HIV Questions & Answers
What is HIV?
HIV is the virus that causes AIDS.
What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome.
That doesn't help me any what does AIDS mean?
OK let's break it down. Acquired. This means you get it. It is not something that you are born with. This word means that at one time the person had a completely normal and functioning immune system and it stopped working correctly
Immune. This means protected, in a medical use situation it means protected from disease
Deficiency. This means you are lacking in full or part the normal amount. In a medical or disease use there are many deficiencies. You could be deficient in vitamin C for instance.
Syndrome. In a medical sense it means a collection of symptoms.
So to sum up; AIDS is a collection of symptoms involving your immune system not being up to par, that you didn't always have.
GRID was the name originally given to AIDS. It stood for Gay Related Immune Deficiency. It was changed in 1982 after the syndrome was found in Haitians, IV drug users and hemophiliacs.
What is ARC?
A condition in which antibody tests for AIDS virus are positive. THe patients may exhibit some or all of the following symptoms: enlarged lymph nodes, fatigue, fever, night sweats, weight loss, and unexplained diarrhea, but do not have any of the more serious complications of AIDS. They have not had any of the opportunistic illnesses that define AIDS. The term is not used much since the early 90s, but appears in older references
What's the difference between HIV and AIDS?
HIV is predecessor to AIDS in almost all cases. HIV means you have the virus known to cause AIDS but it hasn't devastated your immune system yet. The patient usually is nearly 100% well but is very capable of transmitting the virus.
AIDS means you have HIV and one of the defined opportunistic illnesses (insert link). After that you are defined has have AIDS. Even if you recover from said illness you are still classed as having AIDS.
What are the symptoms of HIV infection?
Initial HIV infection was originally thought to have no symptoms whatsoever. After 20 years of research this has proved to only be partially true. While some people show no symptoms after the initial infection with the HIV virus, most do. It takes the form of high fever, night sweats, and respiratory distress. It basically appears to be a severe cold or flu that occurs within 7 to 10 days after exposure. This occurs in over 85% of all people after initial infection and most often goes unrecognized.
This is virtually never fatal and the patient recovers, however he now infected and completely capable of infecting others. From initial exposure to development of full-blown AIDS is anywhere from two to five years, this is without any drug treatment or any other intervention.
However there have been cases now where people have tested positive and clearly have HIV since 1981 and have taken no drug treatment and are completely healthy. This is very rare, but not unheard of.
Because the initial sign of HIV infection takes the form of a flu or severe cold most people, unless they are actively looking for infection don't recognize it as the first step of HIV infection and write it off to a bad cold.
Is AIDS always fatal?
Surprisingly no. It is virtually fatal, but at this point we really don't know. One thing we do know is there has never been an illness in the history of the world where someone is not immune.
For example, rabies, which is regarded as universally fatal, has at least five known people to have recovered from the illness on their own. Of course this total, is five people in the entire history of the world, and rabies has been known as far back as recorded history goes. So if you get rabies you're certainly not going to be that lucky.
With HIV there are currently around two dozen people that have had infection 25 years and still are asymptomatic. They do not take drugs and show no sign of illness. Some of these people have genetic conditions This is not very encouraging for the millions who have it. (insert link for more details)
So even if I have HIV I might not die from it?
No, your chances of not dying from AIDS if you have HIV are much less than your winning a 200 million dollar lottery prize. We all know you ain't going to win that lottery and you aren't going to be one of those few people who remain asymptomatic. Those two dozen people are extremely lucky and you won't be one of them. Providing a bus doesn't hit you, AIDS will kill you if you get HIV. Eventually even if you are on cocktail drugs, the HIV virus will adapt to them and you will die. However because the cocktail drugs can lengthen life, you may die of something else before AIDS finally causes your demise
Is HIV a strong virus?
HIV is a fragile virus and it is not easily transmissible. The virus cannot live very long outside the human body, it is easily destroyed by bleach and very selective about what species it will infect. For instance the chlorine in a pool would kill it. It cannot penetrate intact skin; it needs to enter via a cut or via a mucous membrane such as in the anus, the tip of the penis, the vagina or the eye.
