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Research has revealed a great deal of valuable medical, scientific, and public healthinformation about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted havebeen clearly identified. Unfortunately, false information or statements that are notsupported by scientific findings continue to be shared widely through the Internet orpopular press. Therefore, the Centers for Disease Control and Prevention (CDC)has prepared this fact sheet to correct a few misperceptions about HIV.

HIV is spread by sexual contact with an infected person, by sharing needles and/orsyringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born toHIV-infected women may become infected before or during birth or throughbreast-feeding after birth.

In the health care setting, workers have been infected with HIV after being stuckwith needles containing HIV-infected blood or, less frequently, after infected bloodgets into a worker’s open cut or a mucous membrane (for example, the eyes orinside of the nose). There has been only one instance of patients being infected by ahealth care worker in the United States; this involved HIV transmission from oneinfected dentist to six patients. Investigations have been completed involving morethan 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and noother cases of this type of transmission have been identified in the United States.

Some people fear that HIV might be transmitted in other ways; however, noscientific evidence to support any of these fears has been found. If HIV were beingtransmitted through other routes (such as through air, water, or insects), the patternof reported AIDS cases would be much different from what has been observed.For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmissionare thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC.No additional routes of transmission have been recorded, despite a national sentinel system designed todetect just such an occurrence.

The following paragraphs specifically address some of the common misperceptionsabout HIV transmission.

Scientists and medical authorities agree that HIV does not survive well in theenvironment, making the possibility of environmental transmission remote. HIV isfound in varying concentrations or amounts in blood, semen, vaginal fluid, breastmilk, saliva, and tears. (See page 3,Saliva, Tears, and Sweat.) To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although theseunnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limitedlaboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reducesthe amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used inlaboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to thatwhich has been observed--essentially zero. Incorrect interpretation of conclusions drawn from laboratorystudies have unnecessarily alarmed some people.

Results from laboratory studies should not be used to assess specific personal risk of infection because (1) theamount of virus studied is not found in human specimens or elsewhere in nature, and (2) no one has beenidentified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable toreproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions),except under laboratory conditions, therefore, it does not spread or maintain infectiousness outside its host.

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranesand infected blood. To prevent even such rare occurrences, precautions, as described in previously publishedguidelines, should be taken in all settings "including the home" to prevent exposuresto the blood of persons who are HIV infected, at risk for HIV infection, or whoseinfection and risk status are unknown. For example,

• Gloves should be worn during contact with blood or other body fluids that could possibly contain visibleblood, such as urine, feces, or vomit.
• Cuts, sores, or breaks on both the care giver’s and patient’s exposed skin should be covered with bandages.
• Hands and other parts of the body should be washed immediately after contact with blood or other bodyfluids, and surfaces soiled with blood should be disinfected appropriately.
• Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, shouldbe avoided.
• Needles and other sharp instruments should be used only when medically necessary and handled accordingto recommendations for health-care settings. (Do not put caps back on needles by hand or remove needlesfrom syringes. Dispose of needles in puncture-proof containers

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries suchas food-service establishments (see information on survival of HIV in the environment). Food-service workersknown to be infected with HIV need not be restricted from work unless they have other infections or illnesses(such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, shouldbe restricted. CDC recommends that all food-service workers follow recommended standards and practices ofgood personal hygiene and food sanitation.

In 1985, CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers,cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from apersonal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such astattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughlycleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated withblood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned anddisinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.

CDC knows of no instances of HIV transmission through tattooing or body piercing, although hepatitis B virushas been transmitted during some of these practices. One case of HIV transmission from acupuncture has beendocumented. Body piercing (other than ear piercing) is relatively new in the United States, and the medicalcomplications for body piercing appear to be greater than for tattoos. Healing of piercings generally will takeweeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) orinflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abradedtissues come into contact with an infected person’s blood or other infectious body fluid. Additionally, HIV couldbe transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.

Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of thepotential for contact with blood during "French" or open-mouth kissing, CDC recommends against engaging inthis activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissingis believed to be very low. CDC has investigated only one case of HIV infection that may be attributed tocontact with blood during open-mouth kissing.

In 1997, CDC published findings from a state health department investigation of an incident that suggestedblood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature inwhich HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing anddamage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that didnot result in HIV infection.

HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important tounderstand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can betransmitted by that body fluid. HIV hasnot been recovered from the sweat of HIV-infected persons. Contactwith saliva, tears, or sweat has never been shown to result in transmission of HIV.

From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting andbloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown noevidence of HIV transmission through insects--even in areas where there are many cases of AIDS and largepopulations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them,supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites aperson, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten.Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseasesas yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIVlives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV doesnot reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking orbiting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on orbites. HIV is not found in insect feces.

There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV fromone person to another through HIV-infected blood left on its mouth parts. Two factors serve to explain why thisis so--first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insectmouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects havedetermined that biting insects normally do not travel from one person to the next immediately after ingestingblood. Rather, they fly to a resting place to digest this blood meal.

Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA).Condom manufacturers in the United States test each latex condom for defects, including holes, before it ispackaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging insexual intercourse--vaginal, anal, or oral--can greatly reduce a person’s risk of acquiring or transmittingsexually transmitted diseases, including HIV infection.

There are many different types and brands of condoms available--however, only latex or polyurethanecondoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have beenshown to pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores andare therefore not recommended for disease prevention (they are documented to be effective for contraception).Women may wish to consider using the female condom when a male condom cannot be used.

For condoms to provide maximum protection, they must be usedconsistently (every time) andcorrectly.Several studies of correct and consistent condom use clearly show that latex condom breakage rates in thiscountry are less than 2 percent. Even when condoms do break, one study showed that more than half of suchbreaks occurred prior to ejaculation.

When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the timeamong couples using them as their only method of contraception. Similarly, numerous studies among sexuallyactive people have demonstrated that a properly used latex condom provides a high degree of protectionagainst a variety of sexually transmitted diseases, including HIV infection.

For more detailed information about condoms, see the CDC publication"Male Latex Condoms and Sexually Transmitted Diseases."

CDC is committed to providing the scientific community and the public with accurate and objectiveinformation about HIV infection and AIDS. It is vital that clear information on HIV infection and AIDS bereadily available to help prevent further transmission of the virus and to allay fears and prejudices caused bymisinformation. For a complete description of CDC’s HIV/AIDS prevention programs, see"CDC's Role in HIV and AIDS Prevention."

For more information...

CDC National AIDS Hotline:
1-800-342-AIDS
Spanish: 1-800-344-SIDA
Deaf: 1-800-243-7889

CDC National Prevention Information Network:
P.O. Box 6003
Rockville, Maryland 20849-6003
1-800-458-5231

Internet Resources:
NCHSTP:http://www.cdc.gov/nchstp/od/nchstp.html
DHAP:http://www.cdc.gov/hiv
NPIN:http://www.cdcnpin.org