This article isn't here to scare you: after all, most of you who have been sexually active are much more likely to end up with HPV, Herpes or Chlamydia than you are with HIV. But that doesn't mean it's smart to forget about HIV, or figure it's nothing you've got to know about, especially since unlike other, more common STIs, HIV/AIDS is one of the rare few that has the capacity to cause very serious long-term health problems and can even be fatal.
While it's less common for western teens than other sexually transmitted infections, it also isn't anything close to rare: a few million teens and young adults worldwide acquire HIV every single year. Every hour of every day, one young American between the ages of 13 and 21 is infected with the HIV virus.
In the United States alone, 25% of all new HIV infections are in people of all sexes and orientations between the ages of 13 and 21, and a majority of those young adults don't even know they have it: in a Kaiser Foundation survey of youth about HIV, less than 30% of respondents have ever even been tested, and less than 50% reported they even knew where to go to get testing in the first place.
Among gay youth, awareness about HIV and the real risks posed has also been decreasing, and concerns about safer sex have decreased. That may well be in part because the overwhelming bias about gay men and HIV/AIDS was so extreme it had gay men of all ages in a very real state of panic for a long time, or because more focus -- as it should be -- has been put on other populations when it comes to HIV and AIDS, not just on gay men. But it's likely also in part because so many people with HIV seem to be doing just fine thanks to advanced drugs, and more dangerously, because in some gay populations, risking HIV is sometimes seen as a rite of passage, much like risking pregnancy is sometimes viewed among young straight women. But the risks to gay men -- the risks to anyone -- remain very real: around 50% of all new AIDS cases in young men are from men sleeping with men. (The same risks do not exist with young gay women: female-to-female HIV transmission is very rare.)
According to the Centers for Disease Control, at the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV and/or AIDS. The CDC has estimated that approximately 40,000 persons in the United States become infected with HIV each year, however a new CDC report shows that the actual number of cases is greater than they estimated: approximately 56,300 new HIV infections occurred in the United States in 2006, which is approximately 40% higher than CDC’s previous estimate.
That new report also found that of the new cases in 2006, 53% were from male-to-male sexual contact, and 31% from male-to-female sexual contact (only 12% of cases were due to IV drug use). The vast majority of HIV infections arise from sexual contact, for both men and women alike. AIDS is currently the fifth leading cause of death among all adults aged 25 to 44 in the United States: that CDC report found that more infections occurred in 2006 among young people under 30 (aged 13–29) than any other age group. So, no matter who we are, who we sleep with, or how safe we think we are, we can say pretty clearly that being ignorant about HIV and AIDS is a clear danger to our health and the health of those around us.
Because for so many years, information about HIV and AIDS was so biased, an unfortunate result of those biases has been that lots of folks have outdated or incorrect information about HIV. Let's debunk some myths and look at the facts.
Might as well stop right there: you can't spread AIDS to someone else at all. You can only spread HIV person-to-person.
So, what IS HIV? And what is AIDS? Both are acronyms: HIV stands for Human Immunodeficiency Virus; AIDS for Acquired Immune Deficiency Syndrome. HIV is a virus people can and do spread around, and AIDS is a syndrome which people with HIV often eventually develop: HIV often progresses to AIDS, and you can't wind up with AIDS without having contracted HIV first. AIDS is not contagious: HIV is. Neither are currently curable: once you've got HIV or AIDS, you've got them for life.
The HIV virus attacks cells in your body called CD4 cells -- also called T4 or T-helper cells -- which are essential in helping your body fight off infection and disease. As HIV destroys your immune system, that's where and how AIDS -- severe immunodeficiency -- can develop. An HIV-positive (someone diagnosed with the HIV virus) person is diagnosed with AIDS when their immune system becomes seriously compromised -- because those CD4 cells have been killed by HIV --- and manifestations of HIV infection are severe. Then the body becomes incapable of fighting off infections that normally we can handle, and aren't of real danger to us -- things like colds or yeast infections -- but which aren't harmless once we've got AIDS: every infection (same goes with cancers) becomes a major threat to our health because our body is no longer capable of the normal processes that fight off and help us heal from those infections.
