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This webpage is intended to provide a forum for students and staff to have their HIV/AIDS-related questions answered. These questions will be updated as we receive more requests for information.

1: Can you get HIV from oral sex?
2: Can you get infected if you swallow sperm during oral sex without any sores in your mouth?
3: How long does the virus survive in a corpse?
4: How long does it survive in the blood outside the body?
5: Can you get infected through kissing?
6: What are the chances of being infected if you nurse an HIV/AIDS infected person?
7: When doing the HIV test, can you tell when one got infected with the virus?
8: Can one get the virus (infected) from the blood of an animal e.g. meat?
9: Do traditional healers cure AIDS?
10: Is the condom 100% safe if you use it correctly and store it in a suitable environment?
11: Why is it possible for one partner to test positive and the other negative if they've both been practicing safe sex and have been together for a long time?
12: How accurate is HIV testing?
13: Why are females more susceptible to the virus than males?
14: It is said that not all babies get infected in their mothers during pregnancy even if the mother is positive. How is this possible?
15: What does Nevirapine do that prevents the baby from being infected?
16: Is masturbation good? Does it not affect your mentality?
17: Why doesn't the mosquito transmit the virus - seeing that it sucks human blood?
18: When you remove a condom, using your hand (s) - is it not possible to get infected?
19: Why should you use a condom if you're already HIV-positive?
20: Can you get HIV through non-penetrative sex? E.g. when you play with the penis around the vulva or you ejaculate on a woman's thighs?
21: Why should I be tested?
22. Can HIV/AIDS pass through a latex condom?
23. Why is it that not every foetus in a HIV-positive/AIDS mother gets infected?
24. Why is it that only when a foetus passes through the birth canal, the baby can contract HIV/AIDS?
25. What is it about the placenta that prevents a foetus from contracting HIV/AIDS?
26. As HIV/AIDS is a viral disease, how long will it take before the virus changes its shape and become airborne?
27. Can HIV/AIDS be passed through the mouth/saliva if one has any sores in the mouth?
28. If saliva is a bodily fluid, why is it that we are told that litres of saliva are necessary to transmit the virus? I do not understand why it is not as "dangerous" as blood and semen?
29.Does HIV/AIDS live inside a syringe and, if so, for how long?

Question 1: Can you get HIV from oral sex?

Yes. Particularly where there is broken tissue or sores in the mouth. Whenever there is a possibility that bodily fluids can be exchanged, the potential of HIV transmission is high. Oral sex can transmit HIV infection both from infected male to uninfected female - and from an infected female to an uninfected male. Both semen and vaginal fluid from HIV infected persons contain large quantities of HIV virions. The viral burden in these fluids reflects the amount of virus that is found in the blood (plasma) i.e.: the viral load, though is a separate 'privileged' site.

Question 2: Can you get infected if you swallow sperm during oral sex without any sores in your mouth?

You can become infected through ingestion of semen from an HIV infected person - regardless of whether the recipient has sores in their mouth. Having a sore or break in the mucosa will simply increase the risk of transmission via oral sex.

Question 3: How long does the virus survive in a corpse?

This question has relevance for those involved in burial practices e.g. bathing the body and touching the body while preparing it for burial. The risk does not only lie with the HIV virus but also with other opportunistic infections. A corpse, particularly of a person known to have been HIV infected, must be handled as if infectious. This would be irrespective of the duration of time since death. Any fluids or tissues should be handled utilising universal precautions - i.e.: with gloves. During autopsy, gloves and eye protections should be used at all times. As above - there is risk from infection beyond HIV. Most other pathogens are heartier and longer-lived than HIV. You would be concerned about hepatitis, and TB amongst many others.

Question 4: How long does it survive in the blood outside the body?

If the blood is dry, the virus will be dead. If it is wet, a chance exists that it could still be active. The risk is very small, but rather be safe. Always try and use gloves when you are in a situation where you might be in contact with blood. HIV is very short lived on an inanimate surface. In wet fluid, consider infectious.

