HIV: Myths, Risks, and the Importance of Knowledge

Q: HIV: Myths, Risks, and the Importance of Knowledge

Anonymous： I've seen your question again, and it's still quite absurd and difficult to answer because medicine is not very scientific and does not have absolute results. <br>Many people who regard medicine as a doctrine might go crazy upon hearing this. <br>The simplest example i

I would like to learn about HIV/AIDS?

I think the doctor may have misunderstood.
I have not engaged in sexual intercourse or kissing with anyone; I have only engaged in self-stimulation and have had no unsafe contact.
Therefore, I believe there is no need for an HIV test.
It's not that I think I might be infected and don't want to get tested; I just find HIV very frightening and want to learn more about the probabilities and knowledge surrounding it so that I can be less fearful.
However, the general public has very little understanding of HIV compared to medical professionals, so I hope the doctor can answer my questions clearly and thoroughly.
I truly hope the doctor can provide clear answers because it often takes me nearly an hour to organize and check these questions.
Thank you very much! I notice that the doctor is very serious and efficient, often responding the next day, but since I have many questions, please take your time to reply.
Thank you so much! (The sexual organs and contact referred to below are those without a condom or with a condom that has holes or is damaged.)
16.
Lastly, can HIV be eliminated by the body's antibodies and white blood cells like other viruses? It is possible; some people have strong immune systems and may not easily develop symptoms after infection.
However, sometimes the virus can remain dormant in the body and only become active when the body weakens.
In other words, once infected, it is difficult for the body to completely eliminate the virus solely through its immune response.
When the body is weaker or has a compromised immune system, the virus can replicate extensively and cause illness.
Does this mean that if someone is exposed to HIV through a transmissible route but the viral load is not high enough to reach a pathogenic level, the body's white blood cells, antibodies, and immune system can completely eliminate it, preventing illness or latency? Is that correct? (This is a very important question.) However, if the viral load is high enough during exposure, and the body's immune response cannot completely eliminate it on the first attempt, even a small amount of the virus entering the body can lead to illness or latency, correct? Does the level of immunity affect the probability of contracting HIV under the same exposure conditions? Does the strength of the immune system influence the required pathogenic viral load for HIV infection? For the reasons mentioned above, exposure to HIV through a transmissible route does not necessarily result in illness, latency, or being a carrier, right?
Additionally, is it true that the fear surrounding HIV is primarily due to its incurability, and that HIV is not particularly aggressive in terms of infection and invasion compared to other viruses? Is it not particularly difficult for the body's immune system, antibodies, and white blood cells to eliminate it? Compared to other viruses and bacteria, should it be considered relatively rare (like rare animals in the world compared to other viruses)? And is the infectiousness upon exposure relatively low? If not, how so? Also, is the viral load required for HIV to cause AIDS lower than that of most other common viruses that cause other diseases? How much lower? What is the approximate population ratio of HIV patients in Taiwan and North America relative to the total population of each region?
