How do people REALLY get HIV?

I see there is impressive knowledge of HIV-AIDS among the board members, so I have a question I want to air. It has to do with how people catch HIV.

In some circles there has been a debate about how reliable the statistics are for how those who are HIV+ got the virus, in particular in developing countries. Some have said that the heterosexual, vaginal-sex transmission that supposedly dominates transmission in Asia and Africa canтАЩt be true. They say that for reasons of cultural taboo, transmission happens via heterosexual and gay anal sex but that this is denied when people are asked about their risk behaviour. This camp says that the virus is so hard to transmit that blood transfusion and the sharing of used needles, along with sperm injection in the anus, are main ways it happens. According to this view vaginal and oral transmission should be rare. Specifically receptive anal sex is seen as the big risk, with the тАЬbottomтАЭ being at much greater risk than the тАЬtopтАЭ.

The conclusion from this is that people in developing countries lie about how they got HIV, with African men, for example, refusing to admit that they have been buttf**ked. They also refuse to admit that they had anal sex with their women (a poor manтАЩs contraception).

In the West iv drug users and gay men dominate among HIV-positive, which points to dirty needles and anal sex as the route of transmission. Why should this be different in developing countries?Africans are upset about what the HIV epidemic implies about Africans having a frivolous sex life, which can explain some of the denial coming out of that continent.

In Thailand, it seems to me that ladyboys (who are traditionally at the receptive end of anal sex) are over-represented among those who get HIV. Another group who seem to get it a lot is the rough moneyboy type, the ones who may have done prison time or done hard drugs. (Disclaimer: This is just my impression and nothing scientific. I am talking about trends, not about every individual case). And of course Thai female prostitutes get it. If the Thai situation is as I think it is, it is consistent with the anal+iv drug use view how HIV transmits.

So what do you think, gentlemen? Is the politically correct view that vaginal and oral sex also carries risk of HIV wrong? Is it all down to bareback butt**ing and drug injection? Is HIV so hard to catch that you basically need a load of it right into the bloodstream via vein injections or rifts in the anal area to get it?

As I understand it, you can only get infected by HIV if blood or semen from an infected person enters your bloodstream. Aside from sharing needles with an infected person (which seems to be by far the riskiest activity) this can happen when a small wound present during, or caused by anal sex allows semen containing HIV to enter the bloodstream, when a small wound preent during or caused by vaginal sex allows semen into the bloodstream, or when a wound, a sore, or damaged gums allows semen into the bloodstraem during oral sex. If there is a wound or sore on the penis, there is also the possibility of a man acquiring HIV from either a woman or a man during either anal or vaginal sex.

As I understand it, there is little or no risk of getting HIV though swallowing the semen or urine of an infected person, as long as no semen or urine enters the bloodstream directly through a cut or sore.

It would follow from this that the risk to a man or woman who is the passive partner in anal sex will be greater than during vaginal sex as the risk of a wound occurring is greater. However, I know of no study that indicates that black, or specifically black men of African origin, participate in anal sex more than any other group. Moreover, few men of any racial origin worry too much about contraception with casual sexual partners. So I suspect the high incidence of HIV among African women and men arises from promiscuous vaginal intercourse rather than anything else.

On the issue of oral sex, there is conflicting advice on internet sites whether or not there is an increased risk if someone comes in your mouth, and whether you should avoid brushing your teeth before having oral sex.

Finally, I would offer anyone still reading this one piece of advice. Don't rely on any medical information or advice you read on a message board such as this one, not even if it comes from me. Read advice from as many different and (so far as you can tell) reliable sources as you can, then form your own judgement.

Regarding oral sex. I read that the environment in the mouth, not to mention the stomach, is so toxic that the HIV virus canтАЩt survive. Acid fluids quickly dissolve the virus. For a HIV virus to enter the bloodstream via the mouth the recipient must have a significant bleeding wound? Such a wound should be full of blood cells trying to close it and fend off infections, right? Plus, in a wound like that the blood goes out, not in. And finally, if you have a wound like that in your mouth, it must be painful. It canтАЩt be inviting to have oral sex in that case.

