The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). The rate of HIV infection is increasing most rapidly among heterosexual women. HIV infection is the fifth leading cause of death among women 19–39 years of age. HIV infection is not a disease that only “other people” get. Every woman must know how to protect herself, her partner, and any children she may choose to have.
How Infection Occurs
The HIV virus enters the bloodstream by way of body fluids—in most cases, blood or semen. Once in the blood, the virus invades and kills cells of the immune system. These cells are white blood cells called CD4 cells. When these cells are destroyed, the body is less able to fight disease. The number of these white blood cells often decreases in patients with advanced HIV infection.
How Infection Is Spread
HIV infection is spread through contact with some types of body fluids of an infected person. This can happen during sex or by sharing needles used to inject drugs. An infected woman who is pregnant can pass the virus to her baby. Women with HIV who breastfeed also can pass the virus to their babies. Once someone is infected, he or she always will carry the virus and can pass it to others.
People may become infected with HIV if they are exposed to infected blood or blood transfusions during a medical procedure. This was not known until 1985, so persons who received blood transfusions before then could have been infected this way. All donor blood in the United States is now screened for diseases such as HIV, so the risk of getting infected this way is very low.
People also may become infected if they are exposed to infected blood by accident. For instance, some health care workers have become infected from contact with their patients’ infected blood.
HIV cannot be spread by casual contact with people and objects (see box). The virus cannot get through skin that is not broken.
Effects of HIV
A person who has been infected with HIV does not get sick with AIDS right away. The virus breaks down the immune system over time. Shortly after infection, some people have a brief illness like the flu. As the immune system becomes weaker, people infected with HIV may have weight loss, fatigue, and fever.
The infection is called AIDS when a person has certain conditions or symptoms that result from a weakened immune system. It also is called AIDS when the number of a person’s CD4 cells decreases below a certain level.
What Does Not Spread HIV
You should know the ways that HIV cannot be spread, or contact for which there is no known risk. HIV has not been shown to spread through: hugging, kissing, or touching, coughing or sneezing, being exposed to another person’s tears or sweat, giving blood, sharing food or drink, touching objects such as bedsheets, towels, toilet seats, telephones, or door knobs.
Using swimming pools, hot tubs, steam baths, or saunas
Over time, HIV infection results in severe illness. The body is left open to harmful infections and certain types of cancer. Such conditions attack the body when the immune system is weak. Sometimes these conditions can be treated. They often come back after treatment, though.
It may be months or years before HIV becomes AIDS. On average, it takes about 11 years from the time of infection to develop AIDS. In some cases, though, it takes much less time. Because symptoms do not appear right away, a person may not know that he or she is infected with HIV. Someone who looks healthy can carry the virus for years without knowing it and can pass it to others.
HIV Transmission in Women
Most women get the HIV virus by using IV drugs or having sex with men who use such drugs. However, the number of women infected by heterosexual activity has
During sex, the virus is spread more easily from men to women than from women to men. The risk of spreading HIV from woman to woman during sex is not known, but it is thought to be low.
Testing for HIV
A simple blood test can tell you whether you have been infected with HIV. It looks for HIV antibodies in the blood. This test is not an AIDS test. It does not tell you if you have AIDS or if you will get sick.
There are several types of HIV tests. A rapid screening test produces very quick results (in about 20 minutes). It often takes about 2 weeks to get results from other types of screening tests. No matter what type of test is taken, if the test result is positive, another test is used to confirm the results.
Who Should Be Tested
Women and men aged 19–64 years should be tested for HIV. People in other age groups also may need to be tested depending on their risk factors. It is especially important for pregnant women to be tested for HIV as part of their prenatal care—even if they do not think they may be infected. You may have counseling before the test, after getting the results, or both.
What the Results Mean
A positive test result means that you are infected with HIV and can pass the virus on to others. You will need to get special health care and take measures to protect others (see box).
A negative test result means that HIV antibodies were not found in your blood. In most cases, antibodies show up in the test within 6–12 weeks after a person is infected. Sometimes it may take longer. For this reason, you may want to take a second test after about 6 months to be sure to get an accurate result. Even if your test results are negative, you should still protect yourself by stopping any behavior that could pose a risk.
There is no vaccine to prevent HIV infection, and there is no cure for AIDS. However, there are some medications that fight HIV–related infections and help protect the immune system. In most cases, many medications are used together. Your doctor will work with you to determine what medicines to take, when to take them, and how much to take of each. It is important to take these drugs exactly as your doctor prescribes. This can help you live a longer, healthier life.
If You Are Infected
A positive HIV test result means that you are infected with the virus. You should take certain steps to avoid passing the infection to others:
Tell sex partners—past and present.
Do not share needles to inject drugs (if you have, tell the person).