Furthermore, is the most common route of infection through open wounds? Or is any route that allows bodily fluids to directly enter the body, including the urethral opening, vagina, and anus, equally likely to result in infection, or is there a difference in probability? Or are these routes not actually transmissible? Is it true that as long as there are no wounds or mucous membranes, it is not a route of infection? Which parts of the body have mucous membranes? Given that blood is the most infectious, and the mouth or tongue often has many unnoticed small wounds, doesn't that mean that the probability of contracting HIV through kissing an infected person is higher than through confirmed sexual contact? Or is it only when there are bleeding wounds that the risk is higher?
In terms of infection probability: scabbed wounds < dried or stopped bleeding wounds < actively bleeding wounds, is that correct? Is there a significant difference in infection probability between dried or stopped bleeding wounds and actively bleeding wounds? Do small, unnoticed wounds in the mouth or tongue have little impact on the probability of infection? Is the type of wound that the doctor refers to as increasing risk typically a visible and noticeable wound? In the case of accidental exposure, what is the estimated probability of contracting HIV through confirmed kissing with an infected person? Is it below 1 in 1000? Is it between 1 in 1000 and 3 in 1000? (This is important.)
Since oral and penetrative sex occurs less frequently and is easier to prevent, I am more concerned about kissing.
In the case of accidental exposure, what is the probability ranking of contracting HIV through the following five actions: (1) contact between genitalia with small wounds or abrasions, (2) oral sex, (3) kissing, (4) severe needle stick accidents (1-2%), and (5) contact between genitalia without small wounds or abrasions? (This is important.)
Lastly, do the glans, foreskin, or penis also have unnoticed small wounds? If not, is it easy for them to occur? Or do they usually occur during sexual intercourse? Or is it not guaranteed but likely? What about self-stimulation? How can I know if there are any wounds or abrasions on my glans, foreskin, or penis? Is there a simple and accurate self-examination method? Personally, I sometimes feel that after self-stimulation, my penis feels less vigorous, and during bathing, I often feel a strange pain in the foreskin or glans area after washing for a long time.
Sometimes, even after washing, I feel a bit strange for a whole day or even 2-3 days.
"Do many people experience similar strange or painful sensations after washing for a long time?" Do these strange sensations indicate that I have been injured or have abrasions? Or is it just a normal reaction from excessive rubbing and washing after ejaculation? Is it because I have a bit of phimosis (the glans is covered by the foreskin when not erect, and I usually have to pull back the foreskin to expose the glans when erect) that makes it more sensitive and prone to these strange sensations? Does phimosis increase the likelihood of abrasions or small wounds on the foreskin or glans?
Additionally, sometimes after prolonged self-stimulation, when the glans is covered by the foreskin, I notice a small, slightly swollen bump at the opening of the foreskin, resembling a large pimple in shape and size, but it feels soft and is just the foreskin swelling.
"Do many people experience similar swelling of the foreskin after prolonged sexual activity?" If that is the case, does that mean there must be an abrasion? What about wounds? Or is swelling unrelated to the presence of abrasions or wounds, or is it likely but not guaranteed? If the foreskin swells and accidentally comes into contact with HIV, does that increase the risk of infection? If so, how much? (I have previously had a condom break, so I am a bit worried even when taking precautions during sexual activity.)
Also, in the case of accidental contact with an infected person, does having abrasions significantly increase the likelihood of contracting HIV? Or is it not much different, or only slightly different? What about small wounds? Is there a significant difference? Or is it not much different, or only slightly different? (I am concerned that the strange painful sensations I feel might indicate small wounds or abrasions.)
Finally, thank you again, doctor, for your clear and detailed answers! I am very grateful!

