Human immunodeficiency virus (HIV) is a virus that attacks the immune system. A person can transmit HIV to another under certain circumstances.
Understanding the facts about HIV transmission can prevent both the spread of misinformation and the transmission of HIV.
How does a person transmit or contract HIV?
HIV may be transmitted through certain bodily fluids that are capable of containing high concentrations of the virus. These fluids include:
- vaginal secretions
- rectal secretions
- breast milk
Amniotic and spinal cord fluids can also contain HIV and could pose a risk to healthcare professionals who are exposed to them. Other bodily fluids, such as tears, saliva, and sweat, do not transmit the virus.
How is HIV transmitted from person to person?
HIV is transmitted when a person who has measurable amounts of the virus in their body passes fluids directly into the bloodstream or through mucous membranes, cuts, or open sores of a person without HIV.
Let’s explore the most common ways that HIV is transmitted.
HIV exposure can occur during sexual intercourse. Both anal sex and vaginal sex have risks of HIV transmission.
Receptive anal sex has the highest risk of transmission among sexual activity.
There may be a number of reasons why, including that bleeding is more likely during anal sex due to the fragile tissues that line the anus and anal canal. This allows the virus to enter the body more easily, even if visible bleeding isn’t observed, as breaks in anal mucosa may be microscopic.
While vaginal sex possibly carries less risk of transmission than anal sex, either partner can contract HIV in this way. According to the Centers for Disease Control and Prevention (CDC), most people with a vagina who contract HIV get it from vaginal sex.
Sharing injection drug equipment
Sharing needles for injecting drugs transmits HIV most efficiently. This is because used needles and syringes can still contain blood, which can carry the virus.
HIV is not the only virus that can be transmitted by sharing drug injection equipment. The viruses that cause hepatitis B and hepatitis C can be transmitted in this way as well.
Less common ways of transmitting or contracting HIV
There are also some less common ways that HIV can be transmitted. Let’s take a look at some of them below.
Is female-to-male HIV transmission unlikely?
Generally speaking, female-to-male (or more accurately, someone with a vagina transmitting the virus to someone with a penis) transmission is less likely than male-to-female transmission.
In fact, it’s estimated that the risk of contracting HIV per heterosexual act is twice as high for females than males. However, female-to-male transmission can still occur.
Some factors can increase the risk of a person with a penis contracting HIV from vaginal sex. For example, open cuts, sores, or ulcers around the penis can provide a way for the virus to enter the body.
What about female-to-female transmission?
Female-to-female (or between two people with vaginas) transmission of HIV has been reported, but it’s generally believed to be less likely. This type of transmission can potentially occur due to exposure to vaginal fluids or menstrual blood.
Oral sex is a less common way to transmit HIV.
Some factors that may increase the risk of HIV transmission through oral sex include:
- open sores in the mouth or on the genitals
- bleeding gums
- having other types of sexually transmitted infections (STIs)
Blood transfusions and organ donation
The risk of contracting HIV from a blood transfusion, other blood products, or organ donation is now extremely rare in the United States. All donated blood or blood products in the United States are tested for several types of bloodborne pathogens, including HIV.
Organ donations are also screened for HIV. Although very rare, it’s possible for HIV transmission to occur following an organ transplant.
However, testing of organ recipients after surgery can quickly detect transmission so that antiretroviral medications can be started promptly.
Pregnancy and breastfeeding
HIV can also be transmitted from a pregnant person to their child during pregnancy, delivery, and through breastfeeding. However, recommended testing of all pregnant people for HIV has greatly reduced the number of babies who contract HIV in this way.
Additionally, if both the birthing parent and child receive HIV medications during pregnancy and breastfeeding, the risk of transmission can almost be eliminated, according to the World Health Organization (WHO).
Deep, open-mouth kissing
While very rare, it’s possible for HIV to be transmitted by deep, open-mouth kissing.
While the virus cannot be transmitted by saliva, transmission can occur if blood is present. This can happen when both partners have bleeding gums, open cuts, or sores in their mouths.
Tattoos and piercings
According to the CDC, there are no known instances in the United States of HIV being transmitted by receiving a tattoo or piercing. However, it’s technically possible for transmission to occur if equipment or ink is reused or shared.