Question 5: Can you get infected through kissing?

There is so much speculation around this issue and there are no absolute answers. If there are open sores in the mouth, the chance does exist that bodily fluids can be exchanged. Saliva can carry the HIV virus but an enormous amount of saliva has to be present for infection to occur. The option here is to dry kiss as opposed to wet kiss but it would be sad that young people miss out on the pleasure of kissing. Kissing provides a good motivation for knowing the HIV status of your partner.

Question 6: What are the chances of being infected if you nurse an HIV/AIDS person?

It is important to distinguish 'nursing' in a clinical setting from 'nursing' or caring for a person in a home setting. It would be a grave mistake to discourage family or loved ones from providing love and care for an HIV infected person due to fear of contracting HIV. Bathing, feeding, hugging, holding hands, cleaning house/dishes, sharing a bathroom - all present near zero risk - and should be joyfully undertaken. Slightly higher risk would occur, as the care provided becomes more medical/clinical in nature. Example would be if you were doing dressing changes for an open wound. Obviously utilising universal precautions (gloves) would be necessary.

Occupational exposure i.e.: needlestick injuries - are a means of contracting HIV. However, even this risk is very small. A skin break with a needle contaminated with blood from an HIV infected person presents a 0.06% risk of infection to the health care worker. This percentage varies with several factors: depth of puncture, type of instrument (hollow bore, wire, scalpel, etc.), viral load of patient, etc. Occupational health should be contacted immediately after exposure to body fluids, and counselling should be providing to allow a rational decision to be made regarding taking HIV anti-retroviral prophylaxis.

Question 7: When doing the HIV test, can you tell when one got infected with the virus?

The 'HIV test' is a test to detect antibodies developed to HIV. It is a marker for HIV infection, but is not a test to detect actual virus. After acute infection, antibodies would not be present, thus the test would be negative. Only after the window period has passed would antibodies be present, and the test show positive. The duration for the 'window period' varies from person to person. Three months is chosen as a safe duration as most every person would have developed antibodies by this time. The test for virus is PCR or polymerase chain reaction. This test amplifies the amount of virus in a small sample of blood and allows detection. Even this test does not allow you to know WHEN a person was infected. It only confirms what level of virus is present. Other tests that confirm presence of virus are the P24 antigen test and Western Blot.

Question 8: Can one get the virus (infected) from the blood of an animal e.g. meat?

If you are talking about eating meat - no. However, there are many animal pathogens that can be acquired through ingestion of undercooked meets. In cultures where eating undercooked or raw meats is the norm, several known infections occur. Ie: ingestion of monkey brain, undercooked pork, drinking of blood, etc. Remember that HIV is a distant relative of SIV (simian immunodeficiency virus) - so infection of pathogens once believed to be confined to animals, CAN be passed to man.

Question 9: Do traditional healers cure AIDS?

Traditional healers can be very successful in dealing with the symptoms of HIV/AIDS and this is where this myth has come from. They have an important role to play in treating symptoms and in boosting the immune system but they cannot cure AIDS.

Question 10: Is the condom 100% safe if you use it correctly and store it in a suitable environment?

Yes and no. If the condom is a reputable brand and if it is used correctly, it can be safe. But what happens if it bursts or tears? This is of particularly reference during the practice of "dry" sex. Even a condom of reputable brand and seemingly intact on visual inspection, can have a micro-perforation. Proper use of a latex condom = 'safer sex', but is not guaranteed to be 100% safe.

Correct use of condoms:

• Use latex condoms only
  

• Check date to be sure not expired
  

• Put condom on erect penis prior to any genital:genital contact.
  

• Hold tip of condom with fingers while unrolling condom.
  

• Keep condom on for duration of sexual interaction
  

• Remove condom from penis carefully as to keep semen within condom
  

• Dispose of condom after single use. New condom with every sexual interaction.

Question 11: Why is it possible for one partner to test positive and the other negative if they've both been practicing safe sex and have been together for a long time?