Neither HIV or AIDS are currently curable. However, both are treatable. Advances in medicines to manage HIV through antiretroviral therapy and other alternative therapies -- as well as increases in screenings to diagnose HIV earlier and earlier -- have made a very real, positive difference when it comes to those living with HIV. HIV is no longer an absolute death sentence.
However, managing HIV also relies on two very important factors: finding HIV early, and having the resources to access and afford the medications for management. One big reason why people of color worldwide are harder hit by HIV and AIDS has to do with class differences -- who has more money and agency -- between the races when it comes to healthcare. And for younger people, many of whom don't have their own healthcare, especially when they're first starting out in their adult lives, and many of whom don't get regular STI/HIV testing, having good drugs and management tools is sometimes of limited use.
Even when good healthcare and treatment for HIV can be accessed, living with HIV is hardly a walk in the park. The medications for HIV patients do a real number on a lot of people in terms of side effects, they can be incredibly expensive, and a lot of other lifestyle changes usually need to be made by those living with HIV to feel okay. In addition, treatment for HIV does not do anything to protect sexual partners from getting HIV from a partner who is HIV-positive: it remains highly contagious and dangerous.
Because of earlier detection and advances in medicines, fewer young people with HIV right now will progress to quickly AIDS, and younger people nowadays with AIDS have been living longer than ever before. But it's important to remember that AIDS is a terminal condition, one that, on average -- when antiretroviral therapies are not used -- develops within about ten years from acquiring HIV on average. On average, once HIV has progressed to AIDS, people with AIDS die within one year. No one who has contracted full-blown AIDS has lived through it. Preventing HIV is still the very best thing we can do.
Unprotected anal intercourse (particularly for the receptive partner: the person in whose bottom a penis is entering) and needle-sharing drug use are absolutely the two most prevalent risks of HIV for young people (and most people, period). But not only do those risks exist for people of all sexes and gender equally -- especially as anal sex becomes more common among heterosexual teens -- heterosexual vaginal intercourse is a very close second when it comes to HIV risks.
Understand that why anal sex presents an increased risk is because anal and rectal tissue is more delicate than vaginal tissue, and more likely to have microtears (incredibly small tears) or abrasions from sex, which present sites for infection. But the same can often be true with vaginal tissue, especially when we consider how many young people are having sex without lubricant, without responsive and gentle partners, and how common date and stranger rapes are for young women (forced or even consensual "rough" sex increases risks of HIV and other STI transmission: sexual violence plays a very big part in the HIV/AIDS pandemic).
HIV is spread through four routes, and most prevalently in this order: male sexual fluids, blood, female vaginal fluids or breastmilk. If you are directly exposed to any of those things or expose others to them -- genitally, orally, or intravenously (in your veins) -- then you could get or spread HIV.
Not at all: all you'd have to do is have unprotected sex with one person who has HIV. By all means, the greater number of sexual partners you have, the greater chance you've got of winding up with a partner with HIV, so limiting partners is a big help is reducing the risk of HIV. But if you're having unsafe sex with even one partner, you're at risk, so it's a very big deal to never make exceptions when it comes to safe sex, not even just "that once."
In the early 80's, when HIV and AIDS were first discovered, a majority of those diagnosed with AIDS were gay men. Diagnosed: that means who were found to have it, that doesn't speak for all the folks who had it without being diagnosed. But at this point, we know that EVERYONE can get HIV and AIDS: in 2004, AIDS was a leading cause of death for black women between the ages of 25 and 34, for instance. Worldwide, more than 90% of HIV infections are due to unprotected heterosexual intercourse (consensual and through rapes), and around half of those living with HIV today worldwide are women.
Most sexual HIV transmission in the western world is indeed male-to-male, and secondarily male-to-female, and women are twice as likely to contract HIV from men than men are from women worldwide. But those male-to-male cases in the U.S. are only a little bit higher than all other kinds of transmission, representing only just over half of all new cases. One troubling thing the Kaiser study showed was that overall, young men expressed less concern and interest in finding out about all aspects of HIV and AIDS, even though men are the most common transmissors of the virus, no matter who they're giving it to.
