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spitting on penis (SALIVA, 2009)
Jun 20, 2009

dear doc, i have read your site and you are doing a great job by helping out people in need and i would like to donate to your foundation. but presently i have got sleepless nights. i was having mutual masturbation with a prostitute and she spit on my penis. do i have a risk of hiv transmission. i had no visible cuts on my penis nor did i see any blood. i had did not have penetrative sex. after a day i feel a small burining sensation in my penis??? have i contracted hiv through this act?? ple answer my qs. i am highly tensed.

Response from Dr. Frascino

Hi,

Saliva that does not contain visible blood is not considered to be a risk for HIV transmission. See below.

Dr. Bob

Is the saliva of person at "window period" riskier than saliva of persons out of that period? (SALIVA) Jun 18, 2008

Dear Dr Bob, First, I would like to express my appreciation to your continuous effort to help all of us finding the truth about HIV. I have found nearly all of your posts on "saliva" but it seems my following question has not been asked and answered before. I hope, you could help me to answer this question. I have learned much about HIV, and I have seen a lot of scientists say that "The concentration of viruses at the window period and the AIDS stage is the highest". As a lot of posts you reply to people on this website, the answer is always "there is no risk when being exposed to saliva". But I'm not sure if that statement is true for "saliva" of all stages: window period, HIV period, AIDS period or the saliva couldn't only transmit during HIV period and it still could transmit HIV during the window and AIDS period because of the highest concentration viruses (as I said above). So I'm wondering that if I'm exposed to the Saliva of a person whose HIV+, how much risk am I facing? Please, tell me because yesterday, I was exposed to saliva of a person, and I'm not sure he's HIV+ at window period or not. I'm looking forward to your response.

Response from Dr. Frascino

Hi,

Saliva does not transmit HIV, unless it contains visible HIV-tainted blood. This includes "saliva of all stages." The only potential exception involves infants ingesting pre-chewed food from an HIV-positive mom. (See below.)

Dr. Bob

WHAT THE HELL IS WRONG WITH RESEARCHERS? MAKE UP THEIR MIND!!!! May 14, 2008

DOC,

IT HAS LONG BEEN SAID THAT HIV IS NOT TRANSMITTED BY SALIVA. BUT NEW STUDIES SHOW THAT IT CAN TRANSMIT HIV... http://www.newstrackindia.com/newsdetails/2333 WHO SHOULD WE BELIEVE? I HAD A FAIRLY RISKY EXPERIENCE WHICH INCLUDED SALIVA. THE MAN FINGERED MY ANUS WITH A CONDOM ON HIS FINGER, BUT USED HIS SPIT AS LUBE. I CAN'T SLEEP DOC. SHOULD I GET TESTED?

LOVE

HILLARY SUPPORTER

Response from Dr. Frascino

Hey Hillary Supporter,

This is not a problem of researchers' being unable to make up their minds, but rather researchers' discovering new information. If we had had more funds dedicated to HIV/AIDS research, prevention and care, we would have known these facts long ago. But Dubya decided spending $5,000 per second (yes, $5,000 per second) on his disastrous war in Iraq was more important. Researchers, not only for HIV/AIDS, but also cancer, diabetes, Alzheimer's, Parkinson's, autism and all other ailments, need to get by with what can be squeezed out of national budgets.

The information you referenced is new, but should not be alarming, in terms of your "spit as lube" experience. In general, saliva that does not contain visible blood is not considered a risk for HIV transmission. The report by the CDC of three African-American infants born in the U.S. who contracted HIV presumably via pre-chewed food suggest that chewing may increase the HIV concentrations in saliva. There is also the possibility that these moms had bleeding gums and transmitted the virus via blood, rather than saliva. Also, it's important to note that newborn infants have different immune mechanisms than adults. The immaturity of their immune systems may well put them at greater risk.

The bottom line on your bottom's risk activity (so to speak) is that your HIV risk assessment would not change based on this new data, OK?

Finally, Hillary would have made a fine president, but Obama will be even better. Hillary should take a few victory laps with her win in West Virginia, finish out the primaries and then bow out gracefully and step in line behind our next president . . . OBAMA!

Dr. Bob

HIV from saliva Jun 26, 2008

HI DR Bob. You have touched on this fairly well but i cant sleep at night and am worried sick. While costructing an exhibition stand i may have got some of a workers saliva into a cut on my hand. In panic he agreed to a test and has tested possitive. My Wife is 5 months pregnant and this is causing major strain in the house. I have been placed on a 28 day course of combivir which is a cause for concern if there is no way of getting HIV from saliva. PLEASE can you shed some light so that i know where i stand.

