they tell you they are not infected, especially if they want to have sex with you. Some people got HIV from their steady partners who were unfaithful “just once”. Even people who got a negative test result might be infected. They might have been infected after they got tested, or they might have gotten the test too soon after they were exposed to HIV. WHAT IF BOTH PEOPLE ARE ALREADY INFECTED? Some people who are HIV-infected don’t see the need to follow safer sex guidelines when they are sexual with other infected people. However, it still makes sense to “play safe”. If you don’t, you could be exposed to other sexually transmitted infections such as herpes or syphilis. If you already have HIV, these diseases can be more serious. Also, you might get “re-infected” with a different strain of HIV. This new version of HIV might not be controlled by the medications you are taking. It might also be resistant to other antiretroviral drugs. There is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following the guidelines for safer sex will reduce the risk. KNOW WHAT YOU’RE DOING Using alcohol or drugs before or during sex greatly increases the chances that you will not follow safer sex guidelines. Be very careful if you have used any alcohol or drugs. SET YOUR LIMITS Decide how much risk you are willing to take. Know how much protection you want to use during different kinds of sexual activities. Before you have sex, think about safer sex set your limits get a supply of lubricant and condoms or other barriers, and be sure they are easy to find when you need them talk to your partners so they know your limits. Stick to your limits. Don’t let alcohol or drugs or an attractive partner make you forget to protect yourself. THE BOTTOM LINE HIV infection can occur during sexual activity. Sex is safe only if there is no HIV, no blood or sexual fluids, or no way for

HOW DO YOU GET INFECTED WITH HIV? HOW CAN YOU PROTECT YOURSELF AND OTHERS? WHAT IF I’VE BEEN EXPOSED? THE BOTTOM LINE HOW DO YOU GET INFECTED WITH HIV? The Human Immunodeficiency Virus (HIV) is not spread easily. You can only get HIV if you get infected blood or sexual fluids into your system. You can’t get it from mosquito bites, coughing or sneezing, sharing household items, or swimming in the same pool as someone with HIV. Some people talk about “shared body fluids” being risky for HIV, but no documented cases of HIV have been caused by sweat, saliva or tears. However, even small amounts of blood in your mouth might transmit HIV during kissing or oral sex. Blood can come from flossing your teeth, or from sores caused by gum disease, or by eating very hot or sharp, pointed food. To infect someone, the virus has to get past the body’s defenses. These include skin and saliva. If your skin is not broken or cut, it protects you against infection from blood or sexual fluids. Saliva contains chemicals that can help kill HIV in your mouth. If HIV-infected blood or sexual fluid gets inside your body, you can get infected. This can happen through an open sore or wound, during sexual activity, or if you share equipment to inject drugs. HIV can also be spread from a mother to her child during pregnancy or delivery. This is called “vertical transmission.” A baby can also be infected by drinking an infected woman’s breast milk. Fact Sheet 611 has more information on pregnancy. Adults exposed to breast milk of an HIV-infected woman may also be exposed to HIV. HOW CAN YOU PROTECT YOURSELF AND OTHERS? Unless you are 100% sure that you and the people you are with do not have HIV infection, you should take steps to prevent getting infected. People recently infected (within the past 2 or 3months) are most likely to transmit HIV to others. This is when theirviral load is the highest. In general, the risk of transmission ishigher with higher viral loads. This fact sheet provides an overview ofHIV prevention, and refers you to other fact sheets for more details on specific topics. Sexual Activity You can avoid any risk of HIV if you practice abstinence (not having sex). You also won’t get infected if your penis, mouth, vagina or rectum doesn’t touch anyone else’s penis, mouth, vagina, or rectum. Safe activities include kissing, erotic massage, masturbation or hand jobs (mutual masturbation). There are no documented cases of HIV transmission through wet clothing. Having sex in a monogamous (faithful) relationship is safe if: Both of you are uninfected (HIV-negative) You both have sex only with your partner Neither one of you gets exposed to HIV through drug use or other activities Oral sex has a lower risk of infection than anal or vaginal sex, especially if there are no open sores or blood in the mouth. See Fact Sheet 152 for more information on the risks of various behaviors. You can reduce the risk of infection with HIV and other sexually transmitted diseases by using barriers