---

| STD/AIDS Prevention Branch Home Page | Where To Get Tested | Frequently Asked Questions |
| HIV/AIDS | STDs | Viral Hepatitis | Community Resources | Disease Reporting Information |
| Data and Statistics | Contact Us |

• How is HIV transmitted?
• Safer sex and condoms
• How to use a condom and other types of barriers
• Types of tests
• Results of tests
• Anonymous or confidential HIV testing
• Frequently Asked Questions
• Harm Reduction and Drug Use

How is HIV transmitted?

HIV is transmitted when infected blood, semen, vaginal fluids, or breast milk enter another person's body. This most often occurs during unprotected sex or during injection drug use (when needles are shared). Anyone who is infected with HIV can transmit it, whether or not they appear sick, have an AIDS diagnosis, or are taking effective treatment for their infection. Infected women who become pregnant can transmit HIV to their newborns and are much more likely to do so if they are not treated effectively.

HIV is spread in the following ways:

Unprotected sexual intercourse.

HIV can enter the body during sex through the mucous membranes of the anus, vagina, penis (urethra), or mouth; AND through cuts, sores, and abrasions on the skin. Unprotected anal and vaginal sex are the riskiest sexual activities. There are a small, but growing, number of reported cases of HIV transmission through oral sex; however, the risk of oral sex transmission is clearly lower than for anal or vaginal sex. With each of these practices, the receptive partner (vagina, anus, mouth) is at greatest risk; however, the inserting partner is also at high risk.

Injection drug use.

Using shared, unsterile needles and syringes carries a high risk of HIV transmission. Sharing cookers, cottons, and water for mixing/bleaching can also transmit HIV. After use, small amounts of blood can remain in the used needles, syringes, cookers, and cottons. Blood may also remain in the water used for mixing drugs or bleaching equipment. This remaining blood can enter the body of the next user when any of these items are shared. If this blood is HIV infected, transmission can easily occur.

From an infected mother to her infant.

HIV can be transmitted from mother to child during pregnancy, during birth, or through breast-feeding. Before treatment with AZT became a routine recommendation, about 1 in 4 or 5 babies born to HIV-infected women became infected. Now, when treatment is taken, the HIV transmission rate from a mother to her baby is greatly reduced. Consequently, all pregnant women should see their doctor, be tested for HIV, and obtain recommended treatment.

HIV is rarely transmitted in the following ways:

Blood transfusions and organ transplants.

The risk of acquiring HIV from a blood transfusion today is estimated to be 1 in 4 for every 600,000 transfusions. The risk of acquiring HIV from an organ transplantation is probably similar. Before 1985, there were no tests to screen blood and organ donations for HIV. Today, blood and organ banks screen out most potential donors at risk for HIV infection in advance. They then do extensive testing on specimens of blood, blood products, and organs for HIV and other blood-borne germs.

The health care setting.

There is a very small, but real, risk of health care workers getting HIV from patients as a result of needle stick accidents and other substantial blood exposures. The risk of patients getting infected from health care workers is also very small. A large series of studies of HIV-infected surgeons and dentists have not shown any transmissions to patients. Nonetheless, seven patients may have become infected from a dentist with AIDS in Florida, and several other transmissions have been traced to surgeons.

HIV is not transmitted in the following ways:

Casual contact.

HIV is not spread by casual contact. It dies quickly outside the body and is easily killed by soap and by common disinfectants such as bleach. There is no risk of HIV infection from:

• donating blood
• mosquito bites
• toilet seats
• shaking hands
• kissing
• hugging
• sharing eating utensils
• food or objects handled by people with HIV or AIDS
• spending time in the same house, business, or public place with a person with HIV/AIDS.

Who is at risk for HIV infection?

Anyone can become infected with HIV. In the United States, men who have sex with other men and people who use needles to inject illicit drugs are at the highest risk of HIV infection. Heterosexual partners of injection drug users and bisexual men account for a growing number of reported AIDS cases in the United States, especially among women.

About 750,000 persons are believed to be infected with HIV in the United States, including approximately 2,000-3,000 people in Hawai‘i.

How can HIV transmission from injection drug use be prevented?

The surest way to completely avoid HIV infection from injection drug use is to abstain. The next surest way is to use a brand new syringe every time you inject. If brand new syringes are not available, properly bleaching a used syringe may be an effective method of reducing HIV transmission.