The wording of this question is a little bit unclear. If I understand it correctly - to mean, "Can a couple, consisting of one HIV positive and one HIV negative person, remain discordant if they practice safe sex?" This can certainly occur. There are whole groups of discordant couples that are followed closely under clinical investigation. Some discordant couples that have been in a long-term committed relationship make a decision to discontinue practicing 'safer sex'. Sometimes this decision is driven by the desire for the woman to become pregnant. Also, indifference on the part of the negative partner, toward becoming infected as their partner is. Discordant couples (like couples where both are positive) require tremendous support to assist with decisions such as 'safer sex' practices and family planning. Once a decision to engage in unprotected sex is made, it will simply be a matter of time before the negative partner becomes infected. The duration of time it will take cannot be accurately predicted. The duration to infection is influenced by multiple factors such as: sexual practices, frequency of intercourse, which gender if the infected partner, viral load of the infected partner, concurrent illness in either partner (ie: Sexually transmitted infection), etc.

Question 12: How accurate is HIV testing?

Rapid tests such as the BioSign HIV-1/HIV-2 WB are quite accurate. Most clinics that utilise rapid testing for HIV screening/testing, use some form of repeat confirmatory test. For a positive initial test, either a second rapid test is performed or another specimen of blood is sent to the laboratory for a traditional ELISA test. Use of a confirmatory test, further increases the accuracy of this method.

Question 13: Why are females more susceptible to the virus than males?

Penile:vaginal or penile:anal sex results in transfer of a large volume of infected fluid (semen) from the male to the female. Semenal fluid is deposited directly to the relatively large mucosal surface of the female vagina, where transmission can take place regardless of presence of skin break or not. The male mucosal tissue has only one small portal of entry, for infected vaginal secretions to pass. Under lubrication of the vagina enhances the risk of abrasions, which increases the likelihood of viral transmission. The natural lubrication of the female genital tract offers some protection, while penile:anal sex (with or without exogenous lubrication) has an extremely high likelihood of mucosal tearing/abrasion. Thus, anal sex presents a very high risk of transmission in either male:female couples or male:male couples.

Question 14: It is said that not all babies get infected in their mothers during pregnancy even if the mother is positive. How is this possible?

Mother-to-child transmission (MTCT) of HIV can occur at any of three points: (1) prenataly while the fetus is in the womb, (2) perinatally - during delivery, and (3) post-nataly via breastfeeding. The greatest percentage of MTCT occurs perinatally, or after rupture of membrane (ROM). During gestation and prior to ROM, the fetus is afforded some protection from the mother's virus, though infection during this period DOES occur. After ROM, the baby is far more vulnerable as infant exposure to maternal blood and fluids now occurs. Like unprotected sex with an infected person, not every interaction is guaranteed to result in transmission. So is the case with MTCT, but the risk is high. Approximately 30% of infected mothers will transmit to their child antenatally. This percentage is affected by several factors including: duration of ROM prior to delivery, viral load of the mother, concurrent illness in the mother, etc. Nevirapine (NVP) prophylaxis reduces the perinatal transmission (no affect on transmission that occurs in the womb or via breastfeeding) by approximately ½….so from 30% to about 15% or less. Other regimens of antiviral prophylaxis for MTCT have different percentages of success. NVP has been approved in the settings such as SA due to its low cost, ease of one dose administration, minimal side effects, and proven efficacy.

Question 15: What does Nevirapine do that prevents the baby from being infected?

