HIV Basics

HIV Transmission

Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers). But there are powerful tools that can help prevent HIV transmission.

This section answers some of the most common questions about the risk of HIV transmission for different types of sex, injection drug use, and other activities.

How is HIV passed from one person to another?

Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers). But there are powerful tools that can help prevent HIV transmission.

Can I get HIV from anal sex?

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You can get HIV if you have anal sex with someone who has HIV without using protection (like condoms or medicine to treat or prevent HIV).
  • Anal sex is the riskiest type of sex for getting or transmitting HIV.
  • Being the receptive partner (bottom) is riskier for getting HIV than being the insertive partner (top).
  • The bottom’s risk of getting HIV is very high because the rectum’s lining is thin and may allow HIV to enter the body during anal sex.
  • The top is also at risk because HIV can enter the body through the opening at the tip of the penis (or urethra), the foreskin if the penis isn’t circumcised, or small cuts, scratches, or open sores anywhere on the penis.

Can I get HIV from vaginal sex?

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You can get HIV if you have vaginal sex with someone who has HIV without using protection (like condoms or medicine to treat or prevent HIV).
  • Vaginal sex is less risky for getting HIV than receptive anal sex.
  • Either partner can get HIV during vaginal sex.
  • Most women who get HIV get it from vaginal sex. HIV can enter a woman’s body during vaginal sex through the mucous membranes that line the vagina and cervix.
  • Men can also get HIV during vaginal sex. This is because vaginal fluid and blood can carry HIV. Men get HIV through the opening at the tip of the penis (or urethra), the foreskin if the penis isn’t circumcised, or small cuts, scratches, or open sores anywhere on the penis.

Can HIV be transmitted from a mother to her baby?

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HIV can be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. However, it is less common because of advances in HIV prevention and treatment.
  • This is called perinatal transmission or mother-to-child transmission.
  • Mother-to-child transmission is the most common way that children get HIV.
  • Recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.
  • If a mother with HIV takes HIV medicine daily as prescribed throughout pregnancy and childbirth, and gives HIV medicine to her baby for 4 to 6 weeks after giving birth, the risk of transmitting HIV to the baby can be less than 1%.

Can I get HIV from sharing needles, syringes, or other drug injection equipment?

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You are at high risk for getting HIV if you share needles, syringes, or other drug injection equipment (for example, cookers) with someone who has HIV. Never share needles or other equipment to inject drugs, hormones, steroids, or silicone.
  • Used needles, syringes, and other injection equipment may have someone else’s blood on them, and blood can carry HIV.
  • People who inject drugs are also at risk for getting HIV (and other sexually transmitted diseases) because they may engage in risky sexual behaviours like having sex without protection (such as condoms or medicine to prevent or treat HIV).
  • You’re also at risk for getting hepatitis B and C, and other infections if you share needles, syringes, or other injection equipment.
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What are some rare ways that HIV has been transmitted?

There is little to no risk of getting HIV from the activities below. For transmission to occur, something very unusual would have to happen.
Oral Sex
  • Oral sex involves putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (rimming).
  • Factors that may affect this risk include ejaculation in the mouth with oral ulcers, bleeding gums, or genital sores, and the presence of other sexually transmitted diseases (STDs).
  • You can get other STDs from oral sex. And if you get feces in your mouth during anilingus, you can get hepatitis A and B, parasites like Giardia, and bacteria like Shigella, Salmonella, Campylobacter, and E. coli.
Workplace
  • The most likely cause is being stuck with a contaminated needle or another sharp object.
  • Careful practice of standard precautions protects patients and health care personnel from possible occupational HIV transmission.
Medical Care
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  • The New Zealand blood supply and donated organs and tissues are thoroughly tested, so it is very unlikely that you would get HIV from blood transfusions, blood products, or organ and tissue transplants.
  • You cannot get HIV from donating blood. Blood collection procedures are highly regulated and safe.
Pre-Chewed Food
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  • The only known cases are among infants. Contamination occurs when blood from a caregiver’s mouth mixes with food that is pre-chewed before feeding to an infant.
  • You can’t get HIV from consuming food handled by someone with HIV.
Biting
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  • Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. Transmission can occur when there is contact between broken skin, wounds, or mucous membranes and blood or body fluids mixed with the blood of a person who has HIV.
  • There is no risk of transmission if the skin is not broken.
Deep, Open-Mouth Kissing
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  • Although very rare, transmission can occur if both partners have sores or bleeding gums and blood from the partner with HIV gets into the bloodstream of the HIV-negative partner.
  • HIV is not transmitted through closed-mouth or “social” kissing with someone who has HIV.
  • HIV is not transmitted through saliva.
Female-to-Female
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  • Case reports of female-to-female transmission of HIV are rare.
  • Vaginal fluids and menstrual blood may carry the virus and exposure to these fluids through mucous membranes (in the vagina or mouth) could potentially lead to HIV infection.
Tattoos and Body Piercings
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  • There are no documented cases in New Zealand of anyone getting HIV this way.
  • However, it is possible to get HIV from tattooing or body piercing if the equipment used for these procedures has someone else’s blood in it or if the ink is shared. This is more likely to happen when the person doing the procedure is unlicensed because of the potential for unsanitary practices such as sharing needles or ink.
  • If you get a tattoo or a body piercing, be sure that the person doing the procedure is properly licensed and that they use only new or sterilised needles, ink, and other supplies.

