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What is HIV / AIDS?
HIV - Human Immunodeficiency Virus - is the virus that causes AIDS. Over time, HIV attacks the body's immune system and makes it impossible for the body to fight off infection. At that point, a person is considered to have AIDS.

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Is There A Cure?
While there is no cure for HIV/AIDS, a combination of medications can keep people with HIV/AIDS feeling healthy for several years. While many people with this disease are living longer because of these new medications, many others have died because of the side effect of these new drugs or have become resistant to the medications.

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How Is HIV Transmitted?
HIV is transmitted through blood, semen, vaginal fluids and breast milk (HIV lives only in human body fluids of an infected person). Some body fluids do NOT spread HIV: saliva, tears, sweat, urine and feces. So you can't get HIV through casual contact such as kissing, hugging, sharing a fork or spoon, or shaking hands. It is not transmitted by toilet seats, swimming pools, donating blood or bug bites. (HIV is killed by air and by plain household bleach or being exposed to disinfectants).

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Who Is At Risk For HIV / AIDS?
The truth is anyone can get HIV or other sexually transmitted diseases if they put themselves at risk. That is men, women, teenagers and senior citizens. If you think "it can't happen to me," think twice. Anyone who has engaged in oral, vaginal or anal sex without a condom or barrier, or anyone who has shared needles can put themselves at risk. Remember, you can't tell if a person has HIV/AIDS by looks, even if a person looks clean, has good hygiene and no visible sores.

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Adolescents and HIV / AIDS Statistics
73% of men and 56% of women have engaged in sexual intercourse before they reach their 18th birthday. One quarter of HIV infections taking place today are infections of people under the age of 21. The largest increase of reported AIDS cases among teenagers and young adults are those resulting from heterosexual sex. One-half of HIV infections taking place today are of people under the age of 25. About 50% of high school seniors report consistent use of condoms. Surveys indicate the use of condoms decline with age. AIDS, is a preventable disease, the second leading cause of death for people ages 25-44. The leading cause of death for people in this age category is by accidental causes. Since AIDS symptoms often occur up to ten years after HIV infection, we know that a large percentage of these people were infected as teenagers and young adults. More than two (2) teenagers in America are infected with HIV every hour. Every year 3 million American teenagers acquire a sexually transmitted disease leaving them more susceptible to HIV infection.

HIV stands for Human Immunodeficiency Virus - the virus which leads to AIDS in many people. You may hear people talk about "HIV infection" or "HIV disease" to describe the health of someone who has the virus but is not yet sick with AIDS. AIDS is a very serious condition which can result from HIV infection.

Scientists first discovered HIV in late 1983 and early 1984.
There are 2 types of HIV:
1) HIV-1: The major type in the United States, Europe and Africa.
2) HIV-2: Found mostly in Western Africa. Both types of HIV infection can make people sick. HIV-2 may progress somewhat more slowly than HIV-1. HIV-1 and HIV-2 are transmitted in the same ways. In New York State, City and State laboratories began doing routine screening of both HIV-1 and HIV-2 in the late fall of 1997 for all HIV antibody tests. The HIV-1 test can miss up to one third of the cases of HIV-2 infection. There have been very few cases of HIV-2 in the United States, but recently numbers are increasing.

What is the Immune System?
Your body usually protects you from getting sick. There are always harmful germs around you, including viruses. Your immune system protects you against germs in many ways. For example, your skin is part of the immune system. It provides a barrier against germs entering the body. If you get cut or have a break in the skin, germs can enter more easily and cause infection.

Another part of your immune system is your blood - made up of red cells and white cells. The white cells help protect you from disease. When a germ invades your body, your white blood cells go to work to destroy it.

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Why Does HIV make people sick?
One type of white cell, called a CD4-T cell or "helper" cell, is very important in fighting disease. This CD4-T cell is the target of HIV. When HIV gets into the blood, it seeks out, attaches to, and then destroys CD4-T cells. So, the very cells which are supposed to protect the body against disease are attacked and destroyed. One result is that people infected with HIV get infections and diseases that people with healthy immune systems don't get - because their CD4-T cells can't protect them.