Additional things that can put you at a higher risk for acquiring HIV are having another existing sexually transmitted infection (such as one of the more common ones: one reason teen girls are at an increased risk of HIV is because so many have Chlamydia without knowing it or treating it), getting wasted and having sex (primarily since that increases the risk of having unsafe sex), and much more rarely now, blood transfusions and having had a mother who was HIV-positive at the time of your birth. We can also safely say that homophobia increases the risk of HIV and AIDS, because in cultures and communities where men who sleep with men -- exclusively, or as well as with women -- have to be (or feel they have to be) on the down low, HIV rates are higher. Likewise, we can say that racism and xenophobia have increased the risk of HIV and AIDS given how much harder hit people and communities of color have been by HIV and AIDS. And by all means, ignorance, denial and silence increases all of our risks.
Just to give you an idea, here are some scenarios by which you and your friends could wind up transmitting or contracting HIV:
In any of those scenarios, you can see how easy it can be -- in certain conditions -- to acquire HIV. You can likely also see how easy it is for it to spread among many people: add just a partner or two to those situations, and you've possibly got one or two more people with HIV from the same person. Add a partner or two to those people, and then a partner or two to all of those people...well, you can see how much easier it can be for an awful lot of people to get sick from what originally might have seemed like a safe situation to any given person.
HIV and AIDS are a real problem all over the map. Certainly, Africa has been hit very hard by HIV and AIDS, largely because of a lack of education about them both (which is also a problem in other continents, including this one), as well as because of cultural issues and lack of good healthcare and treatment. But the World Health Organization has made clear that rates are also strongly rising in China, India, Indonesia and Russia, and rates of HIV have not been decreasing here in the western world. Some of why is because HIV information and treatment is not reaching critical populations at risk, and teens and young adults worldwide are one of those critical populations.
Most people with HIV look just like most people without HIV. HIV positive people usually look no different than anyone else: not facially, not genitally. A whole lot of people with HIV, including people who don't know they have it and aren't being treated for it -- feel and look just fine most of the time. HIV is often asymptomatic (it shows no symptoms), and when symptoms are present, they're a whole lot like just having the flu. Those who have symptoms from HIV experience things like fevers, chronic yeast infections, easy bruising, body rashes, chronic fatigue, diarrhea or weight loss: it's really easy to think you've got something else -- or nothing at all -- when you acquire HIV, especially at first.
When HIV progresses to AIDS, we'd be lyin' if we said that AIDS patients looked picture perfect: people with AIDS are very seriously ill, and often look just as seriously ill as they are. Regardless, just like with any other STI, thinking you can know if and when someone has an STI just by looking is a really stupid thing to think: you can't know a person's STI status based on how they look.
While many general practitioners and clinics have upped their efforts to make HIV screenings more routine, it's never smart to assume you've been tested without finding out for sure. Too, a lot of doctors report that because of the cultural climate in terms of teens and sex, they are nervous to ask teens about their sexual activity and STI testing. It's often estimated that less than 20% of of teens and young adults in the U.S. with HIV have been tested and are aware that they have it.
There's no reason not to be proactive and double check with your healthcare provider that you have been tested for HIV. If you have been sexually active and don't want to tell your doctor (something we wouldn't advise keeping to yourself from healthcare pros, but still), you don't have to disclose that: you can ask for a test without discussing your sexual history at all. If your doctor asks why you're asking for testing, all you need to say is because you want to be sure you don't have HIV.
That's a reasonable fear -- there's so much stigma around HIV, and with young people who usually acquire HIV through drug use or sex, people knowing you've got HIV often also means people knowing (or guessing about) you did whatever it was to wind up with HIV. But that's a fear which isn't grounded in the reality of HIV testing right now.