Practice safer sex.
Never donate or sell your blood or plasma or arrange to be an organ donor.
Do not share toothbrushes, razors, or other objects that could have blood on them.
Be sure to tell every health care provider who treats you, including your dentist, that you are HIV positive.
If you are pregnant, talk to your doctor about special care for you and your newborn.
Protecting Yourself and Others
The number of people in the United States who are infected with HIV is increasing. There are things you can do to decrease your risk of getting or spreading the virus.
Use a Condom
The best way to help prevent the spread of HIV infection during sex is by using latex condoms. Latex condoms also can help prevent the spread of other sexually transmitted diseases (STDs), such as gonorrhea, syphilis, and chlamydia. Condoms made from natural skin or lambskin do not prevent infection. Condoms do not offer complete protection against HIV infection. When used properly, though, they can reduce the chances that one partner will infect the other (see box). For best protection, condoms should be worn every time you have sex.
Practice Safe Sex
The safest practice of all is to not have sex. However, “safe” sex means sexual practices that reduce the risk of HIV transmission. There are aspects of safe sex you should know about.
Know your partner. Keep in mind that it is not just your own behavior that can put you at risk, it is also your partner’s. Ask about your partner’s sexual history and whether he or she has ever used IV drugs. There is no way of knowing for sure if someone has HIV infection without being tested. You and your partner may want to be tested before you begin having sex.
How to Use a Condom
Proper condom use helps protect you and your partner from HIV infection, other STDs, and pregnancy. If your partner refuses to use a condom, you may want to not have sex with him rather than risk your health. If you still want to have sex, use the female condom. A female condom can provide protection close to that of the male condom.
To use the male condom, place the rolled–up condom over the tip of the erect penis. Hold the end of the condom to allow a little extra space at the tip, and then unroll the condom over the penis.
Right after ejaculation, grasp the condom around the base of the penis as it is withdrawn. The condom should then be thrown away—it should never be reused.
To use the female condom, squeeze the inner ring between your fingers and insert it into the vagina. Push the inner ring up until it is just behind the pubic bone. About an inch of the open end should be outside your body.
Right after ejaculation, squeeze and twist the outer ring and pull the pouch out gently. Like the male condom, it should be thrown away—it should never be reused.
Limit sexual partners. The chances of getting infected with HIV increase with each sexual partner you have. The safest kind of relationship is one in which neither partner has had sex with anyone else.
Avoid risky sex practices. The riskiest sex is vaginal or anal sex without a condom. Anal sex poses the most risk because it is more likely to tear or break the skin. This makes it easier for HIV (from an infected partner) to enter the bloodstream.
Hugging, kissing, massage, and fondling are all thought to be safe sex. Mutual masturbation also poses less risk.
Do Not Use Drugs
Injecting (“shooting”) drugs greatly increases your chances of HIV infection. If you are using IV drugs, get help and try to stop. If you cannot stop, do not share needles. If you share needles, the HIV–infected blood left in the needles after injecting can get into you or your needle–sharing partner. Make sure that the needle is clean. Needles should be cleaned after every use with both laundry bleach and water.
Concerns for HIV–Positive Women
Women who are HIV positive have special health concerns. These include birth control, certain conditions, and pregnancy and childbirth.
An HIV–infected woman can avoid pregnancy by using effective birth control. If she becomes pregnant, the fetus is at risk of infection. If you are infected and using birth control to prevent pregnancy, your partner still should use latex condoms during sex to avoid getting the virus from you.
A woman infected with HIV is more likely to get yeast infections and pelvic inflammatory disease—an inflammation of the reproductive organs. Normally, these conditions are easy to treat. In an HIV–infected woman, though, the conditions may resist treatment. They also may be more severe and recur more often.
If you are infected with HIV, you will need to be tested for other STDs. You also should be vaccinated against hepatitis B, influenza, and pneumonia if you are not immune to these diseases. Some cancers, such as cervical cancer, are more common in women who are infected with HIV. Therefore, women who are HIV infected should have a Pap test twice in the first year after HIV is diagnosed and once every year thereafter.
Pregnancy and Childbirth
During pregnancy, all women should be tested for HIV as early as possible. If you are pregnant and infected with HIV, you can infect your baby. Almost 25% of untreated pregnant women with HIV pass the virus to their babies. Treatment with medication during pregnancy can greatly lower this risk. Also, cesarean delivery may be recommended for some women.
The HIV virus can be passed from mother to baby during pregnancy, labor, or delivery. A woman also can infect her baby through breastfeeding because HIV is found in breast milk. HIV–positive women should not breastfeed their babies.
Pregnant women who are infected with HIV need to have their health checked closely. They should report all symptoms to their doctors. This way, they can provide proper care.