HIV is found in blood, semen, vaginal fluids and breast milk, in transmissible numbers. It is found in other bodily fluids at smaller concentrations thought to be non-transmissionable.
On the other hand, polio for example can live on a doorknob for a week. It can live in a pool of water for four months. Hepatitis B can live for a week in dried up blood or clothes. Other viruses can are much more hardy.
How is HIV transmitted?
It is transmitted in four basic ways: sexually, via blood transfusions, IV drug use and breast milk.
All blood is tested for HIV and thus is 99.9% safe now to get a blood transfusion. Prior to 1985 there was no test so people who received a transfusion prior to that date have a risk.
Breast milk is an effective but weak transmission. HIV+ mothers who breast feed their children do not always pass on the virus, but it has been known to occur.
OK so how can I as a gay man get HIV?
Having unprotected anal sex is a great way to get it. HIV is best transmitted via blood and the anus if filled with blood vessels and is rich in blood. Even in people that show no signs of bleeding, bleeding ALWAYS occurs during anal sex. Since HIV is in semen it is basically like taking the HIV virus and injecting it into your blood stream.
I'm a strict top do I have to worry?
I assume you mean a top not using a condom. The answer is, yes, but statistics have shown strict tops show a much less infection rate. One thing you must remember is any statistic quoted here or on any site are not 100% valid. Because HIV is virtually 100% lethal we can ethically conduct studies to statistical standard. We can't risk people's lives for the sake of having statistics. (See link to statistics)
People fail to understand statistics do not tell you IF something will happen they tell you whether something is likely to happen. I urge everyone to read my link to interrupting statistics before reading this so you can get full comprehension.
These statistics apply to men with no other illness and to HIV+ men not those with full blown AIDS.
So understand this, in an urban area such as San Francisco or New York City or Chicago, that rage of HIV infection for unprotected tops is from 15% - 25%.
The risk is higher for uncut males. Statistics for uncircumcised males and being a top without a condom go up to 35%-45%.
Why is the risk less for a top?
Let's look at this. In anal sex the penis inserted is most likely, there will be no tears. This is why uncut guys have a higher rate, simply because the risk of a tear in the foreskin is greater and occurs more.
Also remember when you are a top you are basically depositing semen in someone you are not getting anything deposited back. Also because semen shoots outward if there is anything on the tip of the penis it is thrust back into the bottom when the semen shoots outward.
Why is the risk higher for uncut guys?
The risk is higher simply because the HIV tends to get trapped in the foreskin. The longer it sticks around the greater the danger. Now remember HIV is fragile, it can't live long outside the body, but if it's trapped in the foreskin it will stay alive longer.
This is the reason in general uncut guys have a higher rate of all STDs not just HIV. If your uncut the simplest way is immediately after sex thoroughly wash your penis wish soap. Make sure you wash it entirely and right after sex. No antibacterial soap is needed. Plain soap and hot water will lower the risks to that of a circumcised guy.
I noticed you said "HIV not full blown AIDS," what's up with that
Good catch, shows your reading. These statistics apply only to HIV+ people. If a top is fucking unprotected a person with full blown AIDS his risk more than triples and in many cases approaches that of a bottom. Because HIV during the active AIDS stage is much more virulent and aggressive.
What is the risk of contracting HIV if I'm a bottom?
If you are a bottom using unprotected sex the rate is around 95% for the same giving populations. Since HIV is found in pre-seminal fluids it you pull out of the anus before ejaculation the rate is 90%-93% not much of a difference. But there is some difference.
If the risk is that high, how come I know total bottoms that don't have HIV
Because you have to have HIV to give it. They may be lucky and have only had other HIV- guys to have sex with. It isn't bareback sex that gives you HIV it's bareback sex with someone with HIV. In addition there is a current thought, not proven, that it takes more than one exposure of HIV to get the virus.
So if I use a condom during anal sex I'm safe?
No, you are not. You must be using a latex condom. A lambskin or any kind of animal condom is unsafe. A lambskin condom is 99% effective for protecting against pregnancy but HIV is much smaller so it just goes right on thru a lambskin condom. A latex condom used properly is the only effective condom.