In addition to needles, sharing cookers, cottons, other parts of the syringe (e.g., the barrel and plunger), or water used for mixing/bleaching also can transmit HIV. To avoid infection, these items must not be shared.

Drugs - injected or not - can also increase a person's risk for HIV by impairing judgement, decision-making ability, and/or by enhancing sexual drive. Studies have shown that - even when drunk or high - people can successfully use condoms and clean needles/syringes. Nonetheless, people who are drunk or high often take more risks than if they were sober.

Needle Exchanges trade new needles/syringes for used ones free of charge. For more information, contact CHOW.

How can the sexual transmission of HIV be prevented?

The surest way to avoid the sexual transmission of HIV infection is to abstain from sexual activity with other people. The next surest way is to have sex with only one partner who is known to be uninfected with HIV and who only has sex with you.

For someone with an HIV positive partner, a partner who does not know their HIV status, or multiple sexual partners , touching, dry kissing, body rubbing, and mutual masturbation are the safest sexual activities. For any penetrative sex acts such as vaginal, anal, or oral sex, condoms are highly effective at reducing the risk of HIV transmission especially when used consistently and correctly.

For those with a new sex partner , abstain or use condoms for at least 3 months and then get tested for HIV antibodies. If you and your partner are both HIV negative and each of you are not engaging in other risk behaviors (e.g., sharing needles or having other sex partners), then you won't have to worry about HIV infection.

[back to top]

Safer Sex and Condoms     

Safer sex means always assuming that your partner could be HIV-infected, and never allowing his or her risky body fluids (blood, semen, vaginal fluids, and breast milk) to enter your body. Touching, dry kissing, body rubbing, and mutual masturbation are the safest sexual activities. Safer penetrative sex means always using a latex barrier for anal, vaginal, and oral intercourse. This includes using a condom on a man or barrier protection such as plastic wrap, a dental dam, or cut condom for oral sex on a woman and for oral-anal contact.

Do condoms provide 100% protection from HIV?

No, condoms are not 100% effective at preventing HIV transmission; however, when used correctly and consistently, condoms are highly effective and reliable in reducing the risk of transmitting and acquiring HIV and other sexually transmitted diseases (STDs). The surest ways to avoid the sexual transmission of HIV (and other STDs) is 1) to abstain from sex, or 2) to have sex with only one partner known be uninfected. The next surest way is to use condoms consistently and correctly during all penetrative sexual acts. When condoms do fail, it is most often because of improper and/or inconsistent use.

Following these basic rules will further reduce the small chance of condom failure:

[back to top]

How to use a condom and other types of barriers

Condoms and other barriers, when used consistently and correctly, greatly reduce the risk of HIV and other STDs. Most condom failures result from incorrect use of the condom, not because the condom itself was faulty.

• Condoms are made of latex, polyurethane, or natural animal membranes, and include both traditional (male) and Reality® (female) condoms.
• Other effective barriers for STD protection include dental dams, condoms which have been cut into flat rectangles, plastic wrap, and latex squares.
• "Consistent use" means using a condom or other barrier every time a person has anal or vaginal sex. Ideally, condoms or other barriers should be used for oral as well as genital or anal sex. However, the risk of transmission of HIV and most STDs during oral sex is much lower than for anal or vaginal sex.
• "Correct use" involves following these steps:

