Risks and Protection

What are the various ways of transmitting HIV?

The most common way of transmitting HIV, accounting for almost 80% of all incidences, is through sexual intercourse. Risks occur with the following practices:

• sexual transmission
  • unprotected vaginal intercourse (both partners)
  • unprotected anal intercourse (both partners)
  • oral sex, if sperm or menstrual blood gets into the mouth
  PROTECTIVE MEASURES: Always observe safe sex rules.
  If penetration occurs, always use a condom. During oral sex, avoid getting sperm in your mouth - avoid menstrual blood in your mouth.
  
  
• transmission through drug use
  HIV can be transmitted by sharing needles and syringes when injecting drugs intravenously.
  PROTECTIVE MEASURES: Always use clean needles and syringes. (With regard to other transmissible diseases such as hepatitis C this means: Get your own new needle/syringe for each shot. As well as: Your own filters, your own cotton pad, your own spoon and your own water!)
  
  
• mother-to-child-transmission
  It is possible for an HIV-positive mother to transmit the disease to her child during pregnancy, at birth or when breast feeding. This risk can be drastically reduced by taking appropriate measures. Please mention this to your doctor if the topic is not directly approached.
• In Switzerland, the risk of transmission by blood or blood products in a medical environment is now negligible. Blood and blood products are subject to very strict safety regulations.

Is there a risk of infection when having unprotected sex just once?

Yes! In principle, HIV can be passed on by having intercourse just once with an HIV-positive partner. The more frequently you have unprotected intercourse, the higher the probability of your becoming infected with HIV. If you want to avoid the risk of infection, you must use a condom every time you have intercourse with someone you’re not going steady with, or insist on your partner using one. In a steady relationship it is important to talk about the possibility of occasional unprotected intercourse with others, or the rupture of a condom. If you sleep with someone else and keep having unprotected sex with your partner, you put him or her at risk. Even though talking about this may be unpleasant and may lead to a crisis in your relationship, it is a necessity

Is there a risk of HIV infection for married people or for those living in a steady relationship?

If you suspect that your partner may be having unprotected sexual contacts with others, address the problem. If you have suspicions, take yourself and your health seriously. Discuss how you want to deal with the situation and how to protect yourselves against HIV infection. If you continue having sex with each other, safe sex is necessary until a negative HIV test three months after your partner’s the last risky intercourse. You can also find support at your regional Aids counselling service.
 As for your own casual sexual encounters: Always observe safe sex rules.
 You can forget safe sex rules if you are married or in a steady relationship only if both of you aren’t infected at the beginning of that relationship and are either absolutely faithful to one another or always observe safe sex rules when having sex with others.
If you use drugs intravenously, remember the risk of HIV infection.

Oral sex

• What are the safe sex rules for oral sex?
  Don’t get sperm in your mouth, don't swallow sperm.
  Don’t get menstrual blood in your mouth, don't swallow menstrual blood.
  
  
• As a woman, am I at risk when receiving oral sex?
  You don’t run any risks when being orally satisfied as a woman. If you are HIV-positive, your partner runs a certain risk if you are menstruating. It is possible to transmit HIV through getting menstrual blood into your partner’s mouth. According to the current state of knowledge, vaginal fluids however have not proved to be a risk during oral sex.
  
  
• As a man, am I at risk when receiving oral sex?
  You don’t run any risks of contagion when being satisfied orally as a man. But if you are HIV-positive, your partner runs a considerable risk if you come in his or her mouth. It is important not to get any sperm into your partner’s mouth. According to the current state of knowledge, the so-called pre-cum before climax has proved not to be a risk of infection during oral sex.
  It may be a good idea to agree on a clear warning sign with your partner before having oral sex.
  
  
• Am I at risk when giving a men oral sex?
  It is important not to get any sperm into your mouth, and if you do, don’t swallow. According to the current state of knowledge, the so-called pre-cum before climax does not constitute any risk.
  It may be a good idea to ask your partner to withdraw before climaxing or to give you a clear sign. If he should ejaculate into your mouth, be sure to spit out the sperm immediately and to rinse your mouth several times with lukewarm water. Do not swallow the sperm! Even if you are HIV-positive, there is no risk of infection for your partner.
  
  
• Am I at risk when giving a woman oral sex?
  You run a certain risk if your partner is menstruating. Infection through menstrual blood in your mouth is possible. According to the current state of knowledge, vaginal secretions however have not proved to be a risk during oral sex.
  Even if you are HIV-positive, there is no risk of infection for your partner.

What are the other safe sex rules?