You can get a test for HIV --an oral swab and/or a blood test -- at your regular, general doctor's office or general health clinic, at a hospital, via student health services or through your gynecologist, urologist or sexual health/family planning clinic. There are also clinics which specifically deal with HIV testing and treatment, too. But ALL of those places are legally obligated to protect your privacy.
If you're a minor, you can get HIV testing in most locations worldwide without parental permission or notification. If you choose to use a doctor where your family insurance will cover your visit, then your test may show up on the statement sent to your family, but with so many options for HIV testing in most places -- many of which are low-cost or even free -- there's no need to go through that channel unless you want to. Most HIV results are not sent in the mail, or given to someone else, but given to you, one-on-one, by the person who tested you.
If a person is positive, then that new case will be reported to public health agencies (that's really important to help with prevention efforts as well as with developing treatments), but not with a name made public: a code is used instead. You may be asked, if you test positive, to let the clinic know about your current and previous sexual partners so that they can inform them a previous partner (again, confidentially) has tested positive so they, too, can know to get tested. Or, you may be strongly encouraged to self-report to current and previous partners, something we, too, would strongly urge you to do, even when it is difficult.
We all get that testing can be really scary. (Not to sound like your granny, but back in the day when I first got screenings for HIV, we had to wait weeks and weeks for results, and this is before we had antiretrovirals, when being HIV-positive really was a real death sentence, and we still weren't sure, as we are now, about how it was even transmitted. That wait was absolute torture.) But in so many ways, putting off testing is like letting a pile of unopened bills sit on your desk: the bills aren't going to go away, and the longer you wait to deal with them, the worse things are going to get if you owe. Believe it or not, finally going and getting tested -- and getting in the habit of doing it -- is much more of a relief than it is a burden. If you're feeling really messed up about getting tested, ask your clinic for some extra emotional support before, during and after your tests: they can help and they want to help.
For more on current HIV testing, click here.
Not anything close to likely. Again, there are four major routes of HIV transmission, and if you're not having unprotected sex with anyone in the clinic, sharing needles with anyone in the clinic (and clinicians are beyond impeccable about using clean needles for testing), or breastfeeding from someone in the clinic, you're not going to wind up with HIV. You can't get HIV through casual contact -- like sitting on the same chair or sharing a toilet -- and you also can't get it from even pretty close contact with someone who is HIV positive: close contact like closed-mouth kissing, hugging, handshaking, even sharing glasses or cups, don't present HIV risks.
The most effective way to avoid acquiring HIV is to abstain from vaginal and anal sex with partners (oral sex may present risks, especially if and when blood is involved, but oral sex presents greater STI risks with other STIs than it does with HIV), injection drug use, and any exposure to other people's blood in other contexts (such as in unclean tattoo parlors or via self-done tats, by sharing razors or toothbrushes, or via scenarios like biting or being bitten).
But if you're not abstaining from sex, latex condoms have been shown, time and time again, over a considerable amount of time, to reduce the risk of HIV transmission by as much as 99%, and by 80% on average, with typical (rather than perfect) condom use. To give you an idea of what sort of risk protection 80 - 99% is, anyone with ears has heard again and again how much seatbelts help save lives. Seatbelts prevent death in car accidents by around 40% according to most sources. In other words, using latex condoms for ALL the genital sex you have, always, provides more than twice as much protection for you against HIV than seatbelts provide protection against death in a car. That's a whole lot of protection for something so easy to afford, obtain and use.
If you're going to be sexually active, it's essential to use latex barriers -- male or female condoms -- during sex, to prevent the spread of HIV, as well as other infections and diseases, and it's crucially important that condoms are ALWAYS used, not just sometimes, not most of the time, but every single time.
It's also really important to use condoms correctly: if you or your friends are having condoms break often, you can be sure you're not using them correctly, since rates of breakage shown with correct use are usually less than 2%.
Correct condom use means:
For more detailed instructions on proper condom use, click here.
While latex barrier use all by itself is really critical, getting regularly tested isn't a footnote, either. Regular HIV and STI screenings for EVERYONE who is or has been sexually active (has had any sort of oral or genital sex with another person) are hugely important. Getting tests for ALL STIs, at least once every year, is critical to protect yourself and others.
