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?

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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)

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

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!