Response from Dr. Frascino

Hi,

Yes, I've covered this topic extensively of late. (A quick check of the archives will confirm this!) From an HIV perspective, saliva without the presence of visible blood is not considered to pose an HIV-transmission risk. I have no idea why you were started on a course of PEP (post-exposure prophylaxis). I disagree with that decision and do not feel PEP is warranted. As I have mentioned frequently in this forum, I encourage anyone who has had an HIV exposure significant enough to warrant a course of PEP to be followed by an HIV specialist. The specialist would document your degree of HIV-acquisition risk, optimize (or in your case discontinue) PEP as indicated, evaluated and manage all PEP-related side effects and toxicities, evaluate and manage any intercurrent symptoms and finally arrange for and interpret all post-PEP follow-up testing. If you were to come to the Frascino Medical Group with the medical history you related in your post, you would be advised to discontinue PEP, as it was never warranted.

Dr. Bob

Absolutely Stupid Father and Husband (SALIVA, SWEAT, URINE) (WATERSPORTS)(HIV BASICS) Apr 5, 2008

Dr. Frascino, thank you for all you do. I have a question and I am hoping that you will answer. I had protected oral receptive sex with an HIV+ friend. I am male. To my knowledge the rubber stayed intact but my worry is of the following. I had an abbrasion/scratch in my underneath my scrotum at the time of the rendezvous. I don't think any saliva could have gotten down there but that is my worry. Do you think an HIV test is prudent at this time? As I said, my friend informed me that he was HIV positive diagnosed. Now I can't get the horrors out of my mind from this stupid indescretion. Please help me doc. I'm pretty sure I need to see a shrink but right now, I think your response would me more helpful.

Sincerely,

A Stupid and Scared Man

Response from Dr. Frascino

Hello Scared Man,

From your post, I'm assuming you had protected "insertive," not "receptive," oral sex. Assuming the latex condom was used properly and did not fail, your HIV-acquisition risk would be nonexistent. Saliva does not transmit HIV, unless there is visible blood present. See below.

The only reason to consider HIV testing would be to put your unwarranted worries permanently to rest. The result will undoubtedly be negative.

A shrink might help you confront your irrational HIV fears and also help you explore sexual orientation issues. I would also encourage you to level with your wife, as this is not only the best way to cope with your guilt, but also it's the right thing to do.

You may indeed be a "scared" man, but you are not "stupid." You practiced safer sex and for that I commend your "smarts!"

Dr. Bob

ORAL SEX/SALIVA Feb 22, 2007

HEY MY FAVORITE DOC..ITS YOUR BUDDY IN NYC.DUDE...I THINK I SCREWED UP BY LETTING A GUY WITH HIV SUCK MY DICK-AFTER I HAD BEEN JACKIN IT A LOT..EARLIER THAT SAME DAY..SO IT WAS A LITTLE SORE..AND RED..SPECIALLY CAUSE I TOOK STAMINA RX...AND IT WAS EXTREMELY "HARD"..I MEAN HE DIDNT SUCK IT LONG..I JUS FUCKED HIS MOUF IN AND OUT..A FEW TIMES..NO EJACULATION.WE ALSO DEEPLY TONGUE KISSED AND I HAD A DAMN PIMPLE ON MY TONGUE(U KNOW THE ONES FROM TO MUCH ACIDIC FOODS..LIKE PICKLES AND TOMATOES..LOL)..SINCE IM NEGATIVE AND DONT DO ANAL SEX..GIVE OR TAKE..IM REALLY CONFUSED ABOUT AN INFECTED PERSONS SALIVA..ON MY HORNY COCK..THAT IM ALWAYS PLAYIN WIT..AND WEARIN COCK RINGS...WELL MAN..WHY IS SALIVA SO HARD TO EVALUATE..FOR CONTRACTION..IT REALLY SUCKS...LOL,THANX MAN,SINCERELY-MR."LOVE-THAT-HEAD"..NYC

Response from Dr. Frascino

Hello Mr. "Love-That-Head" NYC,

Saliva that does not contain visible blood is not considered to be a significant risk for HIV transmission, even with a pimply tongue or irritated Mr. Happy. Relax, Max! I see no cause for alarm. I would only caution you about excessive use of your home entertainment center. Burping the nephew frequently is fine, but don't rub the little fellow to the point he's got friction burns!

Stay well.

Dr. Bob

Please help me! (SALIVA, SWEAT, URINE) (WATERSPORTS)(HIV BASICS) Nov 17, 2007

I am extremely scared. I went to use a public bathroom and I waited in line for the urinal. A friend of mine who I believe is HIV+ had just got done urinating. I used the same urinal that he used . . . only he didn't flush. I had already pulled my pants down and had my penis hanging out when I flushed the toilet that had his urine in it. Some of his urine splattered on my penis, and now I am TERRIFIED that I have contracted the HIV virus.