HIV also uses the CD4-T cell to reproduce and create more virus. The cell becomes an "HIV Factory". So when the virus destroys the CD4-T cell, the HIV that was manufactured in it enters into the bloodstream.

HIV can also target and attach to some other body cells (besides CD4-T cells) and cause infection in different parts of the body.


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Where in the Body is HIV Found?

HIV lives only in human fluids. HIV is found most abundantly in the following body fluids:

- Blood
- Semen
- Fluid from a woman's vagina and/or cervix (the wetness in a woman's vagina)
- Breast milk
- Fluids inside the body - fluid around the brain, joints, lungs, heart, and the "bag of water" (amniotic fluid) around a baby growing in the womb

People infected with HIV, can spread HIV to others through these body fluids.

About Pre-cum: Pre-cum is the fluid that comes out of the penis before ejaculation or orgasm. HIV can be found in pre-cum. It is difficult to gather information about the risk of HIV infection through contact with an infected person's pre-cum during oral, anal or vaginal intercourse.

Some body fluids do not spread HIV to others/ These fluids do not spread HIV:
saliva tears sweat urine feces

If a person has HIV, health care workers, friends, co-workers, and family members will not get it by touching or coming into contact with these 5 body fluids. Although the virus may be present in some of these body secretions, it is found in concentrations too low for transmission.

If there is blood present in saliva, urine, or feces, there will be more HIV. Still, there are no recorded cases of anyone getting HIV from these fluids. If transmission did occur under these circumstances remember it would be a blood to blood transmission. Saliva, urine and feces do not transmit HIV.

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How is HIV Spread?
For any virus to spread, certain steps must happen:

1. Someone or something must carry or have the virus. We call this the source of infection. With HIV, specific human body fluids from a person with HIV infection are the source.

2. The virus needs a way to exit (leave) the body.
With HIV, infected body fluids can exit and can be passed to others in these ways:
- During sex (anal, oral, vaginal intercourse)
- Sharing injection drug works (needles)
- From mother to baby in the womb, during birth, or during breast feeding
- In medical care situations, infected blood or body fluids may infect health workers in accidental needle sticks or "splashes"
- Through infected blood or body parts which are donated to others (very low chance).

3. The virus needs a way to enter another person's body. Body fluids from a person infected with HIV can enter another's body in the ways listed under #2 above. It's important to know that no one gets HIV by giving (donating) blood - only by getting HIV infected blood, which is now rare (1 person out of 225,000).

There's one more way for HIV to enter the body which mostly affects health care workers. If a surgeon, for example, is splashed in the face with blood or body fluids from an HIV infected person, he or she may be infected with HIV through the mucus membranes in the eyes, nose, and mouth. That's why health care workers protect themselves with gloves, goggles, and masks. A person infected with HIV cannot pass on the infection by sneezing or coughing or crying. Remember, spit, sweat, and tears do not spread the virus.

4. HIV needs someone able to get infected, a susceptible host. In the case of HIV, every human is susceptible, but only if the person does something to put themselves at risk.
Let's look at each of the ways HIV infection is spread in detail, so you know exactly how people can get HIV and how they can't.

How HIV Can Spread Through Sex

As we've discussed, in a person infected with HIV, HIV is in the semen or vaginal fluid. If the person infected with HIV has unprotected sex with another person, the HIV infected semen or fluid can enter the other person through their rectum, vagina, penis, or mouth. So, these sexual activities can transfer HIV from one person to another:

- Vaginal intercourse
- Oral intercourse
- Anal intercourse
- Other sexual activities that involve the exchange of body fluids, such as sharing "sex toys" or getting semen or vaginal fluid into the body through cuts in the hand.

HIV Infection Can Be Spread By Sex Between:

- A Man and a Woman
- A Man and a Man
- A Woman and a Woman

About Kissing: "Dry Kissing" will not spread HIV. Deep kissing or "French kissing" is more risky. A person infected with HIV could spread HIV to a partner if they both have sores or cuts inside their mouths. This could allow the exchange of HIV infected blood.