So if I use a latex condom I will be safe?
No, see this is getting hard right? Latex condoms must be used with no lubricant or a water based lubricant like KY Jelly or even spit.
If you use a latex condom with oils, baby oils, cold cream, hand lotions or Vaseline it breaks down and the HIV virus just walks right on through that condom.
OK if I have KY and Latex, I'm safe
No, you're safer. You must use the condom properly. Put the condom on as soon as the penis starts to get hard. HIV is present in preseminal fluid. Leave space at the tip (even if it has a space) for cum. Squeeze the tip to get rid of all the air. The most common cause of breakage or condom slippage is the failure to do this.
There is no safe way to use a condom with a Prince Albert or any other piercing. These must be removed.
Condoms should never be reused. Never keep condoms in a wallet or glove compartment. Heat breaks down latex and can put microscopic holes in the condom.
When used correctly condoms decrease the rate of HIV infection to 96%-97%.
Only 96%? I want totally protection
Sorry won't happen. Even for pregnancy condoms are only 98.5% effective and HIV is smaller than the sperm needed for pregnancy so this risk goes up.
So why is it called "Safe sex" if it isn't
Because it's a word. Some people call it "safer sex," but that is semantics. Look at it this way, people have died in car accidents when they are wearing a safety belt, but we don't call it at "safetier belt"
Sex is about minimizing risks not 100% protections. Though HIV is 100% preventable. Don't have sex, don't have blood transfusions, don't do IV drugs and you won't get HIV. You start at this point and assess the risks and decide what your life is worth.
Does a spermicide help any?
It helps against pregnancy but in reality it is thought to make you more prone to HIV infection.
Here is why, at first the use of nonoxynol-9 a highly effective spermicide was shown to also kill HIV in the lab. So it was recommended as an additional preventative against HIV. Later it became clear that nonoxynol-9 causes burning, itching and actually produces minor tears in the vagina as well as the anus. Unless nonoxynol-9 kills every last bit of HIV (Which it is unlikely it will do) the additional abrasions caused by it will just give the surviving HIV viruses an additional route to infect the person.
Thus it is discouraged for HIV protection.
Can I get HIV from oral sex?
Yes, in a San Francisco study about 8% of those people who practiced oral sex and only oral sex, no anal sex whatsoever, got infected with HIV. These people were giving blowjobs not receiving them. Receiving a blowjob is nearly 100% safe.
What if I don't swallow?
Swallowing makes no difference. HIV cannot penetrate an intact throat. HIV is destroyed in the stomach by gastric juices. It is thought people contract HIV through oral sex via blood.
Blood? Huh? That makes no sense?
Yes it does, about 35% of all adults in the United States have gum disease by age 30. By age 40 the rate goes up to nearly 100%. Basically put gum disease equals bleeding. So the HIV is being transmitted from semen to blood via the gums.
We all know blood to semen transfer is heaven sent for the HIV virus.
So should I use a condom for a blowjob?
Yes to decrease risk. There are flavoured condoms and your risk of getting HIV from giving a blowjob with a condom on is nearly zero.
But most people won't do this. A couple of steps you should keep in mind to decrease risk are these. Do not engage in sex 24 hours after brushing your teeth. Most (but not all) people bleed even small amounts after brushing their teeth. It takes around 24 hours for the gums to recover. After a professional dental cleaning it is suggested waiting a week. It is suggested 30 days for major dental procedures such as gum surgery, root canal or tooth removal.
Condom for a blowjob? Come on who's gonna do this?
Well that is up to you. Remember this isn't about being risk free it's reducing risk. You find a level of risk you're comfortable with and stay with it.
Can I get HIV from rimming?
No, rimming is near zero risk for HIV, however rimming is a very easy way to get Hepatitis B and other amebic STDs.
Can I get HIV from kissing?
No, even deep kissing appears to be safe. After 25 years of study of HIV there has never been on documented case of transmission by kissing. Even though HIV is found in saliva and tears it is not found in great amounts. Furthermore saliva has a property that inhibits HIV. Of course since no one "just kisses" and has no other further contact we can't be 100% sure but if it isn't 100% it is darn close to 100% safe.