Also, one time my friend was goofing off and slashed me with a small metal object, drawing blood. Could I contract HIV through that little of contact with a small, sharp object? It was only a little prick . . . .

Response from Dr. Frascino

Hello,

1. There is no HIV risk from being pissed off or pissed on. Urine, without visible blood, does not transmit HIV. (See below.)

2. Regarding the little prick, well, little pricks or king-sized schlongs can transmit HIV if you have unsafe sex with them, but contact with a small sharp object? No.

Dr. Bob

very scared about watersports risk Nov 19, 2006

hello, I m from Romania, 30 years old and very scared regarding an unusual exposure. i met a prostitute in romania which engaged in bdsm play and watersports with me. everything was safe (condoms used), just that she urinated on me and a litle splash of piss reached my eyes. i felt them a little burning, but washed the eyes after less than 1 minute with water. please, can u tell me if there was any risk for sts and especially hiv? thanks in advance and hope u ll understand me despite my english.

robert

Response from Dr. Frascino

Hello Robert,

A Romanian dominatrix? Hmmm . . . how exotic and erotic is that?!?

Regarding your golden shower splish-splash, you can relax. Urine that does not contain visible blood is considered to be sterile and unable to transmit STDs/HIV. Check out the archives for additional information once you manage to wiggle out of your leather restraints.

Stay safe. Stay well.

Dr. Bob

Dr. Bob, hope you had a good vacation. Please answer. (SALIVA, SWEAT) (HIV BASICS) Oct 10, 2007

Dr. Bob, My very close friend has tested positive for HIV recently. We used to be very very close, so i used to share the same soda from the same straw with her. meaning i used to share and consume her saliva. I did that lot of times, may be ten times until now. Do i need to worry about getting HIV from this incident?

Please answer. I am very very fond of your great work. I will definitely donate. Thanks!

Response from Dr. Frascino

Hello,

Actually, it wasn't a vacation, but thanks I still had an excellent time!

Turning now to your question, HIV/AIDS is not transmitted by casual contact, which includes sharing straws, sodas and saliva! Period! See below.

Thanks for your donation to help others in desperate need. (www.concertedeffort.org)

Be well. Your very close friend needs your friendship and support now more than ever.

Dr. Bob

Can I get HIV from dried spit inserted in anus? Mar 8, 2007

Okay, I'm really worried that I might have gotten HIV last week. I'm so paranoid that I'm having trouble focusing in school and at work. Please answer this please!!! This is what happened. I came home from work and went straight to take a bath. My dad had told me that 2 of his cousins were staying the night with us. While in the bath I saw a beer bottle and decided to use it for anal pleasure. after having it been inserted in me for a few seconds (15- 30) I relized THIS MIGHT HAVE BEEN MY COUSINS USED BEAR BOTTLE!!!! I immediatly stopped and threw the bottle away. I also immediatly stopped pleasuring myself anally. I'm not sure that my dads cousins have AIDS, but they are promiscuous and I don't believe I had any tears in my rectum or anus. However, 3- 4 days before this happened I had stomach problems and had to wipe my anus while on the toilet. I did this many times and by the time my stomach stopped hurting the area around my anus was very sore and I'm sure that i had a few small abrasians from wiping so much. But I do believe that these healed before my beer bottle encounter and the beer bottle was dry (the saliva was dry). Is it likly that I could have gotten HIV from this. I plan on getting tested but I need to know something while I'm in the window period. Please please please respond to this. I'm very scared and will never do anything like this again.

Response from Dr. Frascino

Hello,

You stuck a beer bottle up your butt??? Hmmm . . . OK, let's review. When out drinking beer and someone yells "bottoms up," that's not what they mean, OK?

Returning now to your question, your HIV risk from your Heineken-up-the-heinie experience is nonexistent. But there can be other risks from ramming a Bud up your rosebud. So please be more discerning when choosing toys for your backdoor action.

Dr. Bob

Are my Symptoms a sign of early HIV infection Mar 16, 2007

Hi, I recently posted a question on this site about my risk of catching HIV. My post was responded and it told me I had ZERO-Risk! However, I'm still a little worried and want to know if the symptoms I'm suffering from are HIV related. My ZERO- RISK exposure happened 2 and a half weeks ago. My symptoms are as follows: 1. 1 day of diarreah (I'm not too worried about this becuase I had eaten spicy food the day before.) 2. I had a canker sore ( my doctor told me it was from stress) 3. Slight lower rib cage discomfort. 4. It's hard to explain this but my throat is slightly sore but only in my lower throat. It also feels as if I'm having trouble breathing. Like my lungs are trying to puch the air I breath out. All of these symptoms are very much mild however, I'm freakin out about numbers 4 and 3 becuase I don't recall ever feeling this way. Thankyou for your time. P.S. you might remember me "Heinikin-in the-hiny".