What body fluids transmit HIV?

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Only certain body fluids from a person who has HIV can transmit HIV. These fluids include:
  • blood,
  • semen (cum),
  • pre-seminal fluid (pre-cum),
  • rectal fluids,
  • vaginal fluids, and
  • breast milk.
These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.

How well does HIV survive outside the body?

HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host. It is not transmitted
  • By mosquitoes, ticks, or other insects.
  • Through saliva, tears, or sweat.
  • By hugging, shaking hands, sharing toilets, sharing dishes, or closed-mouth or “social” kissing with someone who has HIV.
  • Through other sexual activities that don’t involve the exchange of body fluids (for example, touching).
  • Through the air.
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What can increase the risk of getting or transmitting HIV?

Viral Load
The higher someone’s viral load, the more likely that person is to transmit HIV.
  • Viral load is the amount of HIV in the blood of someone who has HIV.
  • Viral load is highest during the acute phase of HIV, and without HIV treatment.
  • Taking HIV medicine can make the viral load very low—so low that a test can’t detect it (called an undetectable viral load).
  • People with HIV who keep an undetectable viral load (or stay virally suppressed) can live long, healthy lives. Having an undetectable viral load also helps prevent transmitting the virus to others through sex or sharing needles, syringes, or other injection equipment, and from mother to child during pregnancy, birth, and breastfeeding.
Other Sexually Transmitted Diseases
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If you have another sexually transmitted disease (STD), you may be more likely to get or transmit HIV.
  • Getting tested and treated for STDs can lower your chances of getting or transmitting HIV and other STDs.
  • If you have HIV and get and keep an undetectable viral load, getting an STD does not appear to increase the risk of transmitting HIV. But STDs can cause other problems.
  • Using condoms can reduce your chances of getting or transmitting STDs that can be transmitted through genital fluids, such as gonorrhoea, chlamydia, and HIV.
  • Condoms are less effective at preventing STDs that can be transmitted through sores or cuts on the skin, like human papillomavirus, genital herpes, and syphilis.
If you’re sexually active, you and your partners should get tested for STDs, even if you don’t have symptoms.
Alcohol and Drug Use
When you’re drunk or high, you’re more likely to engage in risky sexual behaviours like having sex without protection (such as condoms or medicine to prevent or treat HIV).
  • Being drunk or high affects your ability to make safe choices.
  • Drinking alcohol, particularly binge drinking, and using “club drugs” can alter your judgment, lower your inhibitions, and impair your decisions about sex or drug use.
  • You may be more likely to have unplanned sex, have a harder time using a condom the right way every time you have sex, have more sexual partners, or use other drugs.
If you’re going to a party or another place where you know you’ll be drinking or using drugs, you can bring a condom so that you can reduce your risk of getting or transmitting HIV if you have vaginal or anal sex.

Counselling, medicines, and other methods are available to help you stop or cut down on drinking or using drugs. Talk with a counsellor, doctor, or other health care provider about options that might be right for you.

HIV and Substance Use

Substance use disorders, which are problematic patterns of using alcohol or another substance, such as crack cocaine, methamphetamine (“meth”), amyl nitrite (“poppers”), prescription opioids, and heroin, are closely associated with HIV and other sexually transmitted diseases.

Injection drug use (IDU) can be a direct route of HIV transmission if people share needles, syringes, or other injection materials that are contaminated with HIV. However, drinking alcohol and ingesting, smoking, or inhaling drugs are also associated with increased risk for HIV. These substances alter judgment, which can lead to risky sexual behaviours (e.g., having sex without a condom, having multiple partners) that can make people more likely to get and transmit HIV.

In people living with HIV, substance use can hasten disease progression, affect adherence to antiretroviral therapy (HIV medicine), and worsen the overall consequences of HIV.

Commonly Used Substances and HIV Risk

  • Alcohol. Excessive alcohol consumption, notably binge drinking, can be an important risk factor for HIV because it is linked to risky sexual behaviours and, among people living with HIV, can hurt treatment outcomes.
  • Opioids. Opioids, a class of drugs that reduce pain, include both prescription drugs and heroin. They are associated with HIV risk behaviours such as needle sharing when infected and risky sex, and have been linked to a recent HIV outbreak.
  • Methamphetamine. “Meth” is linked to risky sexual behaviour that places people at greater HIV risk. It can be injected, which also increases HIV risk if people share needles and other injection equipment.
  • Crack cocaine. Crack cocaine is a stimulant that can create a cycle in which people quickly exhaust their resources and turn to other ways to get the drug, including trading sex for drugs or money, which increases HIV risk.
  • Inhalants. Use of amyl nitrite (“poppers”) has long been linked to risky sexual behaviours, illegal drug use, and sexually transmitted diseases among gay and bisexual men.
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About HIV

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About HIV

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HIV Transmission

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HIV Transmission

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HIV Prevention

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HIV Prevention

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PrEP

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PrEP

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PEP

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PEP

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HIV Stigma

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HIV Stigma

Information contained in this section is a reproduction for New Zealand of content published on the CDC (Centers for Disease Control and Prevention) Website
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