HIV may be transmitted through accidental job-related injuries, such as cuts and needlesticks.
Healthcare professionals are most at risk for this type of transmission, but the likelihood is very low. The CDC looked at data from 1985 to 2013 and found 58 confirmed and 150 possible cases of occupationally acquired HIV were reported. During this period, only one case was reported between 1999 and 2013.
Bites that break the skin
A bite that opens the skin and causes bleeding can lead to the transmission of HIV. However, according to the CDC, there have been very few cases of a human bite causing enough damage to the skin to transmit HIV.
Ways HIV cannot be transmitted
There’s no need to be afraid of having casual contact with someone who is living with HIV. The virus does not live on the skin and cannot live very long outside the body.
Here are some ways that HIV cannot be transmitted:
- holding hands
- shaking hands
- sharing a toilet
- sharing dishes
- through air and water
- sitting next to someone with HIV
- closed-mouth kissing
- scratching surface skin
- a bite that doesn’t break the skin
- insects that bite, like ticks and mosquitoes
- other casual contact that does not involve transmission of bodily fluids
Does HIV load affect HIV transmission?
Having a detectable or measurable viral load can be a risk factor of HIV transmission. Viral load is the amount of virus that can be detected in the blood. The rate of HIV transmission goes up with increasing viral load.
Viral load is highest both during the early (acute) phase of HIV and without treatment with antiretroviral medications. Taking antiretroviral medications every day can reduce a person’s viral load to very low levels that cannot be detected through testing.
In this way, antiretroviral medications are not only a treatment, but an important tool for prevention. When HIV cannot be detected in the blood, a person living with HIV cannot sexually transmit the virus to a partner without HIV.
It can take up to 6 months of taking antiretroviral medications each day to achieve an undetectable viral load.
A person’s viral load is said to be “durably undetectable” when all test results are undetectable for at least 6 months after the first undetectable result.
People most at risk of HIV
There are several factors related to population, behavior, and health that may put a person at increased risk of HIV. These include:
- engaging in anal or vaginal sex without a condom or other barrier method
- having sex with multiple or anonymous partners
- sharing drug injection equipment
- having other STIs
- receiving injections or other medical procedures with unsterile equipment
Additionally, there are several groups that the CDC has identified as currently making up a larger number of new HIV cases in the United States based on their population numbers. This can mean there’s a bigger risk factor within these groups.
- men who have sex with men (MSM)
- African Americans
- people who use injection drugs
- transgender people
However, it’s important to remember that HIV can affect anyone, regardless of race, gender, or sexual orientation.
Is there a connection between HIV and other sexually transmitted infections?
Having an STI can increase the risk of HIV transmission. Some examples of STIs include:
- human papillomavirus (HPV) infection
There are a couple reasons that STIs can raise HIV risk. First, the symptoms of many STIs include genital inflammation, sores, or ulcers. These can all increase the chance of transmitting the virus from one person to another.
Second, like HIV, transmission of STIs is associated with some of the same types of behaviors, such as engaging in sex without a condom or other barrier method.
Some research has also indicated that certain STIs may be more closely linked with HIV transmission than others. These STIs include:
To prevent transmission of both HIV and other STIs, always use a barrier method during vaginal, anal, or oral sex.
Keep open lines of communication with sexual partners, such as sharing STI status and discussing the risks associated with sex without a barrier method.
HIV is most commonly transmitted through anal and vaginal sex and the sharing of drug injection equipment.
Examples of less common routes of transmission include oral sex and transmission during pregnancy.
HIV is not transmitted through things like casual contact or closed-mouth kissing.
There are several ways to prevent HIV transmission. For example, people living with HIV can take antiretroviral medications daily to reduce viral load to undetectable levels. Undetectable levels practically eliminate any risk of transmitting HIV during sex.
When having sex, always use a condom or other barrier method. Partners without HIV can also look into taking pre-exposure prophylaxis (PrEP). People who inject drugs can use safe injection sites and needle exchange programs.
When HIV first emerged, living with HIV carried tremendous social stigma. Today, improving HIV education and banishing the myths about HIV transmission are the best ways to end the stigma that can be associated with living with HIV.
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