About Biting: In the United States there is one documented case of HIV transmission through biting. It is important to remember that although the behavior of biting did reportedly result in HIV transmission the body fluid that was present in this instance was blood and not saliva. In this incident there was severe trauma with extensive tissue tearing and damage and presence of blood reporting. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not results in HIV infection. Again, blood can transmit HIV, saliva can not/

A person can get HIV infection from one unprotected sexual contact, and some people do. Others don't. We don't know why some people get HIV right away and others don't. We do know that each time a person has unprotected sex with a person with HIV, the chances of getting HIV go up. We also know that certain things increase the risk of an uninfected person becoming infected with HIV if they have unprotected sexual contact with a person who had HIV, for example the presence of an STD in either sexual partner.

What Are The Most Common STD's?
The symptoms of the different STD's are often very similar and frequently there are no symptoms. Community education efforts can help raise awareness about STD's. Community HIV/AIDS Educators can play an important role in encouraging community members to ask for routine screening for STD's and seek treatment whenever necessary.
Remember, you can't tell by looking at a person if he/she is infected with a disease that can be passed to others during sex. It's possible to have more than one STD at the same time, and it's also possible to get the same disease again. The longer treatment is put off, the more damage the disease can do to the body. Anyone who suspects that they've been exposed to an STD should visit their doctor or clinic immediately. Sex partners should be checked and treated at the same time to avoid re-infecting each other. Clinic treatment is confidential and persons under 18 can be treated without their parents' consent or knowledge.

Although some of these conditions can develop with out any sexual contact, all can be transmitted sexually.
Diease	Usual time from contact to first symtoms	Usaual Symtoms	Diagnosis	Complications
GONORRHEA (Also called dose, clap, drip) Cause: bacterium	2-10 days sometimes 30 days	Yellowish-green genital discharge, burning sensation during urination, occasionally no symptoms in men; usually no symptoms in women.	Examination, smear for men, culture for women	Pelvic inflammatory disease (severe abdominal pain), ectopic (tubal) pregnancy, sterility (will not be able to have children), arthtitis, blindness, eye infection in new
SYPHILIS (Also called syph, pox, bad blood) Cause: spirochete	10-90 days Average 21 days	First Stage: painless sore that disappears without treatment on genitals, fingers, lips, breast;Second state: rash, fever, flu-like ilness; Latent stage: none	Examination, Blood test	Brain damage, insanity, paralysis, heart disease, death. Damage to skin, bones, eyes, liver, teeth of fetus and newborns.
HERPES SIMPLEX (Also called herpes, virus) Cause: virus	Up to 2 weeks	Swollen, tender, painful blisters on genitals or lips	Pap Smear examination, herpes culture	Strong evidence linking infection to cervical cancer; severe central nrevous system damage or death in infants infected during birth.
NON-GONOCOCCAL URETHRITIS cause: chlamydia, mycoplasmas	1-3 weeks	Thin, clear discharge, frequent urination; usually no itching, occasionally burning with urination	Examination, screening test or culture for chlamydia	Urethral stristures and prostate problems in men, pelvic inflammatory disease in women and possible eye infections or pneumonia in newborns.
NON-GONOCOCCAL CERVICITIS (mucopurulent cervictis) Cause: chlamydia, other bacteria	Varies 1-3 weeks	Discharge occassionally bleeding after sex, abnormal periods	Examination, screening test or culture for chlamydia	Pelvic inflammatory disease, sterility, tubal pregnancy, scar tissue and possible eye infections or pneumonia in newborns.
TRICHOMONAS (Also called trich, TV, vaginitis) Cause: protozoa	Varies 1-4 weeks	Discharge, intense itching, burning and redness of genitals and thighs; painful intercourse; usually no symtoms in men.	Pap smear, examination, urinalysis, wet mount prepaeration	Gland infections in females, prostatitisin men.
CANDIDIASIS (Also called moniliasis, vaginal thrush, yeast, candidiasis) Cause: fungus	Varies	Thick, cheesy, smelly vaginal discharge; itching,skin irritation; usually no symtoms in men.	Examination, culture, wet mount preparation	Secondary infectionsby bacteria; mouth and throat infections of newborn.
NON-SPECIFIC VAGINITIS Cause: bacteris or chemical irritation	Varies	Varies- may have discahrge, itching,burning with urination redness of genitals	Examination, culture, wet mount preparation	Medical complications unknown.
VENEREAL WARTS (Also called genital warts, condylomata acuminata) Cause:virus	Varies, 1-8 months usually 2 months	Local irritation, itching, pink or red cauliflower like raised areas; sometimes they can look like ordinary skin warts	Examination	Highly contagious; can spread enough to block vaginal opening. May also be linked to cervical cancer in women.
PEDICULOSIS PUBIS ( Also called crabs, cooties, lice)	3-14 days	Intense itching, pin-head blood spots on underwear; small eggs or nit on pubic hair	Examination	No medical complications
SCABIES (Also called the itch)	Varies 4-6 Weeks	Severe nighttime itching, raised gray lines in skin where mite burrows may infest elbows, hands, breasts and buttocks as well as genitals	Examination	Unknown
A.I.D.S. Acquired Immunodeficiency Syndrome Cause: Human immunodeficiency virus (HIV)	2 years to 5 years or more	Purplish discolorations on arms and legs, unexplained weight loss, persistent cough, loss of appetite, fever, extreme fatigue	Blood tests, specific tests for cancer and infections	Severe psychiatric problems, death

