At the end of September, the Equal Employment Opportunity Commission filed a lawsuit against a Subway franchise located in Sheridan, Indiana. The lawsuit alleges that employee John Doe was hired to work at the store on January 1, 2015. Twelve days later, the employee disclosed his HIV-positive status to the store manager. Doe reported to the EEOC that, on February 14, his supervisor called him at home to fire him, telling Doe he might be a liability to the company.
The day after the lawsuit was filed, Indianapolis-based radio station 103.3 invited its listeners to call in during a morning show to voice their opinions over the air about the lawsuit. I listened to part of this broadcast and was blown away by some of these callers and their sheer ignorance of HIV in terms of how the virus spreads and how long the virus lives outside the body.
Feeling inspired by this radio broadcast, I have created this HIV transmission fact sheet using information obtained from the Centers for Disease Control and Prevention (CDC), AIDS Vancouver Island and online resources aidsmap.com and aids.gov.
There are three stages of HIV infection. The first stage is acute infection, in which large amounts of the virus are being produced in the body. Within 2 to 4 weeks of initial infection, many people develop flu-like symptoms, which is the body’s natural response to HIV infection. The second stage of HIV infection is clinical latency, in which the virus reproduces at very low levels, although it is still alive. With proper HIV treatment, people can live with clinical latency for several decades. The last stage of HIV infection is AIDS. Without treatment, the average life span of a person with AIDS is between one and three years.
For transmission to occur, HIV needs three things: a body fluid with a high HIV viral load, an activity that shares those fluids and a way for HIV to get into the bloodstream. Numerous laboratory studies have looked at how HIV responds to different factors and how viral loads can change due to those same factors.
Survival of HIV outside the body depends on many factors: the body fluid in which the virus is located, i.e. blood, semen, vaginal and cervical secretions, breast milk or saliva; concentration of the virus within that body fluid (i.e., if the HIV-positive person is regularly using antiretroviral medications to suppress the virus); temperature; acidity and exposure to sunlight and humidity.
Body fluids and secretions that do not transmit HIV include saliva, sweat, skin oils, tears, snot, urine, feces, vomit and ear wax. Simply put, a restaurant worker with HIV will not transmit the virus to customers or coworkers through every day, non-sexual contact.
The way HIV enters the body is through an open sore, a fresh cut or a puncture wound, such as a needle poke; through unprotected anal or vaginal sex; and from mother to child during pregnancy or during breast feeding.
HIV is not spread through bug bites, animal bites, using public bathrooms, going to the gym, touching common surfaces such as doorknobs or benches, sharing food or drinks, sneezing, kissing, hugging or touching.
Female-to-female sexual contact is the least likely way to spread HIV through sexual contact. Researchers believe this is because the pH levels in the vagina are an inhospitable place for the virus to live and replicate and saliva is not a body fluid that transmits the virus.
It is possible to transmit HIV through fellatio, or a blowjob, but conditions have to be just so for this to happen: for example, the male receiving oral pleasure is HIV positive, the person giving the pleasure has a fresh cut on the inside of the mouth and ejaculation into the mouth occurs. The CDC reports the risk of HIV transmission through oral sex is “much lower than anal or vaginal sex.”
“HIV transmission has not been reported as a consequence of contact with spillages of blood, semen or other body fluids,” according to aidsmap. The CDC has similar verbiage on its website.
HIV present in blood can live “a long time” when inside the human body or when inside a vacuum, such as a blood donation bag or the barrel of a needle. In Southern Indiana, an HIV outbreak with over 153 confirmed cases was traced back to HIV-contaminated needles. The ability of HIV to live inside needle barrels is why tattoo equipment must be properly sterilized between uses.
A small amount of HIV is found in the breast milk of HIV-positive mothers, with this amount being just enough to infect a newborn with the virus, which is why these women are advised against breast feeding.
HIV-positive people who are regularly taking antiretroviral medications, such as Truvada used as PrEP, can have very low viral loads, which means the amount of virus found in their blood samples is not detectable as a result of the low viral load. Viral load tests only determine the amount of virus found within blood. HIV can still be present in genital fluids, such as semen or vaginal secretions, which means it is possible for people with low viral loads to transmit the virus to others through unprotected sex.
According to the CDC, the presence of other sexually transmitted diseases can increase the viral load found in genital fluids. For example, if an HIV-positive male contracts gonorrhea, this secondary infection will cause the viral load in his semen to increase.
Other diseases or infections in conjunction with HIV can signal the transition of HIV to full-blown AIDS. CD4 cells, which are made in the spleen, lymph nodes and thymus gland, are a type of white blood cell in the body that fight infections. HIV destroys CD4 cells in its quest to replicate within the body.
Healthy people without HIV have CD4 cell levels of between 500 and 1,600 cells/mm3. AIDS occurs when an HIV-positive person’s CD4 cell count falls below 200 cells/mm3 or when the infected person develops one or more opportunistic infections, regardless of CD4 cell count.
There are over 20 opportunistic infections, thus named because they take advantage of a weakened immune system and can cause devastating illnesses as a result. The CDC lists invasive cervical cancer, herpes simplex, histoplasmosis, lymphoma, tuberculosis, recurrent pneumonia, salmonella, toxoplasmosis of the brain and wasting syndrome due to HIV among common opportunistic infections for HIV patients.
It is important to keep in mind that, even though HIV transmission varies in risk from one method to another with some methods being very low risk, we should continue to practice safety during our sexual encounters.