So saliva kills HIV?
No I didn't say that, I said it inhibits HIV. This means it prevents it from growing and in a sense, "doing it's thing," The HIV remains much alive. And if you were bleeding HIV could theoretically spread if you open mouth kissed someone, it isn't likely because of the inhibiting factors. Remember your immune system is killing HIV but eventually it becomes overwhelmed and cannot do it anymore.
Do other facts make you more susceptible to HIV infection?
Yes, it is thought the infection rate of HIV is dependent on several things. For instance using poppers will increase your chance of getting HIV. Poppers temporarily suppress your immune system. In fact it was originally thought that poppers were causing AIDS. Poppers also allow pain to be pleasurable. This allows a greater tearing during anal sex and more of the HIV to get into your body and infect you.
Having another STD taxes the immune system and makes it easier for HIV to invade. In fact over three quarters of HIV infected people are currently suffering from an illness (STD or otherwise).
What is the "cumulative assault" theory?
This is the theory that says the immune system can deal effectively with an assault by HIV. But the more times you get the HIV virus put into your body the greater stress it puts on the immune system and the less likely it can fight off further introductions of HIV to the system.
The idea has merit for other viral illnesses. For instance in Lassa Fever, if it can be determined exactly when you were infected, by testing you 24 hours later, (sometimes in as little as 8 hours) they can tell how bad the course of the illness will be.
However because HIV is virtually 100% lethal we cannot due proper testing with the virus. We simply do not kill people for the sake of knowing something.
So you're saying it takes more than one exposure to HIV to get AIDS?
It appears that a single exposure to the HIV virus is not enough to give you HIV infection or AIDS. But appearances can be deceiving and the data can be corrupted, since we cannot test HIV in a controlled environment, this is at best, an educated guess.
Let's also remember because we cannot do controlled tests we don't know Howit transmitted. We cannot even use data from people say, accidentally stuck with a needle. Because supposing two people get stuck with a needle known to contain HIV. But one of them has a cold and one doesn't. The one with the cold gets it, the one without a cold doesn't. Does this mean that you can get HIV from a single transmission or did the cold have something to do with it?
Again we can't do controlled studies so we don't really know for sure, we can make guesses.
Has anyone gotten HIV from a needle stick?
To date the CDC reports 55 known cases and over 150 probable cases. However in the 55 known cases not all were from sticks known to contain HIV. Some were multiple pricks of various illnesses. Of the 150+ probable cases we cannot be sure because the people were engaging in unprotected sex or using IV drugs, so it's probable they got HIV from the stick but it can't be certain.
The issue is further clouded by the fact 55 people is simply too small a pool to get a truly accurate statistic.
Another problem is the infection rate for accidental needle sticks by professionals dealing with other illnesses is so much higher. Hepatitis-B needle sticks are much higher. About 150 people, in the United States each year die from hepatitis-B they've contracted thru needle sticks.
That is compared to 55 people in the 25 years people have known about AIDS. So one can infer that it takes more than one exposure to HIV but it can't be certain.
Why can't you get AIDS from a mosquito bite?
This is a question that bothers a lot of people. After all, bugs transmit malaria, so is Lyme Disease (by ticks).
First of all HIV is fragile and will not live for any length of time in a mosquito. HIV like most (but not all) viruses are very selective about which species they will infect. So HIV gets into the mosquito and dies or is destroyed by the mosquito stomach.
Second, mosquitoes do not put blood INTO a person when the bite. They extract it. They first inject the person they are going to bite with their saliva, which prevents the blood from thickening. It is an allergic reaction to this saliva that makes you itch. Then the mosquito sucks out your blood.
Thus no transmission takes place.
Contrast to Malaria, which isn't a virus, but requires a mosquito to breed. In fact Malaria could not be if it didn't have the mosquito to help it. In fact it is not just a mosquito it is a specific kind of mosquito it needs. Get rid of that species of mosquito and you get rid of malaria.
As you can see they are two different things
Can you get HIV from a tattoo?
