II. Transmission
- See HIV Exposure for estimated risk per exposure type
- HIV is passed via cellular fluids
- Sexual intercourse
- Breast Milk
- Blood exposure
- Transfusions
- Whole blood, RBC, WBC, Clotting Factors and Plasma Transfusions may transmit HIV
- Gamma Globulin Administration is NOT associated with HIV Transmission
- HIV is present in other fluids, but not transmitted
- Transmission is potentiated by other factors
- Menses
- Concurrent other Sexually Transmitted Infection (e.g. Syphilis, Chlamydia, Gonorrhea)
- Coinfection increases localized inflammation (e.g. epididymis, Urethra, vagina)
- Inflammation increases the number of HIV-carrying Macrophages
- HIV is NOT spread by other listed exposures
- Mosquito Bites (or other vectors)
III. Prevention: Sexual behaviors
-
General
- Safest behavior is abstinence
- If not abstinent, then practice monogamy
- If not monogamous, then limit number of partners
- Preventive strategies
- Highly active, modern Antiretroviral therapy (ART) reduces transmission significantly
- Undectable viral loads are associated with virtually no transmission risk
- Broyles (2023) Lancet 402(10400):464-71 +PMID: 37490935 [PubMed]
- Disclose your HIV status to all sexual partners
- Always use Condoms (reduces transmission risk by 80-95%)
- Consider Male Circumcision if uncircumsized (reduces transmission risk by 50-80%)
- Avoid behaviors that cause mucosal Trauma
- No sex unless sober
- Highly active, modern Antiretroviral therapy (ART) reduces transmission significantly
IV. Prevention: Intravenous Drug Abuse
- Strongly consider drug rehabilitation program
- Do not share needles
- Use new needles (bleach needles if not new)
V. Prevention: Household measures
- HIV is not spread by casual contact
- However, precautions are recommended:
- Apply bleach to blood spills
- Do not share ToothBrushes or razors
VI. Prevention: Medical Care
- See HIV Preexposure Prophylaxis
- See HIV Postexposure Prophylaxis
- Treat comorbid Sexually Transmitted Disease
- STDs facilitate HIV Transmission
- Early diagnosis and treatment of HIV
- Prior guidelines were that HIV Transmission still occurs at undetectable viral load
- Current U.S. guidelines in 2026 are Undectable=Untransmittable (U=U, see above)
- Antiretrovirals dramatically lower transmission risk
- Prenatal HIV diagnosis and treatment is critical
- Sexual partners also benefit from lower risk
- Prior guidelines were that HIV Transmission still occurs at undetectable viral load