How is HIV passed from one person to another?

The following is copied from the Centers for Disease Control:

“Only certain body fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth. 

In the United States, HIV is spread mainly by having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV.

For the HIV-negative partner, receptive anal sex (bottoming) is the highest-risk sexual behavior, but you can also get HIV from insertive anal sex (topping).

Either partner can get HIV through vaginal sex, though it is less risky for getting HIV than receptive anal sex.

Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV. HIV can live in a used needle up to 42 days depending on temperature and other factors.

Less commonly, HIV may be spread from mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.

By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.”

HIV Is NOT Passed By:

• Donating blood
• Hugging, dry kissing, or sharing food
• Telephones, toilet seats, towels, or eating utensils
• Tears, saliva, sweat, or urine
• Mosquitoes or other insects

How can I prevent getting HIV from anal or vaginal sex?

The following is copied from the Centers for Disease Control:

“Use condoms the right way every time you have sex, take medicines to prevent or treat HIV if appropriate, choose less risky sexual behaviors, get tested for other sexually transmitted diseases (STDs), and limit your number of sex partners. The more of these actions you take, the safer you can be.

Specifically, you can:

• Use condoms the right way every time you have sex (see How well do condoms prevent HIV?). Learn the right way to use a male condom.

• Reduce your number of sexual partners. This can lower your chances of having a sex partner who will transmit HIV to you. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.

• Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicines daily to prevent HIV infection, if you are at very high risk for HIV. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you aren’t in a mutually monogamous relationship with a partner who recently tested HIV-negative, and you are a:

• gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months;

• man who has sex with both men and women; or

• heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at very high risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).

• Post-exposure prophylaxis (PEP) means taking HIV medicines after being potentially exposed to HIV to prevent becoming infected. If you’re HIV-negative or don’t know your HIV status and think you have recently been exposed to HIV during sex (for example, if the condom breaks), talk to your health care provider or an emergency room doctor about PEP right away (within 3 days). The sooner you start PEP, the better; every hour counts. If you’re prescribed PEP, you’ll need to take it once or twice daily for 28 days. Keep in mind that your chance of getting HIV is lower if your HIV-positive partner is taking medicine to treat HIV infection (called antiretroviral therapy, or ART) as prescribed and his or her viral load stays undetectable (see Does my HIV-positive partner’s viral load affect my risk of getting HIV?).

• If you’re HIV-negative and your partner is HIV-positive, encourage your partner to get and stay on treatment. If taken as prescribed, HIV medicine (ART) can make the amount of HIV in the blood (viral load) very low—so low that a test can’t detect it (called an undetectable viral load). People with HIV who get and keep an undetectable viral load can stay healthy for many years and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

• Choose less risky sexual behaviors. HIV is mainly spread by having anal or vaginal sex without a condom or without taking medicines to prevent or treat HIV.

Receptive anal sex is the riskiest type of sex for getting HIV. It’s possible for either partner—the partner inserting the penis in the anus (the top) or the partner receiving the penis (the bottom)—to get HIV, but it is much riskier for an HIV-negative partner to be the receptive partner. That’s because the lining of the rectum is thin and may allow HIV to enter the body during anal sex.

Vaginal sex also carries a risk for getting HIV, though it is less risky than receptive anal sex. Most women who get HIV get it from vaginal sex, but men can also get HIV from vaginal sex.

In general, there is little to no risk of getting or transmitting HIV from oral sex. Theoretically, transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other STDs, which may or may not be visible. See: How can I prevent getting HIV from oral sex?

Sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission but may pose a risk for other STDs.”

"1.1 million people in the US are living with HIV. 1 in 7 of them don't know they have it."

The Importance of HIV Testing and Early Detection

If you have been diagnosed with HIV, it is important to seek medical care immediately. Early detection is critical for remaining healthy and reducing the likelihood of transmitting it to others. 

“The science is clear: with HIV, undetectable equals untransmittable. U=U means that people living with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the blood—by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others.” (Eisinger, et al. DOI: 10.1001/jama.2018.21167 (2019).)

WNCAP provides free and confidential rapid testing for HIV, and Hepatitis C. Testing is available by appointment at the Asheville office (554 Fairview Rd.​), Monday – Friday from 9:00 am – 5:00 pm. Click here to make an appointment. Feel free to contact WNCAP for more information at info@wncap.org or (828) 252-7489.