Not likely, you could only get it if the needle wasn't properly sterilized. Even then the risk would be very low. Remember the HIV virus is fragile and would not survive the open air on the end of a needle for more than a few minutes. There has never been a case of AIDS reported from tattoo needles. However hepatitis from improper needle use on tattoos while not common is not unheard of.
Why don't heterosexual people get AIDS?
Well they do but not in great numbers. In the late 80s it was thought there would be a great explosion into the heterosexual population but it never occurred.
There are two theories as why this never happened. One HIV is dependent on behaviour. Studies have indicated the average heterosexual has about 8 different sexual partners for intercourse over a LIFETIME. Other studies have placed it as low as 3 different partners for rural people to as high as 12 different sexual partners in large urban cities like San Francisco and New York City.
If the cumulative theory is correct it may take more than one exposure to get HIV. So the straight population may be exposed to it but since they don't have as many different sexual partners they aren't getting it.
We also know the vagina is much less likely to bleed during sex and is set up to neutralize foreign items like viruses and bacteria. Vaginal sex even unprotected is much less likely to transmit HIV, since straight people by in large don't participate in anal sex; the key way HIV is spread is eliminated.
Another probable cause is HIV never got into the mainstream to begin with. You have to have HIV to give it. If heterosexual people are having sex only with other heterosexual people they will never get it. This is because if the virus isn't present in heterosexual people, it doesn't magically appear. For the same reason if two people are HIV negative they can have unprotected sex and they will never get HIV, as long as they truly remain exclusive with each other.
So two monogamous people don't need safe sex?
No, and here is why. The biggest new infection rate in gay men comes from monogamous males. Study after study going back to 1984 show gay men are simply not monogamous. What happens is two supposedly monogamous people decide they will be faithful and dispense with the condoms. Then one cheats. Now what is he to do? If he tells his partner he cheated he is out the door. So he lies. Suddenly the partner is having unprotected sex with someone who is not monogamous.
Quite often the first incidence of cheating leads to more and the whole monogamous issue falls to pieces and they both wind up infected.
OK that's fine but I trust my partner.
I personally can name 5 people that trusted their partner in monogamous relationships yet somehow got HIV from this monogamous partner. But if you want to risk it, you should be tested for HIV, then wait six months and get tested again. If you still both test negative and are absolutely certain their is no cheating, going condomless at this point is not safe but at a risk level of 90%. You should wait an additional six months get tested and after a year of certain monogamy with three negative HIV tests that is near 100% safe.
What if I slip and have unprotected sex
Get to a doctor ASAP. It is thought a regiment of anti-HIV drugs can prevent HIV transmission. Again this is by far from certain. There are plenty of studied cases where it didn't work. There are plenty of cases where it seems to work, but did it? Or was the "cumulative theory" and those people wouldn't have gotten it anyway. Since HIV is virtually 100% lethal we can't do controlled studies and can only make "good" guesses. Note these "guesses" are good but not even up to the level of "educated guesses."
If you are in a relationship and have unprotected sex with someone other than your partner, you immediately need to go back to using condoms and both get tested again. You should continue to use condoms through one or two more additiona HIV tests.
Why is AIDS and HIV in Africa so different than America?
That is a complex question, which deserves a whole independent section that I have put here. (insert link)
Why do some people say HIV doesn't cause AIDS?
I have discussed this in a separate section (insert link). Basically HIV and AIDS has a long political association with it, a lot of the science is sloppy and some just can't be done due to the lethality of HIV.
So what if I get HIV I'll just take the drugs.
The HIV drugs called "cocktails" are toxic to the body. They are not drinks but called cocktails because you need to take more than one kind of drug. They stress out the body and for most people cause many symptoms. To be honest I know of people who have taken the drugs since 1997 and have no problems, they pop a pill and that's about it.
But there are many other people I know that every day get violently ill, vomiting, dizziness, extreme diarrhea and lethargy. It can also make you accumulate fat in your stomach or back and you get a paunch. This is commonly seen as the fat is removed from your legs and deposited in your stomach. So these people have bird legs and look like they are pregnant.
I have known of people who have left jobs because they can barely function due to the effects. In truth you won't know how your body reacts till you get it. Will you be the lucky one that can get HIV and pop a pill and forget it?