Response from Dr. Frascino

Hello Heineken-up-the-Heinie Guy,

Are you back again??? Exactly what part of "nonexistent risk" are you having difficulty understanding.

Dude, HIV is not your problem. No way. No how. Consequently, your symptoms could not possibly be HIV related, right? Of course right!

Dr. Bob

A Few more "What If's" and Risk Apr 6, 2007

Hey Dr. Bob, it's Hieniken-up-the-Hiny Guy again. I've been coping weel for the last two weeks, but I've recently put myself back into a panic. Please just entertain this one last question even though you've already answered me. Okay so the bottle... it was on the back of the toilet so the person who used it probably was taking a crap... so if a minimal amount of feces was on it and if the person using it had spit into it and had blood in their mouth is there more of a risk? Even though it wasn't used for at least 20 minutes? Also, I have a small rash, which my parent think is a heat rash, and a sore throat and a few bumps on my inner thigh. I'm so worried. I understand that there are many people who have questions far greater than mine and I understand if it takes you a while to answer this question but please do. Thanks, you're an awesome person!

Response from Dr. Frascino

Hello,

OK, Heineken-Up-The Heine Guy,

Enough is enough. Looks like I'm going to have to put out a restraining order on you! Dude, it's time for you to see a psychiatrist. You are what-if-ing yourself right into the loony bin! You may think you've been coping "weel," but I can assure you, if you are concocting scenarios like the possibility of poop on a beer bottle that an HIV-positive guy with a bloody mouth then spit into before you decided to shove the whole kit and caboodle up where the sun don't shine, well, let me tell you, you don't need an HIV expert; you need a shrink's couch. Just to calm your completely whacko fears once again, see below. And why are you going to learn the correct spelling of Heineken and Heine?

Dr. Bob

Just on confirm a few doubts Dec 14, 2006

Hi,

I'm from the UK and I just need to confirms some doubts. Firstly, can HIV be transmitted by Saliva, because I shared some food with a person I had only know for a day.

Secondly, thus may be a silly question, but can HIV be transmitted by touching a steering wheel (hands get sweaty) then touching your willy?

Thanks a lot!

Response from Dr. Frascino

Hello,

You want to "confirm some doubts???" Boy, have you come to the wrong place. Sorry, I cannot "confirm" your doubts about spit and sweat transmitting HIV. However, I'd be more than delighted to dispel those doubts. And while we are on the subject of non-infectious bodily secretions, I may as well include the whole list (see below) as well as some more basic facts about HIV transmission (see below).

Get informed! Stay safe! Stay well!

Dr. Bob

hiv in nasal mucus? Aug 12, 2006

Dear dr. Frascino, does nasal mucus contain HIV and can an accidental ingestion of nasal mucus of a person with HIV and not on HAART be at risk? Thank you!

Response from Dr. Frascino

Hello,

Nasal secretions similar to saliva, sputum, sweat, tears, urine, vomitus and feces are not implicated in the transmission of HIV, unless they contain visible blood.

Out of curiosity, how did you mange to "accidentally" chow down some HIV positive boogers?

Dr. Bob

HIV from stools Apr 28, 2007

Hi Doctor, I've searched the archives but can't seem to find an answer to this question. I would like to know if HIV can be transmitted through coming in contact with someone else's stools/shit, for there could be blood in it. Please let me know. Thank-you so much.

Response from Dr. Frascino

Hello,

You couldn't have searched all that hard. See below.

Dr. Bob

just one shake Feb 7, 2007

Hello Doc, My girlfriend is working as a bartender and she cut her self by cutting fruit. Then she shaked hand with some guy has AIDS and he had sweat hands. She felt burn reaction from his sweat on her finger. It's possibility to infected this way? thank you

Response from Dr. Frascino

Hello,

Nope! Even if sweaty hands poz-guy had also picked his nose, peed on his fingers and upchucked a Big Mac all over his hands before the handshake, your girlfriend's HIV risk remains completely nonexistent. (Tears, sweat, saliva, nasal mucous, urine, vomitus and feces do not transmit HIV, unless there is visible blood.)

Dr. Bob

HIV infection by sweat May 6, 2007

Doc, I just read on the CDC site that they did not find and HIV in sweat of a HIV+ person and they have concluded that sweat = NO HIV. However the document is dated 1999 and has not been undated since then. My question is does the CDC statement "Sweat contains no HIV" still hold true?

