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Environmental transmission
Nov 25, 1996

Dear Doctor, For the longest time I have been wondering and scared if I or my family are at risk of getting AIDS. I have read several books now on the subject and 2 conflicting statements keep cropping up which confuse me. One is that if you come in contact with with blood and have an open wound, you are at risk. The other statement is the you can't get infected from touching things other people touch- (inanimate objects or environmental surfaces). It seems to me that there is always a chance to get hurt on something where someone else got hurt within the previous few minutes. So many people touch and use the same objects shortly afterwards. I know the chance is small, but it's big enough for me to keep getting tested every 3 months (That may sound paranoid but I have 2 small children and am pregnant with a third). I feel an intense responsibility to them an would like to be freed from the mental stress. Other people laugh about my worries, but I don't want to have to feel like I have to walk around in armor to avoid this frightening disease. I am sure it happens to everyone now and then that they hurt themselves on a bus, in a department store or supermarket, especially children. I have also never read how much blood is required for transmission to be possible - a drop? More? Less? SO, do the statements in all the literature contradict each other or is it really a risk of transmission in the public environment, has anybody been infected in this way before? I know life is full of risks and I could die from a rock falling on my head while crossing the street or cancer, etc., but at least then I would not infect my whole family or my unborn child. Thank you in advance for answering me, i'm sure it seems obvious to you, but sometimes when I read your work, I can feel the pressure of my fears leaving me, and something like that cannot be had for love or money. Thanks again.

Response from Mr. Sowadsky

Hi.Thank you for your question. In the 15+ years that HIV/AIDS has been with us, there has not been a single case of HIV transmission transmitted through ANY form of casual day-to-day contact. None. HIV is transmitted in a very limited number of ways. Let me review once again how one can become infected.

Blood, pre-cum, semen, vaginal secretions, and breast milk all contain high concentrations of HIV, and all have been linked to transmission of the virus.

Saliva, tears, sweat, and urine can have the virus in them, but in such small concentrations that nobody has ever been infected through them. However, if any body fluid is visibly contaminated with blood, the risk of transmission exists.

The HIV virus must get into the bloodstream in order to infect you. If it doesn't get into the bloodstream, you will not get the infection. Blood, pre-cum, semen, vaginal secretions, or breast milk must have direct access to your bloodstream in order to infect you. The greater the amount of these body fluids that you are exposed to, the greater the risk of infection there would be. Activities where this can happen include vaginal intercourse (both partners), anal intercourse (both partners), giving oral sex, sharing needles (IV, tattoo etc.), and rarely through receiving a blood transfusion. HIV can also be transmitted from mother to child. HIV is NOT transmitted through any form of casual contact.

In summary, in order for infection to occur, 3 things must happen:

You must be exposed to pre-cum, semen, vaginal secretions, blood, or breast milk.

The virus must get directly into your bloodstream through some fresh cut, open sore, abrasion etc.

Transmission must go directly from 1 person to the other very quickly.....the virus does not survive more than a few minutes outside the body.

No matter what the circumstances are, if you think about these 3 criteria for transmission, you'll be able to determine whether you're at risk for HIV or not. Because HIV will not survive outside the body for more than a few minutes, and because a person would not be exposed to vaginal secretions, breast milk, pre-cum or semen through casual contact, HIV cannot be transmitted by casual contact.

However, if a person is bleeding, and their blood within minutes gets directly into your bloodstream, then there would be a risk of infection. This would normally only occur if you were providing first aid to a bleeding person. However, today, standard infection control guidelines (called Universal Precautions), would make infection unlikely even during first aid situations, if proper infection control guidelines are followed. Anyone could learn these guidelines in any first aid class. I highly recommend everyone to take a first aid class (and a CPR class too!), since you never know when you're going to have to provide first aid to someone, be it a stranger, a family member, a neighbor, etc.

In your specific case, if you are having an ongoing fear of getting AIDS from day-to-day contact, then perhaps counseling is an option for you. Counseling can help identify why you are so scared of getting this disease through casual contact (despite the fact that HIV has never been transmitted this way). Counseling can also help you cope with this fear. I deal with persons in your situation everyday, and counseling has helped many people deal with their fears of AIDS. So perhaps this would be the solution to your fears.

Since you are pregnant, I recommend you get tested now for HIV. This is not because of the risk of casual contact (which there isn't any), but because we are now recommending routine screening for EVERY pregnant woman. This is a standard recommendation since we can now reduce the chance of the baby becoming infected through early medical intervention (assuming the mother is found to be positive). However, if you did not engage in any risky activities (see above), we would not expect you to be infected with HIV. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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