Lastly HIV cocktails are ineffective for about 15% of all people.
What exactly is an "AIDS LOOK"
This is a term applied to HIV positive people with a condition called lipodystrophy. This is characterized by abnormal distribution of fat in the body. It usually refers to the loss of fat in the face.
Lipo is Latin for "fat" and dystrophy is Latin for "degeneration"
This condition is not caused by HIV or any of the associated illnesses of AIDS but rather is a side effect of antivirals (mainly the protease inhibitors). It does not effect all people on such drugs and effects people to varying degrees but it is the cause for the sunken cheeks and the "humps" on the back of some but not all HIV positive people on antivirals.
This condition has been dubbed "buffalo hump" and "protease paunch." This condition does not reverse itself by going off antivirals, in fact short of surgery it is hard to correct.
Click Here for examples of lipodystrophy.
(Link opens in a new window).
I've heard you really don't die from AIDS what that about?
Strictly speaking they are correct. In reality what HIV does is weaken your immune system and allows you to get a disease. In an individual with a normal immune system you'd simply fight off that disease. But because AIDS has compromised your immune system you can't fight those diseases off, so you die. So as you can see it is not AIDS your dying from but one of the many opportunistic illnesses AIDS allows to develop.
What does opportunistic illness mean?
This is a disease that is not normally seen in a person with a fully functioning immune system. In other words since you're immune system is compromised AIDS is taking the "opportunity" it wouldn't normally have to infect you.
What is this super strain of HIV I keep hearing about?
Like people viruses are individuals. Not all are the same. As a matter of fact their are two different kind of HIV viruses, HIV-1 and HIV-2 (insert link)
Not all people who are HIV+ are infected with the same form of the virus. Some strains of the virus are very aggressive, while some are relatively passive. It's like any virus. Ever have a cold go around the office some people get sicker than others. Of course some of it is due to the fact some people's immune systems are stronger, but some of it is due to different strains or forms of the same virus.
The super strain of HIV turned out to be false but it will come. I have talked about this in a separate section (insert link here)
Paradoxically there is evidence that as a whole the HIV virus is getting less deadly not more. This is common to most viruses.
I already have HIV so I don't need to play safe.
No, this is false. At first it seems odds but while there is one kind of HIV there are several subtypes. You can have more than one. Viruses can "talk" to each other and exchange genetic material I have got into this further here (insert link****)
But to simplify it let's look at it like this. Suppose you have HIV and it responds well to one kind of HIV drug. And suppose you have unprotected sex with a guy who has HIV that didn't respond to that drug but responded to another drug. When you allow his HIV in your body genetic exchanges can take place. This means if you keep doing it your HIV won't respond to your drugs anymore. So you'll have to change drugs perhaps to something more toxic.
If you extend this pattern you can see eventually no HIV drugs will help you and if you extend this to the gay population or the general population we're back to pre 1995 when we had virtually no drugs to help.
That sounds logical but does it really happen?
You bet, and a lot. Let's look at another drug, penicillin. If you go back to 1945 and look at all the diseases that could be cured by the form of penicillin they had then, today in 2006, 61 years later only 4% of the same disease even RESPOND, not cure but RESPOND to that same form of penicillin. The bacteria adapted, this is evolution in action
What do you mean "form of penicillin"?
As bacteria became immune to one form of penicillin scientists and drug companies alter it so works again. Of course this only lasts a little while and the bacteria again adapts. There is only so much "fiddling" science can do.
So we may have diseases antibiotics can't treat?
We do now. In 2004 54 Americans died from massive bacterial infections that could not be treated by any antibiotics. Can you imagine how shocked the loved ones of a person who was fine on a Friday got sick and by Sunday was dead. How those people sat around in shock wondering WHY a bacterial infection can't be cured? This happens and each year the number gets bigger.
Remember in the first few decades of the 1900s before sulfa drugs and antibiotics they often would have to amputate limbs in order to stop a blood infection of the arm. That was all they had.
This is why you are not helping yourself or the gay community or earth's population in general by barebacking. For more information see the full page (insert link)