The STD/HIV Connection
An untreated STD in a person living with HIV can increase the amount of HIV in semen and vaginal secretions. Studies have shown that the amount of virus in semen and vaginal secretions can be 3-8 times greater if a person has an STD. With these higher amounts of HIV present, it can be easier for the infection to be passed to others when they have unprotected sex.
An untreated STD can make it easier for a person not infected with HIV to become infected. We know that STD's that cause sores (i.e. herpes, genital warts) provide an opening on the skin that can make it easier for HIV infection to occur if the person has unprotected sex with an HIV positive person. We now also know that the presence of any STD can increase a person's chance of being infected with HIV. STD's can bring many CD4 cells into the genital area. (This is true for STD's that don't cause open sores, i.e. chlamydia, gonorreah and for those that do cause open sores, i.e. herpes, genital warts). Since there are more CD4 cells in the genital area and these are the cells that HIV is looking to infect, a person with an untreated STD who had unprotected sex with an HIV positive person can be at higher risk of HIV infection. One large study in Africa demonstrated that diagnosis and treatment of STD's in the general community decreased the rate of new HIV infections in that community.

One way to look at the relationship between STD's and HIV is to recognize that the STD/HIV relationship falls across three interelated catergories:

Behavioral - The transmission of HIV and STD's are related to the shared risk behaviors of sex and substance use. Unprotected sex can result in both HIV and STD transmission. Individuals who share needles are at increased risk for both STD's and HIV.

Epidemiological - Populations with large numbers of individuals engaging in needle sharing and the exchange of sex for drugs show overlapping high numbers of STD and HIV infection. These populations are disproportionately women and adolescents of color.

Biological - As we previously described, the presence of an STD increases the chances that HIV transmission will occur through sexual contact.

How HIV Can Spread Through Sharing Needles Or Works Shooting drugs:
When people inject or "shoot" drugs, they use the following items (often called "works")
- A Needle
- A Syringe (barrel and plunger)
- A Cooker (container used to dissolve drugs from solid to liquid; may be a spoon or bottle top)
- A Cotton/filter (used to strain the drug)
- A Water glass (used to rinse the syringe and or dilute the drug).

If a person infected with HIV shoots up and then shares the works with others, infected blood gets on the works and will be directly injected into someone else. Here's how it happens:

1. When a drug user inserts the needle, she/he checks to see that it's in a vein by drawing back on the plunger. If some blood enters the barrel, the needle is in the right place. Sometimes, drug users draw blood into the syringe on purpose to mix it with the drug they are going to inject. This is called "booting". Either way, HIV infected blood can get into the needle, barrel, and plunger.

2. If the needle is shared, the next user draws up more drug from the cooker through the cotton filter. The infected blood gets on the cooker and filter.

