Family doctor

Overview:

• The HIV virus is spread in sexual fluids, saliva and blood contact.
• Close physical contact and some exchange of fluids is required to pass the virus to someone else.
• Using condoms is the best method of prevention if you are sexually active.
• Unprotected anal intercourse and sharing needles and syringes carry a very high risk of spreading HIV.
• Oral sex and even protected anal sex may carry a higher risk than has been previously thought.
• Women are more at risk than men from vaginal sex.

How is HIV spread?

HIV is not passed by casual contact, like a cold or the flu. The virus does not survive for long outside the body and is not spread through everyday contact at home, at school or work.

HIV is passed from one person to another in sexual fluids and blood. This may happen during sexual intercourse, from a mother who has the virus to her baby during birth, or when sharing needles to inject drugs.

In New Zealand, blood, semen and organ donors are tested for HIV, but testing doesn't happen in all countries.

While the rate of HIV infection has slowed in the past there are concerns about complacent attitudes among those infected with the virus, and among those at high-risk of contracting it.

There is an incorrect perception that new AIDS drugs are able to "cure" the disease. However, drug-resistance can develop and some patients have problems with complex drug regimes.

Men who have sex with men remain the highest at-risk group of HIV infection, followed by injecting drug users. In heterosexual relationships, the virus is more likely to be passed from a man to a woman, than the other way round.

HIV Prevention:

There are times when you may be at risk from HIV but there are things you can do to avoid catching the virus.

Relationships:

Either abstaining from sex or having a totally monogamous relationship are the best ways to avoid HIV.

There are some activities that are thought to be associated with minimal risk from HIV. These include dry kissing, cuddling, touching, masturbation, and massage.

Urine, sweat, saliva, tears and faeces are considered to be extremely low risk for spreading HIV.

Using a condom makes all kinds of intercourse safer because the condom stops sexual fluids passing from one person to another. Even the least effective condoms offer a protection factor of over 10,000 compared with unprotected sex.

However, there are concerns that condom use is limited by the fact women do not have control over their use. The female condom does provide protection against HIV, but they are more expensive than male condoms and are perceived to be messy.

Women:

Women are at particular risk world wide. Currently in the US, one in three new cases of HIV occur among women.

It is thought hormonal changes during the menstrual cycle can alter the levels of membrane co-receptors for HIV, making it easier for the virus to infect cells.

Any vaginal infections or minor ulcerations and sores can also greatly increase the risk of becoming infected with HIV.

Homosexual relationships:

Unprotected anal intercourse for men or women carries a very high risk of HIV spread.

Public health agencies advise oral sex to be a relatively low risk activity providing there are no cuts, sores or bleeding gums in the mouth. And oral-anal sex (rimming), wet kissing and mutual masturbation to be very low risk.

However, recent evidence raises the possibility that perceived low-risk sexual activities may carry a higher risk than previously thought.

A study of 1500 HIV negative homosexual and bisexual men in America has found that only 15 percent of new infections were linked to unprotected anal intercourse. So-called "lower-risk" activities such as oral sex and protected anal sex with a condom were major risks for HIV transmission.

Although a given sexual practice may be considered low risk, the risk is never zero.

Injecting drugs

Injecting drugs is the second highest risk factor for getting infected with HIV.

Transmission of HIV through using needles has a flow-on effect because sexual partners become infected, followed by children whose mothers have been infected.

HIV can be spread if drug users share their needles, syringes, spoons and filters.

Using clean needles and syringes reduces the risk substantially.

Clean needles can be obtained through needle exchange programmes in most cities.

Other sexually transmitted diseases

Early detection and treatment of STDs is believed to be an effective HIV prevention strategy.

Other sexually transmitted diseases (STDs) can make it easier to contract HIV. STDs can cause genital sores, which can make it easier for HIV to get into your blood during sex.

Improved treatment of STDs in Tanzania has led to a significant reduction in the rate of HIV infection.

Skin piercing

The needles used in tattooing, ear piercing, electrolysis and acupuncture carry no risk of HIV if they have been sterilised, or if new ones are used each time. Ask about sterilisation before you have the treatment.

Future trends

A new stealth condom is being developed which is put in the vagina as a liquid and which solidifies into a plastic to prevent sperm and the HIV virus from coming into contact with vaginal tissue.

Chemical substances which kill the HIV virus are also being developed for vaginal or anal use.

Getting help

If you are worried you might have HIV, a blood test can be done to see if you have the virus.

For more information about HIV contact your family doctor, local STD clinic, Family Planning Clinic or the nearest branch of the New Zealand AIDS Foundation. The AIDS Hotline Freephone 0800 802-437.

Clean needles and syringes can be bought from some pharmacies which are part of the Needle Exchange Programme. The Auckland Drug Information Outreach Trust has a list of needle exchange pharmacies throughout New Zealand. Ph 376 8519.