like condoms. Traditional condoms go on the penis, and a new type of condom goes in the vagina or in the rectum. For more information on condoms, see Fact Sheet 153. Some chemicals called spermicides can prevent pregnancy but they don’t prevent HIV. They might even increase your risk of getting infected if they cause irritation or swelling. For more information on safer sex, see Fact Sheet 151. Drug Use If you’re high on drugs, you might forget to use protection during sex. If you use someone else’s equipment (needles, syringes, cookers, cotton or rinse water) you can get infected by tiny amounts of blood. The best way to avoid infection is to not use drugs. If you use drugs, you can prevent infection by not injecting them. If you do inject, don’t share equipment. If you must share, clean equipment with bleach and water before every use. Fact Sheet 154 has more details on drug use and HIV prevention. Some communities have started exchange programs that give free, clean syringes to people so they won’t need to share. Vertical Transmission With no treatment, about 25% of the babies of HIV-infected womenwould be born infected. The risk drops to about 4% if a woman takes AZTduring pregnancy and delivery, and her newborn is given AZT. The riskis 2% or less if the mother is taking combination antiretroviral therapy(ART). Caesarean section deliveries probably don’t reduce transmissionrisk if the mother’s viral load is below 1000. Babies can get infected if they drink breast milk from an HIV-infected woman. Women with HIV should use baby formulas or breast milk from a woman who is not infected to feed their babies. Fact Sheet 611 has more information on HIV and pregnancy. Contact with Blood HIV is one of many diseases that can be transmitted by blood. Be careful if you are helping someone who is bleeding. If your work exposes you to blood, be sure to protect any cuts or open sores on your skin, as well as your eyes and mouth. Your employer should provide gloves, facemasks and other protective equipment, plus training about how to avoid diseases that are spread by blood. WHAT IF I’VE BEEN EXPOSED? If you think you have been exposed to HIV, talk to your health care provider or the public health department, and get tested. For more information on HIV testing, see Fact Sheet 102. If you are sure that you have been exposed, call your healthcare provider immediately to discuss whether you should start takingantiretroviral drugs (ARVs). This is called “post exposure prophylaxis”or PEP. You would take two or three medications for several weeks. These drugs can decrease the risk of infection, but they have some serious side effects. Fact Sheet 156 has more information on PEP. THE BOTTOM LINE HIV does not spread easily from person to person. To get infected with HIV,

WHAT DOES “AIDS” MEAN? HOW DO YOU GET AIDS? WHAT HAPPENS IF I’M HIV POSITIVE? HOW DO I KNOW IF I HAVE AIDS? IS THERE A CURE FOR AIDS? WHAT DOES “AIDS” MEAN? AIDS stands for Acquired Immune Deficiency Syndrome: Acquired means you can get infected with it; Immune Deficiency means a weakness in the body’s system that fights diseases. Syndrome means a group of health problems that make up a disease. AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will try to fight the infection. It will make “antibodies,” special molecules to fight HIV. A blood test for HIV looks for these antibodies. If you have them in your blood, it means that you have HIV infection. People who have the HIV antibodies are called “HIV-Positive.” Fact Sheet 102 has more information on HIV testing. Being HIV-positive, or having HIV disease, is not the same as having AIDS. Many people are HIV-positive but don’t get sick for many years. As HIV disease continues, it slowly wears down the immune system. Viruses, parasites, fungi and bacteria that usually don’t cause any problems can make you very sick if your immune system is damaged. These are called “opportunistic infections.” See Fact Sheet 500 for an overview of opportunistic infections. HOW DO YOU GET AIDS? You don’t actually “get” AIDS. You might get infected with HIV, and later you might develop AIDS. You can get infected with HIV from anyone who’s infected, even if they don’t look sick and even if they haven’t tested HIV-positive yet. The blood, vaginal fluid, semen, and breast milk of people infected with HIV has enough of the virus in it to infect other people. Most people get the HIV virus by: having sex with an infected person sharing a needle (shooting drugs) with someone who’s infected being born when their mother is infected, or drinking the breast milk of an infected woman Getting a transfusion of infected blood used to be a way people got AIDS, but now the blood supply is screened very carefully and the risk is extremely low. There are no documented cases of HIV being transmitted by tears or saliva, but it is possible to be infected