I also have trouble seeing how HIV can enter the (undamaged) penis of the active partner in either vaginal or anal sex. There are no acids to kill the virus, but still the virus has to penetrate the skin and enter the bloodstream тАУ preferably by the thousands or millions so one of them can succeed in reproducing.

The Africans. To spread HIV like they do they must have a lot of casual, unprotected sex. Lots and lots of it. If HIV spreads via vaginal intercourse it can explain how the women got it, but how did the men get it?

[Boxer]

I believe that you can get any virus in the penis from unsafe anal or vaginal sex or other sex not just HIV, Ghonorea to name one instance. Cuming in the mouth is asking for trouble the semen, just one of them, is in the throat and into the blood system that way via the stomach, forget cuts and other mouth infections as a main source but they dont help. Sucking makes fluid from your body to lubricate the mouth, that fluid is taken back in throat with or without pre cum or fluids from your infected partner. Data collected says low infection rate this way but is it worth the risk, cover it up!

[mikelele-old]

I read somewhere that the mucous membranes and such membranes that are found in the anal passages and throat are designed for a certain amount of absorption of liquids into the blood stream. Also the 'wound' may only be a micro-tear in the skin's epidermis and though blood would normally flow outward, the pressures of sexual activity may be enough to push a virus through into the micro vessels and eventualy into blood stream.

African men, in common with gay men, do have on average a lot of sexual partners, many of these being sex workers. Since most sex workers in Africa are women and a high proportion are HIV positive and have huge numbers of straight male partners, this would help explain why there is a high rate of HIV among African men., even if the risk of infection during each individual sexual episode is low. The pattern of transmission in africa is largely from sex workers to men, from men to their wives, and from their wives to their children.

A virus is a very tiny organism and its survival depends on finding a way into a human or other body. It is therefore highly adapted to doing so. Since HIV can't (thank heaven) enter the body through inhalation, to survive it needs to be highly adapted to exploit what opportunities it can to enter the human body. It most definitely is not necessary to have a bleeding wound for HIV to enter the bloodstream though the mouth or any other orafice, ANY break in the skin or mucous membrane is enough. Any preexisting infection such as a boil, gingevitis, a bacterial or fungal skin infection etc could also provide a sufficient break in the skin to let HIV in. Such infections are common both in the mouth and on the penis, particularly in hot and humid countries

The Africans. To spread HIV like they do they must have a lot of casual, unprotected sex. Lots and lots of it. If HIV spreads via vaginal intercourse it can explain how the women got it, but how did the men get it?

Perhaps a broader question could be, why is Africa affected so badly? There are plenty of nations that have poor access to sexual health education, yet for some reason Africa is the worst sufferer of HIV and Aids diagnoses. Racist virus?

If HIV can be absorbed through the penis and vagina so much, why the massively different HIV rates for the straight population of the west, compared to Africa? We have endless unplanned pregnancies, especially teenage unplanned pregnancies, and those are just the unsafe sexual encounters that resulted in a child. Why aren't all our western teens suffering from HIV or Aids? Under existing conditions, HIV should be as rife amongst the western youth as the adult population of Africa.

“Britain has the highest rate of teenage pregnancy in Western Europe. In 2000, there were over 87,000 children in Britain who have a teenage mother.” (www.childline.org.uk (http://www.childline.org.uk))

I'm no expert, so i can only offer possibilities and more questions...

Question 1 - Africa) could the higher incidence in Africa be due to a combination of sexual culture coupled with a lack of education about AIDS and poor availability of condoms?