Nevirapine is an antiretroviral drug. Just as AZT or 3TC are. There are 3 main classes of anti-retroviral drugs; (1) nucleoside reverse transcriptase inhibitors (NRTI's), (2) non-nucleoside reverse transcriptase inhibitors (NNRTI's), and (3) protease inhibitors (PI's). AZT, 3TC, d4T are all NRTI's. Indinavir is a PI. Nevirapine is an NNRTI. NNRTI's work by inhibiting the viral enzyme called 'reverse transcriptase' or RT. The RT is the enzyme that transcribes viral RNA into DNA - which will allow the viral genome to integrate itself into our cellular DNA. NNRTI's such as nevirapine block the RT enzyme at it's active site, thereby inhibiting viral incorporation into the cell and subsequent viral replication. By giving this to the mother at the onset of labour, it interferes with the function of her HIV. Further benefit is afforded by giving a dose of nevirapine elixir to the baby within 72 hours after birth. The again will inhibit the incorporation and replication of any virus that is transmitted to the baby during labour and delivery. Nevirapine effectively reduces the risk of transmission by 50%. It is does not guarantee that the infant will not be infected. Again, it will have no affect on infection that occurred prior to labour or infection that occurs via breastfeeding after delivery.

Question 16: Is masturbation good? Does it not affect your mentality?

Definitely not! Masturbation is the safest option people have with regards to sexual practice and the transmission of sexually transmitted infections such as HIV/AIDS. It's fine - go for it and enjoy!

Question 17: Why doesn't the mosquito transmit the virus - seeing that it sucks human blood?

Precisely because it sucks blood - it does not transfer or inject blood.

Question 18: When you remove a condom using your hand(s) - is it not possible to get infected?

If the female removes the condom and she has a big cut on her hand, if she removes the condom and gets semen on her hand, there is a risk that HIV can be transmitted. Again, basically it is about the exchange of bodily fluids. The safest option here is that the male removes his own condom.

Question 19: Why should you use a condom if you're already HIV-positive?

There are many reasons for a positive person to engage in 'safer sex' and use a condom. Unprotected sex puts a positive person (male or female) at risk of acquiring a non-HIV sexually transmitted disease. (For the positive female, it allows them to become pregnant, and then have to face the risk of infecting their unborn child.) Acquiring an STD for an HIV positive person has many ramifications. As with any concurrent illness, it has a deleterious affect on the immune system and allows disease to progress more rapidly. Having an STD increases the likelihood that you will transmit the virus. For a female, having an STD increases the risk of complications with pregnancy - including premature birth and transmission of infection directly to the infant during delivery. If the positive person is in a discordant relationship (partner is HIV negative), use of a condom provides some protection for their partner. If the partner is positive as well, and the two did not acquire the virus from one another, there are two strains of HIV between them. Re-infection of a positive person can occur, but this is not the primary or main reason for use of a condom. An additional factor that will become more of an issue as ARV's become more available… if one partner is receiving ARV's and has been non-adherent and now has drug-resistant HIV, this person can transmit drug-resistant HIV to their partner. Now the other person may have resistance to future treatment with ARV's.

Question 20: Can you get HIV through non-penetrative sex? E.g. when you play with the penis around the vulva or you ejaculate on a woman's thighs?

Yet again, this all relates to the exchange of bodily fluids - if the ejaculation is close to the female genital area, and if there is broken skin or an open wound, there is a chance that infection may occur. This practice is called "ukuSoma" (sexuality pleasure between the thighs) and it is a much safer option than full penetrative sex, although it is a lot safer for men than it is for women.

Question 21: Why should I be tested?

We know that there are many people that say that would rather not know their status but there are many reasons why you should elect to know your status:

• In knowing your status, you can practise safe sex and prevent the transmission of HIV
  

• If you are tested and you are not positive, you will be greatly relieved
  

• If you are positive, you can promote your health e.g. exercise, healthy diet, positive attitude
  

• You can ensure that you do not keep reinfecting yourself and your partner by using condoms. You will decrease the pace at which you will become ill with full-blown AIDS.
  

• Knowing your sero-status is extremely important. Even if there is no means of accessing expensive anti-retroviral (ARV) treatment, there are HIV clinics that provide treatment for HIV associated opportunistic infections (OI's). HIV does not kill patients - opportunistic infections do! TB is the number one killer of HIV infected patients in South Africa, and it (like most all) OI's is treatable! Knowing your HIV status allows you to get into close clinical follow-up, and have early diagnosis and treatment of OI's. This WILL prolong life!
  