3. If the needle and syringe are rinsed off in the water glass between users, HIV infected blood can get into the water. If the water is used by others to mix drugs, HIV can get into the drugs.

Body piercing, tattooing, injecting steroids, removing unwanted hair: Needles used for any of these purposes can transmit HIV if used on a person infected with HIV and then reused on someone else (without sterilizing).

How HIV Can Spread From Mother To Baby
There are 3 ways mothers can pass HIV infection to their babies:
1. in the womb, from the amniotic fluid ("bag of waters" or "water bag") or through the placenta.
2. during birth, when a baby is directly exposed to its mother's blood and vaginal/cervical fluid.
3. through breast feeding. HIV is passed in breast milk. Breast feeding increase the risk
of transmission from an HIV-infected mother to infant by 14%.

Additional facts:
Studies show that WITHOUT MEDICAL TREATMENT about 15-25% of babies born to mothers infected with HIV are infected.
With treatment, the chances of transmission of HIV from mother to baby can be reduced significantly. Studies show that it can be reduced from 25% to 3%.
All newborns are tested for HIV antibodies under the state's Newborn Screening Programs and all mothers are routinely provided the test result. If the HIV test done on the newborn is positive, it means that the mother is living with an HIV infection. Due to passive transfer of antibodies during pregnancy, all babies born to women living with HIV will have a positive HIV antibody test.
Further tests are needed to determine whether the baby is actually infected with HIV. A PCR (polymerase chain reaction) test is used to detect HIV in the baby's blood. It is possible to identify most babies who are infected with HIV by about one month of age.
If the PCR test does not detect HIV in the baby at one month, he/she will be tested again at four months of age. If the test for the baby does not show HIV infection by four months of age, then the baby is considered not infected.

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How HIV Can Be Spread To Health Workers
The chances of a health worker getting HIV infection from a patient infected with HIV is very low, but it does happen. How it happens:

1. Through needle sticks. For example, a nurse gives a shot to a patient infected with HIV and then sticks herself by accident with the same needle. The patient's HIV infected blood in the needle enters her blood and may cause infection.
2. Through contact with HIV infected body fluids. For example, a surgeon who operates on a patient infected with HIV may, by accident, get HIV infected blood or body fluid into her eyes, nose, mouth, or into a cut in her skin. A dentist is at risk from blood from the mouth of a patient infected with HIV.

Health workers protect themselves by using latex gloves, masks, and goggles. Health care workers can also protect themselves by handling needles and other sharp tools carefully.

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What if a health care worker gets a needle stick or has contact with HIV infected body fluids?
If a health care worker gets a needle stick or has contact with body fluids that may have HIV, there are a number of things that can be done to lower or reduce the chance of the health care worker becoming infected. Medication is available that can reduce the risk of infection. The chances of a a patient getting HIV from a health care worker infected with HIV are very low. There is only 1 proven case of this. A Florida dentist infected with HIV may have passed it to several patients. We don't know exactly how this particular transmission may have happened, but we do know that it did happen.

How HIV Can Be Spread From Infected Blood Or Donated Body Parts
We repeat: There is no risk of HIV infection in giving (donating) blood. The risk of HIV infection from getting a blood transfusion is very small. Before 1985, blood used in hospitals and clinics was not tested for HIV and people were infected with the virus in this way. Now, all blood is tested for HIV. All blood donors are asked if they have had HIV risk activities. When people donate body parts or semen (for sperm banks), they, the donors, are tested for HIV. So, the risk of getting HIV from donated parts or semen is very small.

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How is HIV not spread?
HIV is not spread by contact with/through:
doorknobs, toilet seats, beds, clothes, telephones, mosquitos, food, handshakes, water fountains, hugging, coughing, etc. etc. etc.

Remember, the general rules are:
1. HIV only lives in human body fluids, including: blood, semen, female vaginal and cervical fluids, breast milk, and fluid around parts inside the body.
2. The blood or body fluids of a person infected with HIV must get into the blood of others to infect them. HIV is killed byexposure to the air and by plain household bleach.
HIV is killed by the air and by plain household bleach.
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