Question 2 - Western teens) Why isn't there a higher incidence of AIDS in Western teens when many of them are having promiscuous sex?
Could this simply be a matter of statistics? ie. the more partners you have the more likely you are to meet someone with the virus. So even if they are promiscuous it could take some time before they meet 'that' person, maybe until they are in their 20's? Also it takes time for the disease to become apparent so i guess it could be several years after they first become infected before they are diagnosed - again, well into their 20's?

[Davey612]

All this discussion points to how important condoms are in making sex safer.

Just a couple of additional points: HIV is a virus that needs the correct environment to survive. Hence, the precaution against sharing body fluids and needles.

Something we sometimes forget is that there is another virus closely associated with HIV, and that is Hepatitis C. Unlike HIV, Hepatitis C survives much longer. When I went to a workshop, some information suggest that it can be alive for up to five days outside a body. Some senior citizens from third world countries may have Hepatitis C eventhough they don't know because way back in earlier times, some doctors were using the same syringe (unlike current practice of disposable syringes). Eventhough it was washed and cleaned, the doctors at that time did not know how sturdy the Hepatitis C virus is, and would have unknowingly passed the virus to the next patient that needed an injection.

Ok, lastly, to bring this subject to the gay Thailand forum, here is some info on HIV and Thailand: http://www.unaids.org/en/geographical+a ... ailand.asp (http://www.unaids.org/en/geographical+area/by+country/thailand.asp)

IWanUK

In regard to question 1, yes, it could be. However, even if that were the case, it does not explain why Africa has such a high Aids rate compared to other countries that also satisfy the same criteria.

In regard to question 2, in order for you to be correct in your suggestion, then there has to be a looming HIV crisis in the UK brewing silently. Why have we been yet to see this? Actually this is the same question I just asked.

However to suggest that there is a 'safe condomless promiscuity' where you don't actully expose yourself to HIV and an 'unsafe condomless promiscuity' where you do expose yourself to HIV is rather confusing. You're basically answering my question by citing "bad luck." Still, it's probably the most authorative answer offered to date!

[Hmmm]

Africa has a number of socio-cultural factors which, together, may explain the extraordinary HIV infection rate there:

The pages at this URL expand on the role of each of these in relation to HIV in South Africa:
http://www.health24.com/medical/Conditi ... ,23100.asp (http://www.health24.com/medical/Condition_centres/777-792-814-1762,23100.asp)
* Gender inequality and male dominance
* Violence and sexual violence
* Political transition and the legacy of apartheid
* Stigma and discrimination
* Poverty
* Commercialisation of sex
* Lack of knowledge and misconceptions about HIV/Aids
* Cultural beliefs and practices

Add to this some governments' denial of the HIV threat and 'christian' groups' lies that the HIV virus can pass through a condom, and you have a potent virus 'incubator'.

There simply is no mystery why HIV infection is so much higher in Africa than the UK.

1. In Africa an extremely high proportion of sex workers are HIV+ and a high proportion of the general population is HIV+ while in Britain a relatively low proportion of sex workers are HIV+ and an extremely low proportion of the general population is HIV+.

2. In Africa unprotected sex is still the norm while in Btitain almost everyone having sex with a sex worker uses a condom. There is a good deal of unprotected non-commercial sex, but the risk of getting HIV for heterosexual men and women is low because the incidence of infection among the general population is low.

How did Africa get its high incidence of HIV in the first place? Because the disease was proably present there undetected for years before it was first identified in the West, allowing it to slowly build up in the population, and because even now there is widespread ignorance about the disease and an unwillingness to wear condoms. The disease arrived in Britain relatively late and an effective education programme was started early.

"The disease arrived in Britain relatively late and an effective education programme was started early.[/quote] yang2

Yes the disease arrived in the UK very shortly after the US but someone got at the PM and The Blessed Margaret (Thatcher) instituted a massive scary campaign to educate the public and the social services geared up magnificently help those afflicted.

Thailand also managed a good education programme due to Senator Mechai virtually blackmailing the Government by using the 450 Army radio (yes they do have) stations to publicise the dangers. How sad that this has now been allocated a much smaller budget.

