HIV/AIDS Overview

Illustration of pandemic HIV (Human Immunodeficiency Virus) capsids threatening Africa
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What is HIV?

The human immunodeficiency virus (HIV) is a virus that attacks the cells of the immune system. Although infections may show no clinical signs for years, without treatment the virus can reduce the strength of the immune response and leave HIV-positive individuals susceptible to other diseases. HIV itself usually causes few to no symptoms . It is potentially devastating, instead, because it lowers the body's defenses against other diseases.

The diseases that take advantage of HIV's effects on the immune system are known as opportunistic infections.


The Early History of the HIV Epidemic

HIV first came to public attention in the early 1980s when, on opposite coasts, doctors noticed sudden spikes in the numbers of two rare diseases occurring among gay men. In New York, a group of eight men had been diagnosed with a rare form of cancer known as Kaposi's sarcoma (KS). In both New York and Los Angeles, infections with an unusual type of pneumonia caused by the fungus Pneumocystis carinii (PCP) were also on the rise.

Doctors and scientists, at first, were dumbfounded by the sudden surge in these two diseases. There were many theories early on. Some suspected that they might be related to drug use in the gay community, specifically amyl nitrate ("poppers") or to a particularly dangerous strain of cytomegalovirus.

After about a year of the disease being identified strongly with the gay population, where it was sometimes called "gay-related immunodeficiency" (GRID) or "gay cancer," researchers began to notice that the same syndrome was occurring in other groups of people -- particularly in injection drug users, people from Haiti, and hemophiliacs.

Unfortunately, that belated realization had a high cost. Even today, when the vast majority of HIV infections worldwide are heterosexually transmitted, there are many who still think of it as a "gay disease."


How is HIV Transmitted?

HIV is transmitted through bodily secretions. It is not transmitted by casual contact. Methods of HIV transmission between adults include sex (oral, vaginal, anal) with an infected partner and sharing needles or syringes with an infected partner. HIV can also be transmitted from a mother to her infant during pregnancy, birth, or breastfeeding. Bodily fluids that contain HIV include:

  • blood
  • semen
  • vaginal secretions
  • breast milk

HIV is also found in saliva and tears, but there have been no documented cases of transmission from either of these sources. Contact with the saliva, sweat, and/or tears of a person infected with HIV does not put you at risk of the disease.

Doctors consider there to be an extremely small risk of HIV transmission from open-mouthed kissing someone who is HIV positive; however, this risk is from the possible presence of blood in the mouth. For this reason, some HIV educators recommend not brushing or flossing your teeth right before kissing, since tooth brushing can cause bleeding.

Instead, if you are worried about your breath, use a mouthwash or chew on a piece of gum.

However, this is not something that should cause a great deal of stress since, in the entire history of the HIV/AIDS epidemic, the Centers for Disease Control and Prevention (CDC) have only identified one case of HIV transmission that may be related to open-mouth kissing, and they are not even certain of that one.


How is HIV NOT Transmitted?

HIV is not transmitted through casual contact. You can't get it from hugging, shaking hands, sharing food, or even a casual kiss. Because HIV is such a fragile virus, it doesn't live long outside the body.

You are therefore also not at risk of the virus if you use public restrooms, drinking fountains, doorknobs or any other public facilities. HIV is a relatively difficult virus to transmit.


Who is at Risk Of HIV?

There is no group that is safe from the risk of HIV. HIV transmission can occur in people old and young, gay and straight, white, black, or any other race. If you have unprotected sex, or share needles, you are at risk of HIV infection no matter who you are. Doubtful? According to the CDC, in 2005:

  • There were more new diagnoses of HIV in individuals over 40 than in people under 40, but it was a close call.
  • Though blacks bear a disproportionate burden of HIV in the United States, whites and Hispanics accounted for approximately half of all new HIV diagnoses.
  • Heterosexual sex was responsible for twice as many new HIV cases as injection drug use.
  • Male-to-male sexual transmission was the source of approximately half of new reported HIV infections.
  • Approximately one quarter of all new infections occurred in women.


Can HIV Be Prevented?

HIV prevention is a matter of taking proper precautions. Using a condom or other barrier correctly every time you have anal, vaginal, or oral sex, not sharing needles or syringes, and wearing latex gloves whenever you come into contact with blood or other secretions will vastly reduce your risk of becoming infected with HIV. Although proper precautions should always be taken, regular testing is also essential, so that people know their HIV status and can make informed decisions about their HIV risk

Although circumcised men have a reduced risk of HIV compared to uncircumcised men, circumcision is only recommended as an intervention for men who live in areas with a high prevalence of HIV and a low prevalence of condom use. Circumcision does not eliminate the possibility of men contracting HIV from their male or female sexual partners, it only reduces it.