Traditional (Male) condoms
a.	Latex (rubber) or polyurethane condoms are best to use. Some people, however, have allergies to latex; polyurethane condoms are good alternatives for such people. Natural membrane condoms may be slightly less effective, but they are better than nothing and probably prevent most STD/HIV transmission.
b.	Condoms need to fit properly. They come in slightly different sizes, shapes, and styles, but most condoms will fit most men.
c.	Condoms need to be opened and handled carefully. Condoms in damaged packages or past their expiration date should not be used. Condoms should not be stored for prolonged periods in a wallet or in hot or sunny places (for example, in a car or by a window).
d.	Plenty of water-based lubricant should be used to reduce the friction that can cause breakage. Some condoms are packaged with lubricant, but often there is not enough; additional lubricants are recommended. Oil-based lubricants like Vaseline, some hand creams, Crisco, butter, mineral oil, or other oils can dissolve or weaken latex and lead to breakage. Water-based lubricants are available in drug stores next to the condoms.
e.	The condom must be put on after erection and before any sexual touch. Some condoms have a reservoir tip; some don't. In either case, the tip of the condom should be squeezed while the condom is unrolled in order to leave an airless pocket to collect semen.
f.	After intercourse, the penis should be withdrawn while still erect. The base of the condom should be held around the base of the penis to prevent it from slipping off or spilling semen.
g.	Condoms should not be reused. They should be thrown in the trash, not in the toilet. (They can plug the toilet.)
Female condoms
The female condom is an alternative to the male condom for vaginal sex. It can be used for anal sex as well, although its effectiveness for this use has not been well-studied.
a.	Like male condoms, female condoms need to be opened and handled carefully. Condoms in damaged packages or past their expiration date should not be used. Condoms should not be stored for prolonged periods in a wallet or in hot or sunny places (for example, in a car or by a window).
b.	Lubricant should be used to reduce the friction that can cause breakage. The female condom comes with some lubricant. Lubricants are also available in drug stores next to the condoms. (Unlike latex condoms, the Reality and other polyurethane condoms are not damaged by oil-based lubricants. Still, Public Health recommends only water-based lubricants for simplicity's sake, and because the body may not be able to cleanse itself of oils as easily as it can of water-based lubricants.)
c.	The female condom must be inserted in the vagina or anus before any sexual touch. It may be inserted up to 8 hours in advance of intercourse.
d.	The open end of the female condom (at the outer ring) is designed to cover the area around the opening of the vagina or anus. The condom clings to the vaginal or rectal wall, providing a barrier between the vaginal lining and the penis.
e.	For insertion in the vagina, the inner ring should be squeezed between thumb and middle finger. The inner ring is used to guide insertion and to help hold the condom in place. The inner ring should be placed as far as it will go inside the vagina. It is in the right place when it can't be felt. Proper insertion into the vagina may require practice and can be improved by the cooperation of both partners.
f.	For insertion into the anus, the inner ring can be removed. The condom can be inserted in the rectum with fingers or placed on the erect penis. Proper insertion into the anus may require practice and can be improved by the cooperation of both partners.
g.	The condom should not be twisted. The outer ring should remain outside the vagina or anus.
h.	For removal, the outer ring should be grasped and twisted in the hand and then pulled gently to remove the entire condom.
i.	Public Health recommends that female condoms not be reused. Although some studies have shown that they maintain effectiveness when cleaned and reused a few times, Public Health believes the evidence is not yet strong enough to recommend that practice. It is clear that even after careful washing, a used condom is unlikely to be as free of contamination as a new one. After use, female condoms should be thrown in the trash, not in the toilet . (They can plug the toilet.)

Other types of barriers:

• The barrier must be placed on the genitals or anus before oral contact to prevent any exchange of fluids or any contact between mouth and the genitals or anus. It must be in place before any sexual touch. The barrier should cover the vaginal opening and labia or the anus and perineum.
• The barrier can be:
• A condom that has been cut so that it can lay flat
• A dental dam
• A latex square
• Plastic wrap
• Examination gloves that have been cut so they can lay flat
• As with condoms, oral barriers need to be handled carefully. They shouldn't be stored for prolonged intervals in hot or sunny places (for example, in a wallet, in a car or by a window).
• Lubricants can be placed between the oral barrier and the genitals. Only water-based lubricant should be used since oil-based lubricants break down latex. Lubricants are available in drug stores next to the condoms.
• Barriers should not be reused. They should be thrown in the trash, not in the toilet. (They can plug the toilet.)

[back to top]

Types of Tests

There are several ways to test for HIV today. All of these tests are antibody tests. This means that the test is looking for HIV antibodies and not the HIV virus itself. Antibodies are specific proteins made in response to an infection. It takes time for our bodies to make these antibodies. Since everyone’s immune system reacts differently, it can take anywhere from 3-6 months for the HIV antibodies to develop after the initial infection. There are three different ways to test for the HIV antibodies. Each testing site may offer different tests. Check with your site before getting the test. The tests are done by using a blood specimen, an oral specimen (OraSure), or by using a Rapid Antibody Test (OraQuick). All of the tests are highly accurate at detecting HIV antibodies.

Blood Specimen

A small amount of blood is taken from your vein and sent to a lab for the antibody testing. The results are usually ready in 1-2 weeks. Check with your testing site to find out when the tests are ready.

