Frequently Asked Questions (I)

What exactly is the definition of AIDS?

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 can only keep it under control. After a number of years, your immune system starts to lose it's battle against HIV. After an average of 10 years of fighting HIV, your immune system starts to weaken, and 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 full-blown AIDS.

The definition of full-blown AIDS 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 less than 200.
2. A CD4 cell count less than 14%.
3. An opportunistic disease as defined by the US Centers For Disease Control and Prevention (CDC).

The normal CD4 cell count ranges between 800-1200, 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 either #1, #2, or #3 above, they are considered to have full-blown AIDS. If a person doesn't have HIV, or doesn't meet one of the 3 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%) they meet 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 a person is diagnosed with AIDS, they will always be considered to have AIDS, regardless of 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 breastmilk 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?

In summary, in order for infection to occur, 3 things must happen:

1. You must be exposed to pre-cum, semen, vaginal secretions, blood, or breastmilk, AND
2. The virus must get directly into your bloodstream through some fresh cut, open sore, abrasion etc., AND
3. Transmission must go directly from 1 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 3 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 (STD) can be transmitted easier than HIV, so what might be low risk for HIV may be high risk for other STD's.

Can you get HIV through 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 the mouth, the virus can get into your bloodstream. The risk is less than 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 (STD's) including herpes and gonorrhea.

Now, when we're talking about the levels of risk by giving oral sex, there is no one answer since several variables actually determine the true level of risk. Let me talk about the risks of giving a man oral sex as an example.

Both pre-cum and semen contain high concentrations of HIV. Semen is however 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 exposed to a much greater quantity of his body fluid.

Of course, the virus must also be able to get into the 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 the 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).

Regarding the risks of giving a woman oral sex:

Keep in mind that if you are giving a woman oral sex, the same principals apply as described above, that is, the more vaginal secretions and 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.

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 Sexually Transmitted Diseases (STD's). For example, if you give a man oral sex, and that man has gonorrhea, you could get infected with gonorrhea in the 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.

What are the risks from fingering someone?

The following describes in detail all about the risks of fingering.

Fingering is considered low risk for HIV. I am not aware of any 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.

If a cut is beginning to heal, or if it has a scab on it, it is no longer considered a fresh open cut, and is not a direct access to the bloodstream. But the larger the cut, and the fresher the cut, the greater the risk there would be if blood, semen, etc. were to get directly into that open cut. But once the cut begins to heal, the scab that develops acts as a barrier to prevent HIV from entering the bloodstream.

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, 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. If you were to get vaginal secretions directly in a fresh open cut on your hands, yes, there is 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 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.

Any breakdown in the integrity of the skin can allow HIV to enter the bloodstream. This includes cuts, abrasions, lesions from STD's (like herpes), or skin problems like dermatitis. For cuts, once a scab forms (usually within a few hours), this would no longer be an access to the bloodstream. 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.

If a cut has a scab on it, it is no longer considered a fresh open cut, and is not a direct access to the bloodstream. But the larger the cut, and the fresher the cut, the greater the risk there would be if blood, semen, etc. were to get directly into that open cut. But once the cut develops a scab, the scab that develops acts as a barrier to prevent HIV from entering the bloodstream.

Once a scab forms, it is no longer considered a fresh open cut, and is not a direct access to the bloodstream. The deeper and bigger the cut, the longer it would take for a scab to form. A scab will usually develop in minutes to hours (depending on the size of the cut). Once a scab forms, the cut is no longer considered an access to the bloodstream.

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.