Since the document is dated 1999, obviously they must have looked out for HIV in sweat as per the testing proceedures available back in 1999. Is'nt there is a possibility that due to low HIV presence in sweat, the technology back then could not detect them? It's be 8 years since and now the HIV tests have also advanced. Is it possible that if we test now with the latest technology, we will detect HIV is sweat?

My apologies for doubting a reputed org such as CDC. Its just that I am a bit worried due to an encounter wherin my penis came in contact with sweat of probabily hiv+ person (CSW).

Thank you doc.

Response from Dr. Frascino

Hi,

Even with the latest technology, HIV is not transmissible via sweat. And just to be thorough, not only sweat, but also nasal secretions, saliva, sputum, tears, urine, vomitus and feces are not implicated in the transmission of HIV, unless they contain visible blood! And you can date that information May 2007, OK?

Don't sweat the petty stuff and don't worry about petting the sweaty stuff, OK?

Dr. Bob

HIV FROM DANCING (SWEAT) (HIV BASICS) Aug 13, 2007

while dancing at a local club here in south beach i was walking the dancefloor and was hit in the eye by another gay mans sweat as he danced and shaked.if he is poz what is the odd?

Response from Dr. Frascino

Hi,

The information you request was already waiting for you in the archives. (See below.) And just for emphasis, even if the hottie on the dance floor covered you in sweat, tears, snot, pee, poop and vomit, you still would not be at risk for HIV (assuming the aforementioned bodily fluids did not contain blood).

Dr. Bob

HIV positive friend Jul 29, 2006

Hi Doctor I was going to meet a friend for a coffee at his place and he wanted more than a coffee, he told me that he's HIV positive. How does HIV spread, and what can i do.

Response from Dr. Frascino

Hello,

So apparently your buddy wanted both coffee and dessert, eh? (Perhaps coffee and hot-crossed buns?)

How is HIV spread??? Either you are very young (too young to be drinking coffee) or you just recently arrived from a distant galaxy or you've been home schooled and subjected to an abstinence-only sex education course. Well whatever the reason, it's time you learned about HIV, how it is and is not transmitted and how you can protect yourself from becoming infected while enjoying hot, satisfying sex (with or without the Starbucks). I would suggest you begin with a basic pamphlet on HIV/AIDS. I'll reprint one below ("Facts for Life: What You and the People You Care about Need to Know about HIV/AIDS"). I would then suggest you review more detailed information that can be easily accessed on this site and related links and in the archives of this forum.

Get informed. Stay safe. Stay well.

Dr. Bob

Facts for Life: What you and the people you care about need to know about HIV/AIDS

amfAR, The Foundation for AIDS Research, is one of the world's leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy. Since 1985, amfAR has invested nearly $250 million in its programs and has awarded grants to more than 2,000 research teams worldwide. FREQUENTLY ASKED QUESTIONS:

What is HIV What is AIDS?

How quickly do people infected with HIV develop AIDS?

How many people are affected by HIV/AIDS?

How is HIV transmitted?

How is HIV not transmitted?

How can I reduce my risk of becoming infected with HIV through sexual contact?

Are there other ways to avoid getting HIV through sex?

Is there a link between HIV and other sexually transmitted infections?

How can I avoid acquiring HIV from a contaminated syringe?

Are some people at greater risk of HIV infection than others?

Are women especially vulnerable to HIV?

Are young people at significant risk of HIV infection?

Are there treatments for HIV/AIDS?

Is there a cure for AIDS?

Is there a vaccine to prevent HIV infection?

Can you tell whether someone has HIV or AIDS?

How can I know if I'm infected?

Should I get tested?

How can I get tested?

Where can I get more information about HIV and AIDS?

How can I help fight HIV/AIDS?