Yang2:
There simply is no mystery why HIV infection is so much higher in Africa than the UK. In Africa an extremely high proportion of sex workers are HIV+ and a high proportion of the general population is HIV+ while in Britain a relatively low proportion of sex workers are HIV+ and an extremely low proportion of the general population is HIV+. In Africa unprotected sex is still the norm while in Btitain almost everyone having sex with a sex worker uses a condom.

Have you read what you're saying? Essentially it reads as this:

“I know why the UK has far lower rates of HIV/AIDS in the UK than Africa. It is because the UK has lower rates of HIV/AIDS.”

Condoms are irrelevant in the example I gave above regarding teen pregnancies. The UK for example had close to 100,000 teen pregnancies in 2000. What does that do to your western condom usage, and superior sexual health education programmes argument? What makes western kids of today, or of yesterday having unprotected less likely to get HIV/AIDS than an African? Where is the looming aids crisis in the western youth? If the climate is there for disease to spread, it does so without fail. Teenage STD levels are on the increase, but HIV levels are under control compared to Africa where it is like wildfire. It makes no sense to me.

I started this thread by asking if buttf**ing (gay or straight) was underreported as a transmission route for HIV. To varying degrees depending on country, anal sex, homosexualty and IV drug use are all stigmatised activities, and people who get HIV will be tempted to pretend they didn't do any of this.

The mystery is that HIV is so hard to catch, much harder than a flu virus and much harder than the clap (which is a bacteria). How can some countries end up with 20-30% of the population infected if it isn't because of the stigmatised activities mentioned above? Why has HIV never spread to mainstream heterosexual society in Western countries? Condom use isn't that frequent outside the gay community in the West either.

Something doesn't add up here. I don't believe the African conspiracy theory that HIV is made by the CIA to get rid of black people. Even if assuming that Africans have some large equipment (not PC to talk about), that they have a huge number of sex partners (not PC either), and that their lovemaking is energetic to the point of being violent and thus causing rifts and damage (un-PC speculation), they still have to make vaginal transmission from woman to man a main route for the infection, which it isn't anywhere else in the world.

The surest way for a man to get HIV is to get sperm up his bum or polluted blood directly in a vein. The HIV virus can't move around and multiply independently like gonorrea bugs can. It can't be transmitted via drops in the air like the flu. It doesn't infect by kissing. HIV is dependent on getting a ride in body fluids (sperm or blood) from one person right into the bloodstream of the second person, and then finding the right type of cell to attatch itself to. Even with repeated receptive anal sex the virus need not succeed. I know a guy who was f**ed several times by a HIV positive Thai man, no condom used. Everyone thought the bottom guy would be infected when they found out the Thai guy was positive, but he just didn't catch the virus. Evidently even this exposure wasn't enough for the HIV particle to make the jump.

Well, there are those who want to believe that their favourite sexual practice is safe so much that they will believe anything, but it's a shame that they should also feel the need to try to persuade others of this too.

The reality is that you can get HIV from a single session of unprotected anal sex (active or passive), vaginal sex, or oral sex if you're the person doing the sucking. Whether one chooses to believe this, or is prepared to take this risk is up to the individual.

Whatever, "objective" may think he is proving to him self by his partial quote from my previous post, the fact remain that a high rate of HIV in the sexually active population plus unsafe sex equals an even higher rate of HIV, whereas a low rate of HIV infection plus greater condom use equals stasis or a more modest increase. The HIV+ rate in the UK is Low, but not zero. Straight people in the UK do get HIV from unprotected hetero sex, both men and women, but at a very much lower rate than in Africa because far fewer of the partners with whom they have unprotected sex are HIV+, as I said in the part of my post "objective" chose to omit

Well, there are those who want to believe that their favourite sexual practice is safe so much that they will believe anything, but it's a shame that they should also feel the need to try to persuade others of this too.