Niming, 20~29 year old female. Ask Date: 2008/08/08

Dr. Xu Weikai reply Urology

Anonymous: I've seen your question again, and it's still quite absurd and difficult to answer because medicine is not very scientific and does not have absolute results.
Many people who regard medicine as a doctrine might go crazy upon hearing this.
The simplest example is that the same virus can react differently in each person, so why do we use the same medication? After using the same medication, why do the effects vary? Some people recover while others do not.
Can HIV be eliminated by the body's antibodies and white blood cells like other viruses? Perhaps some people have strong immunity and do not easily develop the disease after infection.
However, sometimes the virus lies dormant in the body and only manifests when the body deteriorates.
In other words, once infected, it is difficult to completely eradicate the virus relying solely on one's immune system.
When the body is weaker or has lower resistance, the virus can proliferate and cause illness.
Does this mean that if a person is exposed to HIV through a transmissible route but the concentration of the virus is not high enough to reach a pathogenic level, the body's white blood cells, antibodies, and immune system can completely eliminate it, preventing disease or latency? (This is a very important question.) Some individuals can indeed completely eliminate the HIV that invades their bodies.
The medical community is still researching the unique characteristics of these individuals to determine what type of immune capability allows for complete recovery, which remains unclear.
Most people cannot completely eradicate the virus.
However, if exposed to a sufficiently high viral load, the body's resistance may not be able to eliminate it entirely on the first attempt.
As long as even a small amount of the virus successfully enters the body, illness may occur or the virus may lie dormant and become a source of infection.
Is it true that most people cannot completely kill the invading virus? Under the same exposure conditions, does the level of resistance affect the likelihood of contracting HIV? Does the level of resistance influence the required pathogenic concentration for contracting HIV? For the reasons mentioned above, exposure to HIV through a transmissible route does not necessarily result in disease, latency, or being a source of infection, right? It can be said so, but it's not entirely accurate.
If a person exposed to HIV has strong immunity and a low viral load, they may recover.
If they have weak immunity and a low viral load, the outcome is uncertain.
As long as there is some virus that has not been completely eradicated, it can remain dormant in the body for 10 years or even longer before manifesting.
Once the disease manifests, if untreated, it usually leads to death within a few years.
Current antiviral medications do not completely kill HIV; they merely reduce the viral load during the onset of the disease and prolong life.
Is it also true that the fear surrounding HIV is due to its inability to be cured, and that HIV is not particularly aggressive in terms of infection and invasion compared to other viruses? Yes.
Is it also true that the virus is not particularly difficult to eliminate by the body's immune system, antibodies, and white blood cells? Incorrect; the human body finds it very difficult to eliminate this virus.
In comparison, the SARS virus is much easier to eradicate.
Should it be considered that the quantity of HIV is extremely low compared to other viruses and bacteria (like rare animals in the world)? (??) I cannot answer that because even if there is not much HIV in the world, it can still be encountered in human living environments.
Is the infectiousness relatively low when exposed? It can be said that it is less contagious compared to viruses like the common cold.
If not, how is it? Does the viral load required to cause AIDS differ from that of most other common viruses that cause other diseases? I do not know and cannot provide an answer.
How much difference is there? What is the population ratio of AIDS patients in Taiwan compared to North America? In Taiwan (excluding China), there were about 2,000 confirmed HIV cases last year, and as of now (August 7, 2008), there have been 1,065 confirmed cases this year; the number of confirmed cases of AIDS last year was 1,072, and 504 confirmed cases this year as of August 7.
I do not know about the United States.
Is the most common route of infection through wounds? No, it is through injection (drug use, needle sticks, etc.), or is any route that allows bodily fluids to directly enter the body, including the urethra, vagina, and anus, equally likely to result in infection (it cannot be equally likely) or is there a chance but not as high? (In the case of a wound, the infection probability is quite high; if there is no wound, as I mentioned earlier, certain specific areas like the mouth, nasal cavity, eyes, glans, vagina, and anus are more susceptible to infection, while the thicker skin on the body is less susceptible.) Or are these routes not actually transmission pathways? Is it true that as long as there are no wounds and mucous membranes, it is not a transmission route? Incorrect.
Which parts of the body have mucous membranes? There are quite a few places, as mentioned earlier.
Since blood is the most infectious, and there are many unnoticed small wounds in the mouth or on the tongue, doesn't that mean that the probability of contracting the disease through a tongue kiss with an HIV-positive person is higher than through genital contact under similar circumstances? I do not know which is higher because it involves the intensity of kissing, intercourse, etc., making it difficult to compare, and no one would conduct such a comparison.
Due to the many uncertainties, no one would believe the conclusions drawn.
Is it true that only wounds that bleed have a higher probability of infection? Yes, if the virus comes into contact with a bleeding wound, the risk is higher than with a non-bleeding wound.
Infection probability: scabbed wounds < wounds with platelets that have stopped bleeding or dried blood < bleeding wounds.