with HIV through oral sex or in rare cases through deep kissing, especially if you have open sores in your mouth or bleeding gums. For more information, see the following Fact Sheets: 150: Stopping the Spread of HIV 151: Safer Sex Guidelines 152: How Risky Is It? The Centers for Disease Control and Prevention (CDC) estimates that 1 to 1.2 million U.S. residents are living with HIV infection or AIDS; about a quarter of them do not know they have it. About 75 percent of the 40,000 new infections each year are in men, and about 25 percent in women. About half of the new infections are in Blacks, even though they make up only 12 percent of the US population. In the mid-1990s, AIDS was a leading cause of death. However, newer treatments have cut the AIDS death rate significantly. For more information, see the US Government fact sheet at https://www.niaid.nih.gov/factsheets/aidsstat.htm. WHAT HAPPENS IF I’M HIV POSITIVE? You might not know if you get infected by HIV. Some people get fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash for one or two weeks. Most people think it’s the flu. Some people have no symptoms. Fact Sheet 103 has more information on the early stage of HIV infection. The virus will multiply in your body for a few weeks or even months before your immune system responds. During this time, you won’t test positive for HIV, but you can infect other people. When your immune system responds, it starts to make antibodies. When this happens, you will test positive for HIV. After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer. But during this time, HIV is damaging your immune system. One way to measure the damage to your immune system is to count your CD4 cells you have. These cells, also called “T-helper” cells, are an important part of the immune system. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of blood. Fact Sheet 124 has has more information on CD4 cells. Without treatment, your CD4 cell count will most likely go down. You might start having signs of HIV disease like fevers, night sweats, diarrhea, or swollen lymph nodes. If you have HIV disease, these problems will last more than a few days, and probably continue for several weeks. HOW DO I KNOW IF I HAVE AIDS? HIV disease becomes AIDS when your immune system is seriously damaged. If you have less than 200 CD4 cells or if your CD4 percentage is less than 14%, you have AIDS. See Fact Sheet 124 for more information on CD4 cells. If you get an opportunistic infection, you have AIDS. There is an “official” list of these opportunistic infections put out by the Centers for Disease Control (CDC). The most common ones are: PCP (Pneumocystis pneumonia), a lung infection; KS (Kaposi’s sarcoma), a skin cancer; CMV (Cytomegalovirus), an infection that usually affects the eyes Candida, a fungal infection that can cause thrush (a white film in your mouth) or infections in your throat or vagina AIDS-related diseases also includes serious weight loss, brain tumors, and other health problems. Without treatment, these opportunistic infections can kill you. The official (technical) CDC definition of AIDS is available at https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm AIDS is different in every infected person. Some people die a few months after getting infected, while others live fairly normal lives for many years, even after they “officially” have AIDS. A few HIV-positive people stay healthy for many years even without taking antiretroviral medications (ARVs). IS THERE A CURE FOR AIDS? There is no cure for AIDS. There are drugs that can slow down the HIV virus, and

Background Information 101. What is AIDS? A basic description of the official definition of AIDS. [Revised: September 5, 2006] 102. HIV Testing A description of HIV antibody testing, when to take the test, and what test results mean. [Revised: April 12, 2007] 103. Acute HIV Infection It is not easy to identify people with acute HIV infection. Some people have no symptoms. If symptoms do occur, several diseases like the flu might cause them. If you think you might be in the acute stage of HIV infection, tell your health care provider. [Revised: September 5, 2006] 105. How HIV Drugs Get Approved The phases of research on new medications before they are approved by the FDA, and ways to use unapproved drugs. [Revised: September 6, 2006] 106. HIV Life Cycle

