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The Birds, the Bees, and HIV

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I used to spend every Thursday evening talking fellatio and semen with complete strangers. While this sounds racy, my conversations tended to be more clinical than copulatory. I was a volunteer at the San Francisco AIDS Foundation, and spent four hours a week answering calls on the California HIV/AIDS Hotline. It’s true I heard a lot of who put what where, but it was all in the context of: am I at risk for HIV?


I was a volunteer in 2003—thirty years after it was established that HIV is the virus that causes AIDS—and was surprised by how many people still had misconceptions about transmission of the human immunodeficiency virus. Can I get it from kissing? Touching blood? Shaking hands?


Although I knew how to answer most of these questions, I never quite knew how to quell the anxiety and fear callers had while they waited for test results or recounted a night of unprotected sex. HIV is not an epidemic in the United States, like it is in Africa, India, and other developing nations, but it is still something very much on our minds. And while it used to only be associated with homosexual men and intravenous drug users, HIV is increasing among women. This probably has to do with the fact that women are much more likely to contract HIV from a night of unprotected sex than men are. This—like periods, PMS, and pregnancy—is totally unfair, but just another reason to protect ourselves.


Here are the facts:


For HIV transmission to occur, the virus must be present in sufficient quantity and it must enter the bloodstream. The virus is present in four bodily fluids: the highest concentration is in blood, then semen, then vaginal fluid, and the lowest is in breast milk. Pre-seminal fluid, or pre-cum, can contain small amounts of the virus. The virus cannot be transmitted by sweat, saliva, urine, tears, or feces.


The virus can get into our bloodstream in three ways: sexual contact, blood to blood (intravenous drug use or blood transfusions), and mother to child (before birth or after birth, through breast milk). The majority of women (about 77 percent, according to the CDC) get it from heterosexual sex, the rest from intravenous drug use. Very few cases of mother to child transmission occur in the US because of rigorous prenatal testing. We can’t get it from shaking hands, sharing plates, or even kissing—unless you’re French kissing with gaping wounds in your mouth.


The two main ways that HIV is transmitted sexually is by vaginal and anal sex. The mucous membranes of the anus and vagina are porous and allow entry of the virus into the bloodstream. Anal sex is riskier because tearing can easily occur, which provides another source of entry for the virus. Unprotected vaginal and anal sex are high risk activities.


I was often asked at the Hotline if you can get HIV from oral sex. This is a bit tricky because yes, HIV is present in semen and vaginal fluid, but the mouth happens to be a very inhospitable place for the virus to live. We have oral enzymes that break it down and the skin in our mouths is less penetrable than that of our genital regions. So, oral sex is considered a very low-risk activity for acquiring HIV.


That’s transmission. What about protection? The first method of prevention against HIV is a latex condom. Latex condoms, used properly, will prevent the transmission of HIV and other STDs (not to mention screaming babies). If a lubricant is used, it should be water based (not oil) and it should not contain nonoxynol-9, which was first thought to protect against HIV but is now known to damage the skin, making HIV entry easier. Other fun things that can be used to have safer sex are latex dental dams, plastic wrap, latex gloves and finger cots, all of which can act as barriers between the infectious fluids and mucous membranes or open cuts. Female controlled forms of HIV protection, like microbicides, are being developed but are not yet out on the market.


Because we are living, breathing humans, sometimes we make mistakes—like going on vacation, drinking twelve Mai Tais in one sitting, and hooking up with the hot cabana boy. That leads me to the next topic, which is testing. Almost all HIV tests look for antibodies to HIV, not for the virus itself. The time it takes for your body to react to the virus and make antibodies (called seroconversion) is known as the “window period.” The window period is typically three months, although some people don’t produce antibodies until six months. The window period can be extremely frustrating: you had unprotected sex with cabana boy and now you have to wait three months to get tested?! But getting a test any sooner may not give completely accurate results—it’s better to wait and be sure.


A testing center will either do a blood draw, skin prick, or oral swab to test for HIV (there is no HIV in your saliva, just antibodies to HIV). Although the test itself may only take a couple of hours or even minutes, your testing center will most likely do them in batches, resulting in a week or two wait. Luckily, all this waiting rewards you with a very accurate test. If it’s negative, you are HIV-free (assuming you are not in the window period). If the test is positive, they will run another confirmatory test. Testing is either done anonymously, meaning your name is not associated with your results, or confidentially, meaning the testing center knows your name and may record your status in your medical file.


If you are interested in finding a testing site near you, or would like to find out more information about risk factors for HIV, call the California AIDS Hotline. It’s anonymous, free, and very informative.


California AIDS Hotline


1-800-367-AIDS

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