Is that correct? You could say so, but each wound has a certain degree of healing in the eyes of professionals, so wounds that appear similar may have significantly different healing stages.
Is there a significant difference in infection probability between wounds with platelets that have stopped bleeding or dried blood and bleeding wounds? I do not know.
Is it true that small, nearly imperceptible wounds on the tongue or in the mouth have little impact on the probability of contracting the disease? It cannot be said that way.
Is it true that the wounds referred to by doctors that increase the probability are generally visible and perceptible wounds caused by accidents? Both existing wounds and newly formed wounds can be involved; mucous membranes are only a single layer, while skin has multiple layers, providing different levels of defense.
In the case of accidental contact with an HIV-positive person through a tongue kiss, what is the approximate probability of contracting the disease? I do not know.
Is it below 1 in 1,000? I do not know.
Is it between 1 in 1,000 and 3 in 1,000? I do not know.
(Important) Since oral sex occurs less frequently and is easier to prevent, but tongue kissing is unavoidable, it raises more concerns (Note: then don't tongue kiss).
This is because, as mentioned earlier, the intensity of tongue kissing varies; some people may even bite their lips, and some may maliciously spread the virus.
Additionally, saliva can contain HIV.
Is this the most important question you want to ask? Not only tongue kissing, but any kiss can potentially transfer saliva, right? May I ask, in the case of accidental contact with an HIV-positive person through the following five behaviors (contact between small wounds or broken skin on genitalia, oral sex, tongue kissing, severe needle stick accidents (1% to 2%), contact between genitalia without small wounds or broken skin), what is the order of infection probability? (Important) I cannot be certain, but approximately: needle stick ≥ sexual contact ≥ tongue kissing = oral sex; however, this cannot be fully applied to everyone.
As I mentioned, the intensity and method of these actions differ for each person, so the order should vary for everyone.
Needle sticks may be the most serious.
However, if a patient has a higher concentration of HIV in her secretions (e.g., vaginal fluid, saliva, anal secretions) than in blood, then the risk of infection through fluid contact would be much higher than through a needle stick.
Finally, do the glans, foreskin, or penis also have some unnoticed small wounds? Yes, they can appear with vigorous friction.
If it is not always the case, is it easy to have them? Or does sexual intercourse generally cause some abrasions or small wounds? It depends on how you do it.
Is it not always the case but easy? (I do not understand the meaning.) What about DIY? (Everyone's DIY methods differ, and the intensity varies significantly, so I cannot answer.) How can one know if there are wounds or abrasions on their glans, foreskin, or penis? Generally, small wounds will hurt.
Microscopic wounds may not hurt, but they can hurt when stimulated (e.g., by salt).
Is there a simpler and more accurate self-examination method? There is no method that can guarantee the absence of microscopic wounds 100%, unless a condom is used.
Personally, I sometimes feel that after DIY, my glans feels weaker, and after washing, I often feel a strange pain in the foreskin or glans area that can last for a day or even 2-3 days.
"Do many people experience this strange or painful sensation after washing for a long time like I do?" This strange sensation could indicate an injury.
Is it possible? Or is it an abrasion? It is possible.
Or is it just a normal phenomenon due to excessive rubbing and washing after ejaculation? Rubbing and washing can cause wounds.
Is it because I have a bit of phimosis (the glans is covered by the foreskin when not erect, and usually, I have to push the foreskin back to expose the glans when erect) that makes it more sensitive? Possibly.
Does it make it easier to experience these strange sensations? I do not know.
Does phimosis make it easier to cause abrasions or small wounds on the foreskin or glans? On the contrary, the foreskin can protect the glans.
Additionally, sometimes after a long DIY session, when the glans is covered by the foreskin, there may be a small swollen bump at the opening that feels soft and resembles a large pimple in shape and size.
"Do many people experience swelling of the foreskin like I do after prolonged sexual activity?" No.
In that case, does the foreskin definitely have abrasions? I do not know.
What about wounds? I do not know.
Or is swelling unrelated to the presence of abrasions or wounds, or is it likely to have them? No one has studied that.
If the swollen foreskin accidentally comes into contact with HIV, does it increase the risk of infection? It is more related to the presence of wounds than to swelling.
If it does, how much difference is there? As mentioned earlier.
(Because I once broke a condom, I am a bit worried even when taking precautions during sexual activity.) Condoms can break, possibly due to vigorous activity or insufficient lubrication from the female partner, or if the female partner does not reach an adequate level of arousal.
Additionally, in the case of accidental contact with an HIV-positive person through genital contact with broken skin, does the probability of infection differ significantly? Or is it not much different? What about small wounds? Does it differ significantly? Or is it not much different? (Because I am concerned that the strange painful sensation may indicate small wounds or abrasions.) I do not know your focus.
Without preventive measures, it is easy to get infected.
For medicine, statistics are meaningful.
For individuals, testing after 12 weeks will provide answers.
Is there a significant difference or just a slight difference? It is really impossible to determine.
Because a significant difference and a slight difference are both subjective perceptions and cannot be objectively compared with numbers.
Finally, I hope your questions can be more concise, as many are repetitive and make it difficult to read.