HIV stands for human immunodeficiency virus. It is the virus that causes AIDS. A member of a group of viruses called retroviruses, HIV infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce. AIDS stands for acquired immunodeficiency syndrome. It is a disease in which the body's immune system breaks down and is unable to fight off infections, known as "opportunistic infections," and other illnesses that take advantage of a weakened immune system. When a person is infected with HIV, the virus enters the body and lives and multiplies primarily in the white blood cells. These are immune cells that normally protect us from disease. The hallmark of HIV infection is the progressive loss of a specific type of immune cell called T-helper, or CD4, cells. As the virus grows, it damages or kills these and other cells, weakening the immune system and leaving the person vulnerable to various opportunistic infections and other illnesses ranging from pneumonia to cancer. A person can receive a clinical diagnosis of AIDS, as defined by the U.S. Centers for Disease Control and Prevention (CDC), if he or she has tested positive for HIV and meets one or both of theses conditions: The presence of one or more AIDS-related infections or illnesses; A CD4 count that has reached or fallen below 200 cells per cubic millimeter of blood. Also called the T-cell count, the CD4 count ranges from 450 to 1200 in healthy individuals. In some people, the T-cell decline and opportunistic infections that signal AIDS develop soon after infection with HIV. But most people do not develop symptoms for 10 to 12 years, and a few remain symptom-free for much longer. As with most diseases, early medical care can help prolong a person's life.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there are now 40 million people living with HIV or AIDS worldwide. Most of them do not know they carry HIV and may be spreading the virus to others. In the U.S., approximately one million people have HIV or AIDS, and 40,000 Americans become newly infected with HIV each year. According to the CDC, it is estimated that a quarter of all people with HIV in the U.S. do not know they are carrying the virus. Since the beginning of the epidemic, AIDS has killed more than 25 million people worldwide, including more than 500,000 Americans. AIDS has replaced malaria and tuberculosis as the world's deadliest infectious disease among adults and is the fourth leading cause of death worldwide. Fifteen million children have been orphaned by the epidemic. A person who has HIV carries the virus in certain body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can be transmitted only if such HIV-infected fluids enter the bloodstream of another person. This kind of direct entry can occur (1) through the linings of the vagina, rectum, mouth, and the opening at the tip of the penis; (2) through intravenous injection with a syringe; or (3) through a break in the skin, such as a cut or sore. Usually, HIV is transmitted through: Unprotected sexual intercourse (either vaginal or anal) with someone who has HIV. Women are at greater risk of HIV infection through vaginal sex than men, although the virus can also be transmitted from women to men. Anal sex (whether malemale or malefemale) poses a high risk mainly to the receptive partner, because the lining of the anus and rectum is extremely thin and is filled with small blood vessels that can be easily injured during intercourse. Unprotected oral sex with someone who has HIV. There are far fewer cases of HIV transmission attributed to oral sex than to either vaginal or anal intercourse, but oralgenital contact poses a clear risk of HIV infection, particularly when ejaculation occurs in the mouth. This risk goes up when either partner has cuts or sores, such as those caused by sexually transmitted infections (STIs), recent tooth-brushing, or canker sores, which can allow the virus to enter the bloodstream. Sharing needles or syringes with someone who is HIV infected. Laboratory studies show that infectious HIV can survive in used syringes for a month or more. That's why people who inject drugs should never reuse or share syringes, water, or drug preparation equipment. This includes needles or syringes used to inject illegal drugs such as heroin, as well as steroids. Other types of needles, such as those used for body piercing and tattoos, can also carry HIV. Infection during pregnancy, childbirth, or breast-feeding (mother-to-infant transmission). Any woman who is pregnant or considering becoming pregnant and thinks she may have been exposed to HIVeven if the exposure occurred years agoshould seek testing and counseling. In the U.S., mother-to-infant transmission has dropped to just a few cases each year because pregnant women are routinely tested for HIV. Those who test positive can get drugs to prevent HIV from being passed on to a fetus or infant, and they are counseled not to breast-feed. HIV is not an easy virus to pass from one person to another. It is not transmitted through food or air (for instance, by coughing or sneezing). There has never been a case where a person was infected by a household member, relative, coworker, or friend through casual or everyday contact such as sharing eating utensils or bathroom facilities, or through hugging or kissing. (Most scientists agree that while HIV transmission through deep or prolonged "French" kissing may be possible, it would be extremely unlikely.) Here in the U.S., screening the blood supply for HIV has virtually eliminated the risk of infection through blood transfusions (and you cannot get HIV from giving blood at a blood bank or other established blood collection center). Sweat, tears, vomit, feces, and urine do contain HIV, but have not been reported to transmit the disease (apart from two cases involving transmission from fecal matter via cut skin). Mosquitoes, fleas, and other insects do not transmit HIV.

If you are sexually active, protect yourself against HIV by practicing safer sex. Whenever you have sex, use a condom or "dental dam" (a square of latex recommended for use during oralgenital and oralanal sex). When used properly and consistently, condoms are extremely effective. But remember: Use only latex condoms (or dental dams). Lambskin products provide little protection against HIV. Use only water-based lubricants. Latex condoms are virtually useless when combined with oil- or petroleum-based lubricants such as Vaseline® or hand lotion. (People with latex allergies can use polyethylene condoms with oil-based lubricants). Use protection each and every time you have sex. If necessary, consult a nurse, doctor, or health educator for guidance on the proper use of latex barriers. The male condom is the only widely available barrier against sexual transmission of HIV. Female condoms are fairly unpopular in the U.S. and still relatively expensive, but they are gaining acceptance in some developing countries. Efforts are also under way to develop topical creams or gels called "microbicides," which could be applied prior to sexual intercourse to kill HIV and prevent other STIs that facilitate HIV infection. Having a sexually transmitted infection (STI) can increase your risk of acquiring and transmitting HIV. This is true whether you have open sores or breaks in the skin (as with syphilis, herpes, and chancroid) or not (as with chlamydia and gonorrhea).