Are you talking to me? I haven't mentioned safe sex at all. This isn't about what is safe or not, but about trying to understand the epidemic. (If anyone asks me I recommend 100% condom use).

Consider this: "During 2000тАУ2003, HIV/AIDS rates for African American females were 19 times the rates for white females and 5 times the rates for Hispanic females; they also exceeded the rates for males of all races/ethnicities other than African Americans. Rates for African American males were 7 times those for white males and 3 times those for Hispanic males."

And this: "The highest rates of sexually transmitted diseases (STDs) are those for African Americans. In 2003, African Americans were 20 times as likely as whites to have gonorrhea and 5.2 times as likely to have syphilis [10]. Partly because of physical changes caused by STDs, including genital lesions that can serve as an entry point for HIV, the presence of certain STDs can increase oneтАЩs chances of contracting HIV by 3- to 5-fold. Similarly, a person who is coinfected has a greater chance of spreading HIV to others."

http://www.cdc.gov/hiv/pubs/facts/afam.htm

Yang2: Straight people in the UK do get HIV from unprotected hetero sex, both men and women, but at a very much lower rate than in Africa because far fewer of the partners with whom they have unprotected sex are HIV+, as I said in the part of my post "objective" chose to omit

Your argument is circular. You again say that in order to cause a high rate of HIV in a country for example the UK, that country must..... wait for it.... have a high rate of HIV.


Silom: The highest rates of sexually transmitted diseases (STDs) are those for African Americans.

Silom could the broadly higher rate of otherwise treatable STD's among Black Americans can be attributed to the higher likelihood of being near the poverty line? It would not surprise me if they were broadly the sickest, simply because they are the poorest. I have no data to back that up, it's just something that would not surprise me. Wealth = Health!

Also, just because the presence of certain STD's increase the statistical probability of simultaneously having HIV infection, does not necessarily mean that STD's themselves, nor their symptoms cause higher chance of aquiring HIV infection. It may just mean that people who have STD's tend to be the ones that have plenty of unprotected sex, and therefore are more statistically likely to catch HIV. Could be many reasons. Although I think that there may at least be some kind of co-factor surrounding HIV/AIDS that we are unaware of. I think a piece of the puzzle is yet to be uncovered, because there are just far far too many legitimate exceptions to the current HIV position. And I appear to be the devil for having these views! Gays can be so political!

Silom could the broadly higher rate of otherwise treatable STD's among Black Americans can be attributed to the higher likelihood of being near the poverty line? It would not surprise me if they were broadly the sickest, simply because they are the poorest. I have no data to back that up, it's just something that would not surprise me. Wealth = Health!

Well yes, poverty = low education = shortsighted behaviour = higher risk. But many Mexican immigrants to the US are also poor? Who are poorest, and does it autmatically mean whoever are poorest also get the most HIV?


Also, just because the presence of certain STD's increase the statistical probability of simultaneously having HIV infection, does not necessarily mean that STD's themselves, nor their symptoms cause higher chance of aquiring HIV infection. It may just mean that people who have STD's tend to be the ones that have plenty of unprotected sex, and therefore are more statistically likely to catch HIV.

That was how I read it. I have seen researchers use gonorrea as an indicator of how much unprotected sex a population has. I have seen European researchers worry that the clap is spreading among youths (but still without any big outbreak of HIV).

I agree something is missing in the puzzle. What is the elephant in the room?

Silom- no I was referring to objective who was trying to use part of my post to "prove" his point. Howver I see that objective has a minus 15 karma is thus, presumably, one of the board's trolls. I shall therefore just ignore him.

[Boxer]

Yang2 wrote
"Well, there are those who want to believe that their favourite sexual practice is safe so much that they will believe anything, but it's a shame that they should also feel the need to try to persuade others of this too."
Also true about underage sex i feel.