• Knowing our HIV sero-status allows you to make an informed decision about having children. Perhaps knowing you are infected, will alter a decision to become pregnant.
  

• Knowing your HIV sero-status allows you to plan for the future, for both your own health and well being, as well as that of your children (ie: choosing a guardian for patients who are in end stages of HIV).
  

• Knowing your HIV sero-status allows you to begin to gain more information about HIV re: how you can live well as a positive person. It allows you to investigate sources for ARV treatment, whether on pharmaceutical trials or through an HIV treatment centre.

Question 22. Can HIV/AIDS pass through a latex condom?

Not if the latex condom is intact, without any defects. It is possible that there could be a defect in a condom due to manufacturing error, which is not visible on visual inspection. But this is not a major reason for condom failure - the majority of 'failures' are due to misuse. Meaning not putting the condom on prior to contact, etc.

Question 23. Why is it that not every foetus in a HIV-positive/AIDS mother gets infected?

Not every act of sexual intercourse results in passage of the virus either. Contributing factors in both sexual transmission and MTCT, has to do with how much fluid exchange occurs (either semen or vaginal secretions in the case of sex) and from the circulation of the mother to the fetus in MTCT. MTCT can occur in utero…but more commonly occurs during birth when the membrane around the baby is no longer intact. Other contributing factors - whether instruments are used for assisted birth. This can result in skin breaks in the baby - and increase transmission risk. Early rupture of membranes - also increases the exposure time and therefore transmission risk. If the mother has an STI at the time of delivery, this also increases MTCT of HIV. So many factors come in to play, altering the risk of HIV MTCT.

Question 24. Why is it that only when a foetus passes through the birth canal, the baby can contract HIV/AIDS?

This is not the only time a baby can become infected from their mother. The three times that HIV MTCT occurs is (1) in utero during gestation ~6%, (2) intrapartum or during delivery ~14%, and (3) post-partum through breastmilk 9% dependant on duration of breastfeeding.

Question 25. What is it about the placenta that prevents a foetus from contracting HIV/AIDS?

Mother and fetus have separate circulatory systems that keep fluids separate, however, there is some passage as evidenced by the fact that in utero HIV MTCT takes place. It is not strictly the placenta that is responsible for the separation of fluids - but the presence of separate circulation (i.e.: blood barrier), and an intact membrane surrounding the foetus.

Question 26. As HIV/AIDS is a viral disease, how long will it take before the virus changes its shape and become airborne?

There is no evidence to suggest that HIV will mutate and become an airborne pathogen. Simply due to the fact it is a virus, does not mean that this would occur. Multiple viruses require contact for transmission and are not spread via the airborne/inhalation route (e.g.: herpes, HPV, etc….).

Question 27. Can HIV/AIDS be passed through the mouth/saliva if one has any sores in the mouth?

Yes, if it is a bloody sore or one of the persons has inflamed and bleeding gums.

Question 28. If saliva is a bodily fluid, why is it that we are told that litres of saliva are necessary to transmit the virus? I don't understand why it is not as "dangerous" as blood and semen?

It is due to the amount of virus present in the fluid. There is relatively little virus present in saliva. In order to transmit, there would have to be exchange of an unreasonably enormous volume of saliva. Blood, semen and vaginal secretions on the other hand - contain high amounts of virus (viral load) per volume of fluid.

Question 29. Does HIV/AIDS live inside a syringe and, if so, for how long?

Yes! Sharing needles, particularly when injecting drugs, is a very hearty way for the virus to be transmitted. Because the hub of the needle is airtight, the virus can survive inside it much longer than the virus exposed to air. It is important to teach people who do use injection drugs to NOT share needles. If they insist on sharing needles then they should at least flush the syringe with a bleach solution. Re-using syringes (from patient to patient) can transmit the virus as well.