Risks and modes of transmission.

Sexual Behaviour

Risks are associated mainly with sexual behaviour. HIV is transmitted through the exchange of body fluids, and is principally sexually transmitted as this is the main means of such exchange. Almost 80% of transmission is through sexual exchange of body fluids.

Anal SexVery high: The rectum is a fragile tissue prone to tears when penetration occurs.
Dry SexVery high: Involves the removal of the natural lubrication of the vaginal tract, a sexual preference amongst some males.
Vaginal SexHigh: With increased risk when the woman is menstruating and also a high risk with the presence of sexually transmitted diseases.
Kissing, deep throat and lip contactLow-Medium: Risk may be increased with poor oral hygiene which includes the presense of bleeding gums or sores.
Oral SexLow-Medium: Risk may be increased with poor oral hygiene which includes the presence of bleeding gums or sores.
Sex with a condom, femidomVery low: Providing the condom is good quality and is placed over the penis correctly or the femidom is inserted correctly.
Intimate TouchingNil-Low: Risk increases if finger penetration occurs and cuts occur at the base of the finger nails.
AbstinenceNil: No sexual practices equals no risk

The majority of people that are infected with HIV are likely to have acquired the infection sexually. HIV is present in the majority of body fluids - some of which are infectious and some of which are not. The majority of body fluids are infectious but many people believe that any body fluid is infectious.

Infectious Body FluidsNon Infectious Body Fluids
Blood, all body fluids containing bloodTears
Vaginal secretionsSweat
SemenSaliva*
Pericardial fluidNasal Secretions*
Peritoneal fluidVomit*
Pleural fluidFaeces*
Cerebrospinal fluidUrine*
Amniotic

*NB. If any of the above is mixed with blood they could be considered infectious.

Mother-to-child Transmission

The second principle means of transmission is by means of mother-to-child transmission accounting for some 630,000 infections annually in Africa. In the US, where treatment is readily available for individuals and mothers affected by HIV, the number of infections by this means in 2003–2004 was less than 200.

Other routes of transmission include:

  • Intravenous drug use: Up to 10%
  • Blood transfusions: 5%
  • Exposure to infection through needles etc.: 0.01%
Infection Route Sexual IntercourseRisk of Infection
Female-to-male transmission1 in 700 to 1 in 3000
Male-to-female transmission1 in 200 to 1 in 2000
Male-to-male transmission1 in 10 to 1 in 1600
Oral Sex6% - 8% of transmission
Needles
Needle Stick1 in 200
Needle Sharing1 in 150
Transfusion of infected blood95 in 100
Transmission from mother to infant
Without AZT treatment1 in 3-5
With AZT treatmentLess than 1 in 10
Combination antiretroviral therapy1 in 50

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