Frequently Asked Questions About HIV/AIDS (Part One)

What exactly is AIDS?

AIDS is a disease caused by a virus called HIV (human immunodeficiency virus). AIDS stands for Acquired Immunodeficiency Syndrome.

In this disease, HIV damages the immune system, so the body is no longer able to fight off diseases that normally it would be able to fight off.

HIV infects and eventually destroys a specific type of cell in your immune system called a CD4 cell (also called a T4 cell or a T helper cell).

Think of the CD4 cells as the generals of the immune-system army. The CD4 cells tell other immune-system cells what to do when an invading organism, germ or cancer cell is found in the body. Basically HIV kills off the CD4 cells (that is, it kills off the generals of the army). When the generals of the immune-system army are killed off, the rest of the immune system doesn't know what to do to fight off invaders. This is how HIV damages the immune system.

When HIV first enters the body, your immune system immediately attacks the virus, and keeps it under control for a number of years. During this time, the virus is at constant battle with your immune system. Your body tries to get rid of the virus, but is only able to keep it under control.

After a number of years, your immune system starts to lose its battle against HIV. Then, after an average of 10 years of fighting HIV, if you're not taking HIV treatment, your immune system starts to weaken. This is when full-blown AIDS begins. During this 10-year period, a person may have no symptoms at all, and feel fine and look fine. During this time, the person is considered HIV positive, but does not yet have AIDS.

Definition of AIDS

The definition of AIDS in the U.S. is a very specific one. In order to be diagnosed with AIDS, a person must meet the following requirements:

First, a person must be diagnosed with either HIV-1 or HIV-2.

Second, in addition to having HIV, a person must have at least one of the following:

  1. A CD4 cell count of less than 200.
  2. A CD4 cell count percentage of less than 14%.
  3. An opportunistic disease as defined by the U.S. Centers for Disease Control and Prevention (CDC). (For a list of opportunistic infections, click here.)

The normal CD4 cell count ranges between 800 and 1,200, or greater than 29%. A cell count below 500 or below 29% indicates an initially damaged immune system. A cell count below 200 or below 14% indicates a severely damaged immune system. An opportunistic disease is a disease that primarily causes illness given the opportunity of a damaged immune system.

If a person has HIV and meets any of the three criteria above, he or she is considered to have full-blown AIDS. If a person doesn't have HIV, or doesn't meet one of the three additional requirements above, they do not meet the definition of AIDS.

Note that if a person with HIV has a severely damaged immune system (that is, a CD4 count less than 200 or less than 14%), he or she meets the definition of AIDS even if they do not have an opportunistic disease. It is therefore possible for a person to have full-blown AIDS and have no symptoms at all. If a person has HIV and an opportunistic disease, they also meet the definition of full-blown AIDS. When a person does show symptoms, it is usually due to one of the opportunistic diseases.

Also, once someone has been diagnosed with AIDS, they will always be considered to have AIDS, regardless of any clinical changes later on. For example, if a person has HIV, and a CD4 cell count below 200, they are considered to have AIDS. If their CD4 cell count later goes back above 200, they are still considered to have AIDS.

Which body fluids can transmit the HIV virus, and which ones don't?

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.

How is HIV transmitted?

HIV must get into your 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. Activities where this can happen include vaginal intercourse (both partners), anal intercourse (both partners), giving oral sex, sharing needles (IV drugs, tattooing, 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.

Criteria for HIV transmission

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

  1. You must be exposed to pre-cum, semen, vaginal secretions, blood or breast milk, AND
  2. The virus must get directly into your bloodstream through some fresh cut, open sore, abrasion etc., AND
  3. Transmission must occur, directly from one 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 three criteria for transmission, you'll be able to determine whether you're at risk for HIV or not. But do remember that other sexually transmitted diseases (STDs) can be transmitted more easily than HIV, so what might be low risk for HIV may be high risk for other STDs. (Click here for a list of STDs.)

Can you get HIV through oral sex?

Receiving Oral Sex

If you are receiving oral sex from someone else you are only being exposed to saliva. The concentrations of the virus in saliva are so low that nobody has ever been infected from saliva. Keep in mind, however, that you can get other sexually transmitted diseases (like herpes) by receiving oral sex. However, as far as HIV is concerned, receiving oral sex is extremely low risk.

Giving Oral Sex

If you are giving someone oral sex, there is a risk of infection, since pre-cum, semen, vaginal secretions and menstrual blood can get into your mouth. The more of these body fluids you are exposed to, the greater the risk of infection there would be. If you have any open sores, cuts, abrasions or gum disease in your mouth, the virus can get into your bloodstream. The risk is less than if you had vaginal or anal intercourse, but the risk is real, and transmission can occur. There have already been reported cases of HIV infection specifically through giving oral sex. In addition to HIV, while giving oral sex, you could also be at risk for other sexually transmitted diseases (STDs) including herpes and gonorrhea and even syphilis.

Now, when we're talking about the levels of risk when you give someone oral sex, several variables actually determine the true level of risk. Let's look now, for example, at the risks of giving a man oral sex:

Both pre-cum and semen can contain high concentrations of HIV. Semen, however, is a riskier body fluid, because you are normally exposed to a greater quantity of semen as compared to pre-cum. Does that mean that pre-cum is totally safe? No! But we can say that the more infectious body fluid you are exposed to, the greater the likelihood of transmission. So, you can become infected by pre-cum alone, but you are much more likely to become infected if the guy cums in your mouth, since you're then exposed to a much greater quantity of his body fluid.