HIV Testing

HIV tests work in various ways. Testing can be anonymous or confidential. Tests can be done with a blood test or an oral swab. Furthermore, in some areas, rapid tests are now available that can reduce the time you need to wait for a result from days to about 30 minutes. In 2012, such tests were approved by the FDA for over the counter use at home . However, are not always widely available.

HIV Treatment

HIV treatment is incredibly complex. Any HIV-positive individual should expect to spend a great deal of time discussing possible treatment options with their physician. The goal of HIV treatment is to reduce the levels of virus in the blood to undetectable. This will slow the progression of the virus, and help an HIV-infected person maintain a strong immune system that can fight off other infections.

Although there will soon be new classes of medication on the market, there are currently five different types of HIV-medications:

  1. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTI)
  3. Protease inhibitors
  4. Fusion inhibitors
  5. Integrase inhibitors

Highly active antiretroviral therapy (HAART) usually involves a combination of three or more of these drugs, which work in combination to minimize the amount of virus present in the blood.

HAART is also known as combined antiretroviral therapy (cART)

Because HIV can become resistant to treatment with different medications, it is extremely important for patients to take their drugs exactly as prescribed. There are a limited number of effective HIV treatments. In addition, patients want to be able to continue treatment for as long as possible.

If you are having problems with your treatment, discuss it with your doctor before discontinuing your drugs. Side effects of some HIV treatment can be extraordinarily unpleasant. However, there are ways to adjust your medications to maintain their effectiveness while minimizing the symptoms the drugs themselves cause.

HIV is a Virus ... AIDS is a Definition

AIDS is not one disease. Instead, an HIV-positive person is considered to have AIDS when one of two things happen:

  1. Their CD4 (a type of immune cell) count drops below 200.
  2. They develop an AIDS-defining condition.
    AIDS-defining conditions are diseases that are extremely uncommon in individuals with a healthy immune system. A current list of these disease can be found here. Not all opportunistic infections are AIDS-defining conditions.

HIV and Pregnancy

All pregnant women should be HIV tested as soon as they discover that they are pregnant. HIV treatment during pregnancy is safe for the infant. It also greatly reduces the likelihood of giving birth to an HIV-positive child. Scientists also strongly recommend HIV testing in the third trimester,. That allows drug treatment to be started. If necessary, a mode of delivery can also be chosen to reduce the risk of transmission to the child.

Proper testing and treatment during pregnancy and delivery can reduce the risk of an HIV-positive mother giving birth to an infected child from 25% to 2%.

If you or your partner are HIV positive, and you wish to become pregnant, first talk to your physician. There are ways to plan a pregnancy to reduce the likelihood of infection between partners. There are also ways to lessen the risk for the infant.

Breastfeeding with HIV

In the United States, the CDC recommends that HIV positive women do not breastfeed their infants. HIV can be transmitted through breast milk,. Therefore, since clean water is widely available for making formula, there is no need to take the risk.

However, this recommendation is not necessarily useful in other areas of the world. In some places, the risk of an infant dying of a diarrheal disease is a bigger concern than infection with HIV. Where clean water is not available, breastfeeding with HIV is a far more complex decision that should be discussed with a woman's doctor. It may be the best option available.

Myths About HIV

Myth: HIV is a gay disease.
Fact: Worldwide, 98% of HIV infections are spread through heterosexual intercourse.

Myth: The only way men can become infected sexually is if they receive anal sex from another man.
Fact: Men can contract HIV from their female sexual partners, or if they perform penetrative anal sex.

Myth: You can get HIV from a toilet seat.
Fact: HIV is very difficult to transmit. It requires close personal contact and exchange of bodily fluids. The virus does not live long outside the body.

Myth: Young gay men don't have to worry about HIV.
Fact: Everyone who has unprotected sex or shares needles/syringes needs to worry about HIV.

Myth: HIV is no big deal.
Fact: Although current HIV treatment has greatly extended the healthy lifespan of HIV-positive individuals to lengths approaching those of uninfected people, it is still a serious disease.

Myth: I would know if my partner had HIV.
Fact: People can live with an HIV infection for years, or even decades, without symptoms. The only way to know if someone is HIV-positive is to ask if they've been tested.

A Word from Verywell

Improvements in HIV treatments have made what was once a devastating condition into a chronic illness. With proper treatment, individuals with HIV can live long healthy lives. In addition, when a person has been effectively treated, they pose a very low risk of infecting their partner. This is known as treatment as prevention

The History of HIV/AIDS
CDC Factsheet: How Well Does HIV Survive Outside The Body?. Retrieved from:
CDC Factsheet: HIV Transmission. (since removed)
CDC 2005 HIV/AIDS Surveillance Report. (since removed)
AIDSinfo: HIV and its Treatment
The WHO 2005 HIV/AIDS Surveillance Update Retrieved from: (since removed)
CDC HIV/AIDS Factsheet: Pregnancy and Childbirth, Retrieved from: (since removed)

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