Where there are breaks in the skin, HIV can enter and exit the blood-stream more easily. But even when there are no breaks in the skin, STIs can cause biological changes, such as swelling of tissue, that may make HIV transmission more likely. Studies show that HIV-positive individuals who are infected with another STI are three to five times more likely to contract or transmit the virus through sexual contact. If you are injecting drugs of any type, including steroids, do not share syringes or other injection equipment with anyone else. (Disinfecting previously used needles and syringes with bleach can reduce the risk of HIV transmission). If you are planning to have any part of your body pierced or to get a tattoo, be sure to see a qualified professional who uses sterile equipment. Detailed HIV prevention information for drug users who continue to inject is available from the CDC's National Prevention Information Network at 1-800-458-5321 or online at www.cdc.gov/idu. HIV does not discriminate. It is not who you are, but what you do that determines whether you can become infected with HIV. In the U.S., roughly half of all new HIV infections are related directly or indirectly to injection drug use, i.e., using HIV-contaminated needles or having sexual contact with an HIV-infected drug user. With 40,000 Americans contracting HIV each year, there are clearly many people who are still engaging in high-risk behaviors, and infection rates remain alarmingly high among young people, women, African Americans, and Hispanics. Women are at least twice as likely to contract HIV through vaginal sex with infected males than vice versa. This biological vulnerability is worsened by social and cultural factors that often undermine women's ability to avoid sex with partners who are HIV-infected or to insist on condom use. In the U.S., the proportion of HIV/AIDS cases among women more than tripled from 8 percent in 1985 to 27% in 2004. African American and Hispanic women, who represent less than onequarter of U.S. women, account for 80% of new HIV infections among American women each year. At least half of the 40,000 Americans newly infected with HIV each year are under the age of 25. Roughly two young Americans become infected with HIV every hour of every day, and many of the people now living with HIV in the U.S. became infected when they were teenagers. Statistics show that by the 12th grade, about 60 percent of American youth are sexually active, and two-thirds of STIs affect people under age 25. Many young people also use drugs and alcohol, which can increase the likelihood that they will engage in high-risk sexual behavior. For many years, there were no effective treatments for AIDS. Today, a number of drugs are available to treat HIV infection and AIDS. Some of these are designed to treat the opportunistic infections and illnesses that affect people with HIV/AIDS. In addition, several types of drugs seek to prevent HIV itself from reproducing and destroying the body's immune system: Reverse transcriptase inhibitors attack an HIV enzyme called reverse transcriptase. They include abacavir, delavirdine, didanosine (ddl), efavirenz, emtricitabine (FTC), lamivudine (3TC), nevirapine, stavudine (d4T), tenofovir, zalcitabine (ddC), and zidovudine (AZT); Protease inhibitors attack the HIV enzyme protease and include amprenavir, atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir, and darunavir. Fusion inhibitors stop virus from entering cells. To date, only one fusion inhibitor, enfuvirtide, has been approved by the Food and Drug Administration. Are young people at significant risk of HIV infection? Are there treatments for HIV/AIDS?

Many HIV patients take these drugs in combinationa regimen known as highly active antiretroviral therapy (HAART). When taken as directed, anti-HIV treatment can reduce the amount of HIV in the bloodstream to very low levels and sometimes enables the body's immune cells to rebound to normal levels. Several drugs can be taken to help prevent a number of opportunistic infections including Pneumocystis carinii pneumonia, toxoplasmosis, cryptococcus and cytomegalovirus infection. Once opportunistic infections occur, the same drugs can be used at higher doses to treat these infections, and chemotherapy drugs are available to treat the cancers that commonly occur in AIDS. Researchers are continuing to develop new drugs that act at critical steps in the virus's life cycle. Efforts are under way to identify new targets for anti-HIV medications and to discover ways of restoring the ability of damaged immune systems to defend against HIV and the many illnesses that affect people with HIV. Ultimately, advances in rebuilding the immune systems of HIV patients will benefit people with a number of serious illnesses, including cancer, Alzheimer's disease, multiple sclerosis, and immune deficiencies associated with aging and premature birth. There is still no cure for AIDS. And while new drugs are helping some people who have HIV live longer, healthier lives, there are many problems associated with them: Anti-HIV drugs are highly toxic and can cause serious side effects, including heart damage, kidney failure, and osteoporosis. Many (perhaps even most) patients cannot tolerate long-term treatment with HAART. HIV mutates quickly. Even among those who do well on HAART, roughly half of patients experience treatment failure within a year or two, often because the virus develops resistance to existing drugs. In fact, as many as 10 to 20 percent of newly infected Americans are acquiring viral strains that may already be resistant to current drugs. Because treatment regimens are unpleasant and complex, many patients miss doses of their medication. Failure to take anti-HIV drugs on schedule and in the prescribed dosage encourages the development of new drugresistant viral strains.