In regard to question 1, yes, it could be. However, even if that were the case, it does not explain why Africa has such a high Aids rate compared to other countries that also satisfy the same criteria.


I read a few years ago an explanation that attributes it to eating (Usually, undercooked, over open fires.) bush meat. It went on to claim Africa, and bush meat, as the original source of HIV: there was an endemic of SIV among African monkeys before human infection and the virus jumped to humans: HIV.
And they eat bush meat because it is available and it is free: the poverty angle.

Google Monkeys & HIV and you will find more info, such as:
http://news.nationalgeographic.com/news ... sjump.html (http://news.nationalgeographic.com/news/2003/06/0612_030612_hivvirusjump.html)

Also earlier infection: children, especially Third World children; are being infected because child prostitution and child rape--especially, virgins; some as young as one-year-of age--are on the increase because many believe, are even incouraged by their shamen (Is, Shaman, the correct word?) to believe children are less likely to be infected with HIV and other STD's. This is the result of ignorance...ignorance which often stems from poverty.

Re: transmission through anal sex

Could there be a clue here?


I read somewhere that the mucous membranes and such membranes that are found in the anal passages and throat are designed for a certain amount of absorption of liquids into the blood stream.

The colon is for sure designed to absorb minerals and other particles from food. Could it be that if infected semen penetrates the colon deep enough that it could be absorbed into the blood stream?

Why may some get it this way and not others?
Perhaps it's luck... depth of penetration? The recipients natural resistance to disease? The strength / volume of semen/ the virus? etc etc.
I guess you see parallels in conception... why does one hetero partnership take years trying to conceive when another couple conceive the first at the first attempt. So many variables!

Of course this doesn't explain how the 'top' may catch the virus from an infected 'bottom', unless there is some exchange of blood involved. That can happen quite easily of course if no lube is used. If condoms are not so readily available in Africa, then maybe lube isn't either. could this be another contributory factor?

As I said in my previous post... my comments are pure speculation.
I'm sure there must be a report on these points somewhere on the www.

Re: transmission through anal sex
I'm sure there must be a report on these points somewhere on the www.

That's the problem. I can't find any frank discussion of it. Gay people, black people, drug users, Africans, Thais, they are all up in arms if someone tries to say something un-PC about HIV and Aids. I only find isolated anonymous posts on the Internet like this one from a sex discussion group:



>Newsweek Oct. 31, 2005 issue - A landmark study with major implications for the
> global AIDS epidemic, published this week by French and South African
> researchers, seems to confirm what scientists have long suspected: that
> circumcision cuts the risk of HIV infection dramatically, by as much as
> 60 percent

I don't believe for a second. Here is why:
1. We do know a lot about HIV transmission, and this flies in the face
of most of it. There are really only two efficient transmission methods
that we know of: through the anal walls (very thin, easily torn,
exposing blood vessels to virus contained in semen) and needle sharing.
The risk to a male who is not receiving anal sex is rather miniscule. I
could see someone studying whether circumcision may affect the ability
to TRANSMIT HIV, but not to RECEIVE it.

2. There is a lot a terribly conducted politically motivated AIDS
research coming out of Africa. Some of it falls into the realm of pure
fabrication. This is one of the things that has frustrated the
international community, making them very reticent to become directly
involved in the fight against AIDS there. For example, there is an AIDS
epidemic in large parts of Africa, but sexual behavior surveys do not
reveal any significant risk factors. Anal sex and nonheterosexual
contact are generally found to be denied, which is a baffling finding
to begin with (all cultures exhibit both behaviors at least to some
degree). This is an impossible contradiction: an AIDS epidemic cannot
be maintained through nonanal sexual contact. We also know that Brazil,
which share many cultural practices with parts of Africa, has both a
high rate of AIDS and one of the highest rates of anal sex in the world
(extimated to be as high at 50% of the population, mainly used as cheap
birth control). There is likely a systematic denial of sexual practices
going on in the scientific community in Africa.