Reply Date: 2008/08/08

More Info

Understanding HIV and its transmission is crucial for reducing fear and anxiety surrounding the virus. Let's break down the various aspects of your questions regarding HIV transmission, immune response, and the risks associated with different types of contact.

1. HIV Transmission and Immune Response
HIV (Human Immunodeficiency Virus) is primarily transmitted through specific bodily fluids such as blood, semen, vaginal fluids, rectal fluids, and breast milk. The virus can enter the body through mucous membranes found in the genital area, rectum, and, to a lesser extent, through oral mucosa. The likelihood of infection depends on several factors, including the viral load of the HIV-positive individual, the type of exposure, and the immune status of the exposed person.

When it comes to the immune response, it is true that individuals with a strong immune system may be able to fend off infections more effectively. However, HIV is particularly insidious because it targets CD4 cells, which are crucial for the immune response. Once HIV enters the body, it can replicate and spread, often without immediate symptoms. If the viral load is high enough, even a small amount of virus can lead to infection.

2. Infection Threshold and Immune System
You are correct in your understanding that if the concentration of HIV is low enough, the immune system might be able to eliminate it before it establishes an infection. However, this is not guaranteed. The "infectious dose" of HIV is not precisely defined, but it is known that even a small amount of the virus can lead to infection, especially if it enters through a mucous membrane or an open wound.

3. Environmental Stability of HIV
HIV does not survive long outside the human body. It is sensitive to environmental conditions and cannot reproduce outside a human host. This means that casual contact, such as hugging or sharing utensils, does not pose a risk for transmission. The virus is not particularly robust in the environment compared to other pathogens, which is why understanding the specific transmission routes is essential.

4. Prevalence and Risk Factors
In terms of prevalence, HIV rates vary significantly by region. In the United States, approximately 1.2 million people are living with HIV, while in Taiwan, the number is lower, with about 30,000 reported cases. The risk of transmission is highest through unprotected anal or vaginal intercourse, especially if there are cuts or sores present. Oral sex carries a lower risk, but it is not zero, particularly if there are open sores in the mouth.

5. Injury and Risk of Infection
Regarding your concerns about small cuts or abrasions, it is true that any break in the skin can increase the risk of infection. However, the risk associated with minor abrasions is generally lower than that associated with significant wounds. The presence of blood, especially from an active bleed, significantly increases the risk of transmission.

6. Self-Examination and Sensitivity
If you are experiencing discomfort or unusual sensations in the genital area, it is advisable to consult a healthcare professional for a thorough examination. Self-examination can be challenging, and a medical professional can provide a more accurate assessment. Sensitivity or discomfort after activities like DIY can be normal, but persistent pain or unusual symptoms should not be ignored.

7. Kissing and Transmission Risks
Kissing an HIV-positive individual carries a very low risk of transmission, especially if there are no visible sores or bleeding gums. The presence of small, unnoticed cuts in the mouth can theoretically increase risk, but the likelihood remains low compared to other forms of exposure.

Conclusion
In summary, while HIV is a serious virus, understanding its transmission routes and the factors influencing infection risk can help alleviate fears. Maintaining a healthy immune system, practicing safe sex, and getting regular health check-ups are essential steps in managing your health. If you have specific concerns about your risk or symptoms, consulting a healthcare provider for personalized advice and testing is always a good idea.

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