Of course, the virus must also be able to get into your bloodstream through some type of open sore, abrasion, gum disease, etc. The more openings that HIV has to get into your bloodstream, the greater your risk would be. So the more cuts or open sores in your mouth, the greater the risk would be. Or if a person has gum disease, the more severe the gum disease is, the greater the risk would be.

Without ejaculation, there still is some risk of getting infected through giving oral sex, but the risk would be much greater if the man ejaculated in your mouth. So rather than saying high risk vs. low risk, it's actually a spectrum of risk.

  • No exposure to pre-cum or semen: No risk as far as HIV is concerned.

  • Exposure to pre-cum only: Low risk (but still technically possible). The more pre-cum you get exposed to, the greater the risk would be.

  • Exposure to both pre-cum and semen: Risky, especially if there are cuts/open sores in the mouth. The more semen you're exposed to, and the more cuts/abrasions/gum disease in the mouth, the greater the risk. But overall, although risky, it is still generally considered less of a risk than unprotected intercourse.

So again, we're talking about a spectrum of risk. This is why there will be no absolute answer of high vs. low risk of giving oral sex. But we can say that HIV has now been found to be transmitted by giving oral sex -- especially if there is ejaculation -- but not receiving oral sex.

And by the way, a very important thing to remember is that there doesn't necessarily have to be ejaculation to be infected with other STDs. For example, if you give a man oral sex, and that man has gonorrhea, you could get infected with gonorrhea in your throat, whether the man ejaculates or not. Gonorrhea can cause a discharge that can be very infectious if it gets into the throat (or penis/rectum/vagina) of another person. So things that may be lower risk for HIV (giving oral sex without ejaculation) may be high-risk for other diseases, like gonorrhea.

Regarding the risks of giving a woman oral sex:

Keep in mind that if you are giving a woman oral sex, the exact same principles apply as described above, that is, the more vaginal secretions or menstrual blood that you get in your mouth, and the more cuts and open sores you have in your mouth, the greater the chance of infection.

What are the risks from fingering someone?

Fingering is considered a low-risk for HIV. I am not aware of any documented cases of anyone becoming infected with HIV specifically through this activity. If there are fresh, open cuts on the fingers, there would be some possibility of infection. However, since most of the time people don't have fresh open cuts on their fingers, this is generally considered a low-risk activity.

Any breakdown in the integrity of the skin can allow HIV to enter the bloodstream. This includes cuts, abrasions, lesions from STDs (like herpes) or skin problems like dermatitis. For cuts, once a scab forms (usually within a few hours), this would no longer give access to the bloodstream, preventing HIV from entering. Of course, the deeper the cut, or the more severe the damage to the skin, the longer it will take for healing to take place. Not everyone heals (and therefore produces a scab) at the same rate, so nobody can give you an exact amount of time it would take for a cut to heal, or for a scab to form. But the larger the cut, the greater the amount of time it would take for a scab to form, and for the cut to heal. Let me repeat that the amount of time it takes for a scab to form, and for a cut to heal, can vary from person to person.

Cuts and abrasions are much more likely to occur on mucous membranes than regular skin. Mucous membranes are found on the head of the penis, the vagina, rectum, eyes, nose and mouth. Mucous membranes are much thinner than the skin found on your hands and other parts of your body. Therefore, mucous membranes are much more likely to have microscopic cuts and abrasions.

For example, if you were to get vaginal secretions directly in a fresh open cut on your hands, there would be a possibility of infection. But there would be an even greater possibility of infection if vaginal secretions were to get onto a mucous membrane like the mouth or the head of the penis. So don't panic if you get vaginal secretions or semen on your hands. The skin on your hands is much thicker than the linings made of mucous membranes. The thicker the skin, the less the chance for abrasions and cuts.

Fingering is normally not a high risk activity for HIV. All anyone can say is that if there is a fresh open cut on the finger (see above), then there would be some risk of infection if blood, semen, or vaginal secretions had a direct access to that opening. But the risk is less than intercourse or giving oral sex. That's all anybody could ever say on this issue. It is normally a low risk activity for HIV.

Can you get HIV or another sexually transmitted disease from a person who is not infected? Does anal sex "make" the HIV virus?

Many people incorrectly believe that just having sex (anal intercourse, vaginal intercourse, oral sex, etc.) will give you a disease like HIV/AIDS. The fact is, sex by itself is not what gives you an infectious disease. It is having unprotected sex with an infected person that makes sex risky, as far as HIV and other STDs are concerned.

If you have unprotected sex with a person who is not infected, you are at no risk whatsoever for HIV and other STDs. A person cannot give you a disease that they do not have. Also, if you have sex by yourself (solo masturbation), you are at no risk whatsoever for HIV and other STDs. You cannot give HIV (or any other STD) to yourself.

But, if you have unprotected sex with a person who is infected with HIV or another STD, then you would be at risk of infection. If there is any possibility at all that your partner may have HIV or another STD, I strongly encourage the use of condoms every time you have sex. But if your partner is not infected, you are at no risk at all of getting infected. And if you are not infected, you are not putting yourself (or anybody else) at any risk.

Remember, it is not the sex itself that makes a person get infected with HIV or any other STD. It is having unprotected sex with an infected person, that poses a risk of infection.

Back to Answers to Recent Safe Sex Questions
More Frequently Asked Questions

Do you want more information on AIDS, STDs or safer sex? Contact the U.S. Centers for Disease Control Health Line, open 24 hours a day, seven days a week, at 1-800-232-4636. Or visit The Body's Safe Sex and Prevention Forum.

Until next time . . . Work hard, play hard, play safe, stay sober!