HIV 101

What Is HIV?

To understand what HIV is, let’s break it down:

H – Human – This particular virus can only infect human beings.

I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.

V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

Human Immunodeficiency Virus is a lot like other viruses, including those that cause the "flu" or the common cold. But there is an important difference – over time, your immune system can clear most viruses out of your body. That isn't the case with HIV – the human immune system can't seem to get rid of it. Scientists are still trying to figure out why.

We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them.

Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS.

What Is AIDS?

To understand what AIDS is, let’s break it down:

A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.

I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease.

D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should.

S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs).

You will be diagnosed with AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.

How Do You Get HIV?

HIV is found in specific human body fluids. If any of those fluids enter your body, you can become infected with HIV.

Which Body Fluids Contain HIV?

HIV lives and reproduces in blood and other body fluids. We know that the following fluids can contain high levels of HIV:

• • Blood

  • Semen (cum)

  • Pre-seminal fluid (pre-cum)

• Breast milk

  • Vaginal fluids

  • Rectal (anal) mucous

Other body fluids and waste products—like feces, nasal fluid, saliva, sweat, tears, urine, or vomit—don’t contain enough HIV to infect you, unless they have blood mixed in them and you have significant and direct contact with them.

How Is HIV Transmitted Through Body Fluids?

HIV is transmitted through body fluids in very specific ways:

• • During sexual contact: When you have anal, oral, or vaginal sex with a partner, you will usually have contact with your partner’s body fluids. If your partner has HIV, those body fluids can deliver the virus into your bloodstream through microscopic breaks or rips in the delicate linings of your vagina, vulva, penis, rectum, or mouth. Rips in these areas are very common and mostly unnoticeable. HIV can also enter through open sores, like those caused by herpes or syphilis, if infected body fluids get in them.

  • You need to know that it’s much easier to get HIV (or to give it to someone else), if you have a sexually transmitted disease (STD). For more information, see CDC's The Role Of STD Detection And Treatment In HIV Prevention.

  • During pregnancy, childbirth, or breastfeeding: Babies have constant contact with their mother’s body fluids-including amniotic fluid and blood-throughout pregnancy and childbirth. After birth, infants can get HIV from drinking infected breast milk.

  • As a result of injection drug use: Injecting drugs puts you in contact with blood-your own and others, if you share needles and “works”. Needles or drugs that are contaminated with HIV-infected blood can deliver the virus directly into your body.

  • As a result of occupational exposure: Healthcare workers have the greatest risk for this type of HIV transmission. If you work in a healthcare setting, you can come into contact with infected blood or other fluids through needle sticks or cuts. A few healthcare workers have been infected when body fluids splashed into their eyes, mouth, or into an open sore or cut.

  • As a result of a blood transfusion with infected blood or an organ transplant from an infected donor: Screening requirements make both of these forms of HIV transmission very rare in the United States.

How Do You Get AIDS?

AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s. Read more about how HIV causes AIDS.

Reducing Your Sexual Risk

HIV can be spread by having unprotected sexual contact with an HIV-positive person. "Unprotected" means sex (anal, oral, or vaginal) without barrier protection, like a condom.

Some of the ways to reduce your risk of getting HIV through sexual contact include:

• • Don't have sex. Sex (anal, oral, or vaginal) is the main way that HIV is transmitted. If you aren't having sexual contact, you are 100% protected from getting HIV in that way.

  • Be monogamous. Being monogamous means: 1) You are in a sexual relationship with only one person and 2) Both of you are having sex only with each other. Having only one sex partner reduces your risk of getting HIV—but monogamy won't protect you completely unless you know for sure that both you and your partner are not infected with HIV.

  • Get tested and know your partner's status: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status can be difficult or uncomfortable—but it's important to start the discussion BEFORE you have sex.

  • You need to ask your sexual partners:

    • • Have you been tested for HIV?

      • When was the last time you had an HIV test?

      • What were the results of your HIV test?

  • If you have more than one sex partner, the CDC recommends that you be tested for HIV and other sexually transmitted infections (STIs) every 3-6 months.

  • Use condoms consistently and correctly. To reduce your risk of getting HIV or other STIs, you must use a new condom with every act of anal, oral, or vaginal sex. You also have to use condoms correctly, to keep them from slipping off or breaking.

  • You have to use the right kind of condom too. Latex condoms are highly effective against HIV. (If you are allergic to latex, you can use polyurethane or polyisoprene condoms.) Lambskin condoms will NOT protect you from HIV, because the virus is small enough to slip through lambskin.

  • You should always use a water-based lubricant when you use a condom for anal or vaginal sex. Lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (like petroleum jelly, hand lotion, or cooking oil). Oil-based lubricants can damage condoms and make them less effective.

  • Both male condoms and female condoms will help protect you against HIV and other STIs. To learn more about how to use a condom correctly, see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams.