As you know by now, having other, more commonly transmitted STIs left undiagnosed and untreated not only puts your general and reproductive health in danger -- and that of any sexual partners -- it also puts you at a higher risk of contracting more infections, including HIV. And with HIV in particular, the earlier it is diagnosed, the earlier you can take measures -- such as lifestyle changes and medications -- to start taking care of yourself and to avoid developing AIDS.
One other important way to protect yourself, while ALSO using latex barriers for any partnered sex AND getting regular testing, is just to alter some of your behavior, or live in a way that helps protect you from the start. There's a whole lot of reasons to avoid intravenous drug use, obviously, but HIV prevention is one of those reasons. Too, avoiding or seriously limiting drug and alcohol use is another big help: it's been shown time and time again that drugs and alcohol influence people's sexual behavior, and usually in ways that create extra physical and emotional health risks, including STI risks.
Limiting sexual partners is another biggie. Sometimes, it can be hard to imagine you even have to when you're younger, because every relationship feels like it's going to last forever. But the reality is that very few do, and for teens and young adults, most relationships are really pretty short-lived. That doesn't mean you have to pick one person to date for all of high school and college if that doesn't feel right to you, nor does it mean you have to be celibate if you don't want to. What it does mean is that it's smart and safer to give extra thought to who you'll take as a sexual partner, and to go slow with sexual partnership. There are plenty of ways to test the waters that don't put you at big risks at all, even without use of latex barriers -- things like kissing, petting, frottage, manual sex (handjobs and fingering, so long as hands are clean) and mutual masturbation are all very safe sexual activities when it comes to HIV and other STI risks. One other good rule of thumb is to forestall any sexual activity until you've known someone long enough to feel comfortable talking very openly about the parts of sex that are a drag, like how to have sex safely and responsibly, like sexual history and STI testing history. If you don't feel okay asking for the last dates someone got screened and their results, it's a smart move to wait for any genital sex at all until you do.
Remember, too: it can be easy to feel like we trust someone when they're new to us and we've got no sound reason not to. But not knowing them well IS sound reason not to. To boot, trust doesn't make anything safer when it comes to STIs like HIV. Someone being trustworthy doesn't mean they haven't been at risk, nor does it negate the need for safer sex like latex barriers and STI testing. Want an example of very real trust? Going to the clinic to get tested together and trusting that no matter each of your results, the other person will be kind, understanding and willing to work anything through that needs working through.
Managing barriers, testing and lifestyle issues can seem daunting if you're not in the habit of doing it, but just like getting into any other habit is -- such as exercising daily, getting to work on time or creating a study routine in college -- once you get used to doing all of these things, they really are a breeze.
What if I get a test and find out I'm positive?
No one is going to play Pollyanna and say that getting a positive result is going to be your best day ever. That's tremendously tough news for anyone, and there's little to soften that blow.
But the sooner you find out, the better off you are, and the sooner you can get started on taking care of yourself as best you can. Again, being positive really, truly, is not a death sentence anymore, nor does it mean your whole life is over. People who are HIV-positive now and who get good treatment and take good care of themselves and those around them can have excellent relationships -- including sexual relationships -- get pregnant and have kids, keep their jobs, and achieve the goals they aspire to. That's not to say all of that is always easy as pie -- it's often not -- but it is doable, and all the more so when you face things head-on, and don't delay in getting diagnosed and treated.
There is also more and more support out there for HIV-positive folks, so it's not something most people will have to go alone. Having HIV is in many ways no different than having any other sort of serious disease: people with diabetes or cancers can find ways to survive and manage their diseases, and the same is true for those who have HIV.
There's just no good reason to avoid getting tested regularly. If you find out you don't have HIV, that's one less thing for you to have to worry about. If you find out you do, the sooner you know, the better off you and everyone around you will be, and the better your chances for getting through it and being able to continue the life you're just starting in the healthiest way possible.