Even when patients respond well to treatment, HAART does not eradicate HIV. The virus continues to replicate at low levels and often remains hidden in "reservoirs" in the body, such as in the lymph nodes and brain. In the U.S., the number of AIDS-related deaths has decreased dramatically because of widely available, potent treatments. But more than 95 percent of all people with HIV/AIDS live in the developing world, and many have little or no access to treatment. Despite continued intensive research, experts believe it will be at least a decade before we have a safe, effective, and affordable AIDS vaccine. And even after a vaccine is developed, it will take many years before the millions of people at risk of HIV infection worldwide can be immunized. Until then, other HIV prevention methods, such as practicing safer sex and using sterile syringes, will remain critical. You cannot tell by looking at someone whether he or she is infected with HIV or has AIDS. An infected person can appear completely healthy. But anyone infected with HIV can infect other people, even if they have no symptoms. Immediately after infection, some people may develop mild, temporary flu-like symptoms or persistently swollen glands. Even if you look and feel healthy, you may be infected. The only way to know your HIV status for sure is to be tested for HIV antibodiesproteins the body produces in an effort to fight off infection. This usually requires a blood sample. If a person's blood has HIV antibodies, that means the person is infected.

If you think you might have been exposed to HIV, you should get tested as soon as possible. Here's why: Even in the early stages of infection, you can take concrete steps to protect your long-term health. Regular check-ups with a doctor who has experience with HIV/AIDS will enable you (and your family members or loved ones) to make the best decisions about whether and when to begin anti- HIV treatment, without waiting until you get sick. Taking an active approach to managing HIV may give you many more years of healthy life than you would otherwise have. If you are HIV positive, you will be able to take the precautions necessary to protect others from becoming infected. If you are HIV positive and pregnant, you can take medications and other precautions to significantly reduce the risk of infecting your infant, including not breast-feeding. Most people are tested by private physicians, at local health department facilities, or in hospitals. In addition, many states offer anonymous HIV testing. It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer questions about high-risk behavior and suggest ways you can protect yourself and others in the future. They can also help you understand the meaning of the test results and refer you to local AIDS-related resources. Though less readily available, there is also a viral load test that can reveal the presence of HIV in the blood within three to five days of initial exposure, as well as highly accurate saliva tests that are nearly equivalent to blood tests in determining HIV antibody status. In some clinics you can get a test called OraQuick® that gives a preliminary result in 20 minutes. You can also purchase a kit that allows you to collect your own blood sample, send it to a lab for testing, and receive the results anonymously. Only the Home Access® brand kit is approved by the Food and Drug Administration. It can be found at most drugstores.

Keep in mind that while most blood tests are able to detect HIV infection within four weeks of initial exposure, it can sometimes take as long as three to six months for HIV antibodies to reach detectable levels. The CDC currently recommends testing six months after the last possible exposure to HIV. The CDC's National AIDS Hotline can answer questions about HIV testing and refer you to testing sites in your area. Operators are available toll-free, 24 hours a day, seven days a week, at: 1.800.232.4636 (English, Spanish and TTY/deaf access). There are many valuable sources of HIV/AIDS information, including the following: amfAR's website at www.amfar.org The CDC at www.cdc.gov/hiv or the phone numbers above Your state or local health department (see your local phone book) Your local AIDS service organization (see your local phone book) HIV InSite at hivinsite.ucsf.edu AEGiS (AIDS Education Global Information System) at www.aegis.com The Body: An AIDS and HIV Information Resource at www.thebody.com The Kaiser Family Foundation's HIV/AIDS information section at www.kff.org/hivaids

Everyone can play a role in confronting the HIV/AIDS epidemic. Here are just a few suggestions for how you can make a difference: Volunteer with your local AIDS service organization. Talk with the young people you know about HIV/AIDS. Sponsor an AIDS education event or fund raiser with your local school, community group, or religious organization. Urge government officials to provide adequate funding for AIDS research, prevention education, medical care, and support services. Speak out against AIDS-related discrimination.



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