Besides the two rules for oral sex (see above), there is basically just the one: Unprotected sexual intercourse with penetration – vaginal or anal – constitutes a risk of HIV transmission for both partners. Therefore: Always use a condom (or femidom).

Only use water-soluble lubricantsor siliconbased; oil-based lubricants attack latex.

Use the correct condom size. You can find the right size of condom at www.mysize.ch
Exception: In a monogamous relationship with both partners being negative, you may do without condoms.

Coitus interruptus (withdrawing ibefor comming) is not sufficient protection.

(We advise sexually active people who switch partners occasionally or frequently to get inoculated against hepatitis B.)

Are women at a higher risk of infection than men?

Statistically, women worldwide are at higher risk than men of becoming infected with HIV through unprotected vaginal intercourse. In practice, however, having the biological sex of “female” is not the deciding risk factor. Situations associated with a significantly higher risk of infection – for both sexes – are:

• Having other sexually transmitted diseases (which may not cause symptoms and thus remain undetected)
• Viral load, i.e. your partner has advanced, untreated or primary HIV infection
• Anal sex
• Number of sexual contacts
• Diseases of the genitals associated with defects of the mucus membranes, and
• for women: wearing a coil.

Therefore: Always insist on using condoms. It may be helpful to always carry some with you. Femidoms also protect against HIV infection.

Is there a risk of HIV infection during intercourse without reaching climax?

Yes, there is a risk of transmission when having intercourse, even if no ejaculation occurs. Obviously, not only sperm and vaginal fluids may cause transmission of HIV. It seems that intensive contact of the mucus membranes may be sufficient for transmission.

Are kissing and French kissing dangerous?

HIV cannot be transmitted through kissing or French kissing. There is not risk of transmission through caressing, cuddling, or mutual masturbation either. Nor can HIV be transmitted by the use of public toilets or common household items such as cups, cutlery etc.

What else is not dangerous?

HIV is not transmitted by the use of public toilets, in saunas or swimming pools, through door handles, telephone receivers or the common use of clothes and dishes. HIV is not transmitted through insect or dog bites, nor through any kinds of pets. HIV is not transmitted at the doctor’s or the dentist’s or in hospital. There is no risk at the hairdresser’s, when getting a manicure or pedicure. Getting a piercing or a tattoo is also harmless so long as the people doing them follow the normal rules of hygiene required for their trade. There is no risk of HIV transmission through coughing or sneezing. There is no risk when shaking hands, embracing, caressing or cuddling with an HIV-positive person. HIV is not transmitted through kissing or French kissing. Mutual masturbation is harmless; small hairline cracks at the fingertips or similar tiny lesions that are already healed do not constitute any danger. HIV is not transmitted through urine or excrement. However, there is a considerable risk for the transmission of other diseases such as hepatitis A.

Is there anything I can do immediately after a high-risk situation in order to reduce the danger of HIV infection?

The first weeks after potential transmission of the infection are called the immunological or serological window. During this time, there are no medical procedures that can prove or disprove that infection has taken place. The length of this window depends on the person. In some cases, infection can be detected after only two weeks, but in others, it takes longe

After high-risk situations the only thing you can do is visit one of the HIV treatment centres in the big university hospitals within 72 hours.

The risk will be assessed and possibly, a post-HIV contamination prophylactic (HIV-PEP or PEP) may be administered. This is a preventive medical treatment with highly effective substances for a couple of weeks which will considerably diminish the risk of possible transmission – without however guaranteeing success. Chances of successful treatment are higher the sooner the treatment is started after the risk situation has occurred.

An HIV PEP (HIV post-exposure prophylaxis) can help in the following situations:

1.The contact person is definitely HIV positive; he/she is not undergoing treatment or has not completed an effective antiretroviral treatment and

• unprotected vaginal or anal sexual intercourse has taken place
• unprotected oral sexual intercourse has taken place and the person infected with HIV has ejaculated into the mouth of his partner

(An HIV PEP can also be considered in these situations when it is not known whether the contact person is HIV positive, but he/she comes from a region or belongs to a group where HIV is very widespread.)

2.The potential exposure has taken place as a result of rape
In all other cases, i.e. when it is not certain that the contact person is HIV positive and he/she does not come from a region or belong to a group where HIV is widespread, an HIV PEP is not recommended.

I am afraid that I might have been infected. What can I do?

Don’t bury your head in the sand, but get proper information. Call the regional Aids counselling service or any other counselling service where you can get tested anonymously. Find out if you really have run a risk of infection. Get information on whether an anonymous HIV antibody test is appropriate for you and how you can get proper protection in the future.

In any case: After having run the risk of infection, have intercourse only with proper protection.