  • Condoms do not provide 100% protection against all STIs—but you are ALWAYS safer using a condom! You can get certain STIs, like herpes or HPV, from contact with your partner's bare skin, even if one of you is wearing a condom. But condoms lessen the risk of infection even for those types of STIs.

  • Condoms with the spermicide Nonoxynol-9 are NOT recommended for STI/HIV prevention. Nonoxynol-9 (N9) irritates rectal and vaginal walls, which increases the chance of HIV infection if infected body fluids do come in contact with them.

For more information, see CDC's How To Use A Condom Consistently And Correctly.

Risky Business

All sexual practices can be made "safer"—meaning you can lower your risk of transmitting/contracting STIs and HIV—but some activities are much safer than others. Here's a list of sexual activities and the risks they pose for transmitting HIV or other STIs:

Receptive Anal Sex (Bottoming)

• • The odds of getting HIV from "bottoming" without a condom are higher than any other sexual behavior.

  • HIV has been found in pre-cum (pre-ejaculatory fluid), so having your partner pull out before he cums (ejaculates) may not decrease your risk.

  • Do not douche before sex. Douching irritates the lining of your rectum and this can increase your risk for getting HIV. If you are concerned about cleanliness, clean the rectum gently, with a soapy finger and water.

  • If you are bottoming, always use plenty of water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize damage to the rectum during sex and to prevent the transmission of STIs (including HIV).

Insertive Anal Sex (Topping)

• • "Topping" without a condom is considered a high-risk behavior for transmission of HIV and other STIs.

  • Your partner may have sores or other signs of infection in his/her rectum that you can't see. If you have tears or cuts on your penis, HIV can enter your body this way.

  • It is possible for blood and other fluids containing HIV to infect the cells in the urethra of your penis.

Receptive Vaginal Sex (Risks For Women)

• • Vaginal sex without a condom is considered a high-risk behavior for HIV infection.

  • During vaginal sex, HIV is transmitted from men to women much more easily than from women to men.

  • The risk for transmission is increased if you currently have another STI or vaginal infection. Many STIs and vaginal infections are "silent"—meaning you don't have any symptoms, so you may not be aware that you are infected.

  • Many barrier methods that are used to prevent pregnancy (diaphragm, cervical cap, etc.) DO NOT protect against STIs or HIV infection because they still allow infected semen to come in contact with the lining of your vagina.

  • Oral or hormonal contraceptives (i.e., birth control pills) DO NOT protect against STIs or HIV infection.

  • Female condoms DO prevent against HIV infection, if you use them correctly and consistently.

Insertive Vaginal Sex (Risks For Men)

• • Unprotected vaginal sex is less risky for the male partner than the female partner—but there is still a risk that the male partner can contract HIV and other STIs.

  • Some STIs are "silent," meaning that a woman may have an STI but not have any symptoms. Your partner may not know she has an infection, so it is important to use a condom.

  • Use a new condom with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Performing Oral Sex On A Man

• • You can get HIV by performing oral sex on your male partner, although the risk is not as great as it is with unprotected anal or vaginal sex.

  • You are also at risk for getting other STIs, like chlamydia and gonorrhea.

  • Your risk of contracting HIV is reduced if your male partner does not ejaculate (cum) in your mouth.

  • Your risk of HIV is reduced if you do not have open sores or cuts in your mouth.

  • Using condoms for oral sex reduces your risk of getting HIV or other STIs.

Receiving Oral Sex If You Are A Man

• • There is less associated risk for HIV infection with this sexual activity.

  • Your risk of HIV is reduced if you do not have open sores or cuts on your penis.

  • There is a risk of contracting other STIs, including herpes.

Performing Oral Sex On A Woman

• • HIV has been found in vaginal secretions, so there is a risk of contracting HIV from this activity.

  • It is possible to contract other STIs from this activity.

  • There are effective barriers you can use to protect you from contact with your partner's vaginal fluids. You can cut open an unlubricated condom and lay it over your partner's vulva. You can also use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (Plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

For more information on dental dams, please see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams.

Receiving Oral Sex If You Are A Woman

• • The risk for contracting HIV this way is significantly lower than for unprotected vaginal sex.

  • There is still a risk of contracting other STIs, like herpes, and bacterial infections.

  • You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

• • The risk of getting HIV by rimming is very low—but this kind of sexual contact comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.

  • You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

• • There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.

  • Use medical-grade gloves and lots of water-based lubricant to eliminate this risk.

Sex Toys

• • Using sex toys can be a safe practice, as long as you do not share your toys with your partner.

  • If you share your toy with your partner, use a condom on the toy, if possible, and change the condom before your partner uses it.

  • Clean your toys with soap and water, or a stronger disinfectant if indicated on the cleaning instructions. It is important to do this after each use!

Prevention

• 1. PrEP-Pre-Exposure Prophylaxis is a pill for those at high risk for HIV. Taken daily, it can block HIV.  

  2. U=U-  Undetectable = Untransmittable. It means that someone with an undetectable HIV viral load on HIV treatment (ART) cannot transmit HIV.