HIV Transmission

Brad Spellburg, MD

Who Has HIV Already, and Who is Contracting It Now?
At least 750,000 Americans have contracted the human immunodeficiency virus. Half of these people are homosexual males, a sharp contrast to the worldwide distribution of HIV, in which the overwhelming majority of infections have occurred via heterosexual transmission. Due to the adoption of safe sex practices, however, the rate of new HIV infection among gay males is actually decreasing. Because of the perception of HIV as a "gay" disease, heterosexuals have not taken the warnings about HIV as seriously. As a result, the percent increase in new cases through heterosexual transmission in the United States exceeds the percent increase of new cases in gay males.

How Is HIV Transmitted?
Sexual transmission is the most frequent mode of infection in the United States, while new cases among intravenous drug users and their sexual partners are increasing rapidly. HIV exists at high levels in a variety of bodily fluids, in particular semen, vaginal secretions, and blood. Thus, extensive contact with these fluids imparts a risk of transmission. HIV is actually not a very resilient virus; it does not survive well outside of the body. For example, transmission will not occur through intact, healthy skin, nor can the virus be transmitted by handling inanimate objects that someone who is HIV positive handled before you (for example, casual contact with a doorknob, toilet seat, phone, etc.). HIV cannot be transmitted via a handshake.

While HIV transmission does not occur through intact, healthy skin, it does occur through mucous membranes, thin layers of moist tissue that line the vagina, the inside of the mouth, and the esophagus, stomach, and rectum (i.e. the gastrointestinal tract), among other organs. HIV can also be transmitted through diseased skin or breaks in the skin, such as through genital ulcers caused by sexually transmitted diseases.

Anoreceptive intercourse (aka "catchers" as opposed to "pitchers"), whether male to male or male to female, carries the highest risk of sexual transmission of the virus. Vaginal intercourse also carries a high risk and is becoming a more common mode of transmission in the United States. The rumor that you cannot get HIV from oral sex has persisted for years. Multiple cases of transmission have occurred through oral sex, through contact with male or female genitalia. Any act in which semen, vaginal secretions, or blood comes into direct contact with the inside of the mouth and esophagus, the inside of the vagina, or the inside of the anus, carries a real risk of transmission.

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