WHAT IS POST-EXPOSURE PROPHYLAXIS? WHO SHOULD USE PEP? SHOULD PEP BE USED FOR NON-OCCUPATIONAL EXPOSURE? HOW IS PEP TAKEN? WHAT ARE THE SIDE EFFECTS? THE BOTTOM LINE WHAT IS POST-EXPOSURE PROPHYLAXIS? Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking antiretroviral medications (ARVs) as soon as possible after exposure to HIV, so that the exposure will not result in HIV infection. These medications are only available with a prescription. PEP should begin within as soon as possible after exposure to HIV but certainly within 72 hours. Treatment with 2 or 3 ARVs should continue for 4 weeks, if tolerated. WHO SHOULD USE PEP? Workplace exposure PEP has been standard procedure since 1996 for healthcare workers exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the exposure is from a “needle stick,” when a health care worker accidentally gets jabbed with a needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace exposures by 79%. However, some health care workers who take PEP still get HIV infection. Other exposure In 2005, the Centers for Disease Control reviewed information on PEP. They concluded that it should also be available for use after HIV exposures that are not work-related. People can be exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they share needles for injecting drugs. Infants can be exposed if they drink breast milk from an infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one person became infected with HIV. SHOULD PEP BE USED FOR NON-OCCUPATIONAL EXPOSURE? HIV exposure at work is usually a one-time accident. Other HIV exposures may be due to unsafe behaviors that can occur many times. Some people think that PEP might encourage this unsafe behavior if people think that PEP is an easy way to avoid HIV infection. There are other reasons why PEP might not be a good idea for non-occupational exposure: There is no research to show that PEP works for non-occupational exposure. We don’t know how soon after exposure to HIV someone has to start PEP. PEP is not a “morning-after pill.” It is a program of several drugs, several times each day, for at least 30 days. PEP costs between $600 and $1,000. For best results, you have to take every dose of every PEP medication. Missing doses could mean that you develop HIV infection. It could also allow the virus to develop resistance to the medications. If that happens they would no longer work for you. The medications have serious side effects. About 40% of health care workers did not complete PEP because of the side effects. Despite these concerns, there is growing interest in PEP for non-occupational exposure. Most programs include counseling to inform and encourage people to avoid exposure to HIV. HOW IS PEP TAKEN? PEP should be started as soon as possible after exposure to HIV. The medications used in PEP depend on the exposure to HIV. The following situations are considered serious exposure: Exposure to a large amount of blood. Blood came in contact with cuts or open sores on the skin. Blood was visible on a needle that stuck someone. Exposure to blood from someone who has a high viral load (a large amount of virus in the blood). For serious exposures, the U.S. Public Health Service recommends using a combination of three approved ARVs for four weeks. For less serious exposure, the guidelines recommend four weeks of treatment with two drugs: AZT and 3TC. In January 2001, the Centers for Disease Control warned against using nevirapine for PEP because of the risk of liver damage. See Fact Sheet 431 for more information on nevirapine. The CDC updated its PEP recommendations in September of 2005. WHAT ARE THE SIDE EFFECTS? The most common side effects from PEP medications are nausea and generally not feeling well. Other possible side effects include headaches, fatigue, vomiting and diarrhea. For more information, see the fact sheets on individual ARVs. THE BOTTOM LINE Post-exposure prophylaxis (PEP) is the use of ARVs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79%. The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviors. PEP is a four-week program of two or three ARVs, several times a day. The medications have serious side effects that can make it difficult to finish the program. PEP is not 100% effective; it can not guarantee that exposure to HIV will not become a case of HIV infection. FOR MORE INFORMATION CDC guidelines on PEP are on the Internet. Occupational exposure: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm Non-occupational exposure: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm source: The AIDS Infonet

You most certainly can! You can call the CDC National AIDS Hotline at (800) 342-2437 anytime, 24 hours a day, 365 days of the year.    They are there to help you with your questions, to provide you with further information, and to listen. Additionally, most states also provide their own state AIDS hotlines – although their hours of operation may vary. Click here for our listing of available state AIDS hotlines.

The CDC National AIDS Hotline can help you with requests for printed materials. Call them and tell them who you are and what you need. If you are doing a school project, tell them. If you are giving a presentation to some other kind of group, tell them that. The more they know about what you need, the better they can help you. They are available 24 hours a day, 365 days of the year toll-free at (800) 342-2437.