Orasure

A small amount of oral fluid is taken. This is done by placing a small pad in your mouth against the inside of your cheek for about 3 minutes. It is a quick and painless way to collect a sample. The sample is then sent to a lab for the antibody testing. The results are usually ready in 1-2 weeks. Check with your testing site to find out when the tests are ready.

*It is important to note that taking an oral test does not mean that HIV is transmitted through the saliva. Remember, the OraSure oral fluid test is looking for antibodies from the inside of the cheek. The test is not looking for the HIV virus in the saliva.*

OraQuick

This test has also been called the “Rapid HIV Antibody Test.” This is a test that is done at the testing site by a trained Tester & Counselor. A blood or oral sample is used for this test. The results are usually ready within 20-40 minutes of the test. Some agencies allow you to wait at the site for the results. (If the test result comes back positive, a blood specimen test, outlined above, will be used to confirm the results.)

*There have been many questions about this test since it has been on the market. Many states are already using this test regularly. Hawai‘i Department of Health and its contracted agencies have not been able to implement it yet. There may be some private agencies that are offering this test. Hawai‘i Department of Health hopes to offer this test at a later date.*

**The Rapid test does not have an indeterminate result. Instead of positive or negative, the result can be invalid. This means that there was a problem running the test and the test will need to be repeated**

[back to top]

Results

There are several types of HIV antibody tests used today. All are highly accurate at detecting HIV antibodies, specific proteins made in response to an HIV infection. After infection with HIV, however, it can take up to 3-6 months for HIV antibodies to develop.

A negative HIV antibody test result means that a person does not have detectable HIV antibodies at the time of the test. Since it can take up to 3-6 months after HIV infection for antibodies to develop, a negative test result is reliable only if the person has not had any sexual or needle-sharing risk behavior during the 3-6 months prior to testing. Some people with recent risk behavior will test HIV antibody negative, yet may have actually been infected during the previous 3-6 months; these people will also likely be highly infectious and may easily transmit HIV to their sex and needle-sharing partners. Finally, a negative test result does not mean that a person is safe from future HIV infection. People who test HIV antibody negative are urged to continue to follow HIV prevention guidelines to avoid becoming infected.

A positive HIV antibody test result means that HIV antibodies are present and that the person has HIV infection. It does not mean the person has AIDS, although many HIV-positive people may develop AIDS after years of infection with HIV. Anyone who tests HIV-positive can transmit the virus to others, regardless of how long they have been infected, whether they have AIDS or other symptoms, or whether their HIV infection is being treated effectively. It is extremely important that HIV-positive people follow HIV prevention guidelines, not only to protect their partners from getting HIV infection, but also to protect themselves from infection with other germs that could cause HIV/AIDS-related disease.

An indeterminate HIV antibody test result is neither a positive or negative result. Although uncommon, an indeterminate result can happen for a variety of reasons. The important thing to remember is that you should take the test again. Talk with your HIV Counselor and Tester about when is a good time to retest.

People at increased risk of HIV infection should NEVER donate blood, plasma, or other organs, or go to such facilities to be tested.

[back to top]

Anonymous vs Confidential Registration

The STD/HIV/AIDS Program of the Hawai‘i State Department of Health offers two choices for obtaining HIV counseling & testing: anonymous registration or confidential registration.

Anonymous testing

“Anonymous” means there is no record. HIV test results are filed and accessed by number only. There is no name or information to identify or contact the person who is testing.

• Anonymous test results cannot be used to prove or document HIV status, since no name is connected to the result.
• You get a “test receipt” with your test number on it. You must have that number to get your results. Without that number, we cannot find your result. If you loose the receipt, you will have to test again.

Confidential testing

“Confidential” means we create a record . The record contains information such as your name, address, phone number and date of birth. HIV test results a part of this record. Your record is private information and only people who provide you with services in this clinic have access to it.

• Knowing your HIV status helps us give you proper medical care.
• We can call to remind you to get your results if you don’t call or come back.
• We can help you better plan for future safety by knowing what happened in past visits.
• With a confidential test, there is a way to provide your test result even if you lose your test receipt.

If your HIV results are positive or indeterminate and you are seeking further medical care, and you provide written permission, we can release HIV test results directly to your medical provider.

[back to top]