Sexual Transmission #5 HIV infection is a sexually transmitted disease (STD).

Like other STDs, HIV spreads bidirectionally and appears to be transmitted from male to female and female to male with greater efficiency (up to three-fold) from male to female. Although the majority of sexually transmitted cases reported in the United States occur via male homosexual activity, heterosexual transmission is one of the fastest growing modes of transmission reported in the United States and is the primary mode of disease acquisition in many African countries, where male-to-female prevalence ratios are approximately 1.1:1. Certain cofactors are associated with an increased risk of acquiring HIV infection. Among homosexual men, receptive anal intercourse and contact with a large number of different sexual partners are the most important risk factors. Activities that may lead to damage of the rectal mucosa, such as rectal douching, manual penetration of the rectum ("fisting"), and concomitant ulcerative STDs, increase the likelihood of disease acquisition. Insertive rectal intercourse, fellatio, and ingestion of semen are associated with HIV transmission to a lesser degree. The likelihood of heterosexual acquired disease increases with a higher number of sexual partners, contact with intravenous drug users (IVDUs), prostitution, sexual practices that damage vaginal or rectal mucosa, and a previous history of other STDs. Female-to-female transmission has been reported via orogenital contact.

How is HIV Transmitted?

HIV can be transmitted from an infected person to another through:

Blood (including menstrual blood) Semen Vaginal secretions Breast milk Blood contains the highest concentration of the virus, followed by semen, followed by vaginal fluids, followed by breast milk. * Activities That Allow HIV Transmission

Unprotected sexual contact Direct blood contact, including injection drug needles, blood transfusions, accidents in health care settings or certain blood products Mother to baby (before or during birth, or through breast milk) Sexual intercourse (vaginal and anal): In the genitals and the rectum, HIV may infect the mucous membranes directly or enter through cuts and sores caused during intercourse (many of which would be unnoticed). Vaginal and anal intercourse is a high-risk practice. Oral sex (mouth-penis, mouth-vagina): The mouth is an inhospitable environment for HIV (in semen, vaginal fluid or blood), meaning the risk of HIV transmission through the throat, gums,

and oral membranes is lower than through vaginal or anal membranes. There are however, documented cases where HIV was transmitted orally, so we cant say that getting HIV-infected semen, vaginal fluid or blood in the mouth is without risk. However, oral sex is considered a low risk practice. Sharing injection needles: An injection needle can pass blood directly from one persons bloodstream to another. It is a very efficient way to transmit a blood-borne virus. Sharing needles is considered a high-risk practice. Mother to Child: It is possible for an HIV-infected mother to pass the virus directly before or during birth, or through breast milk. Breast milk contains HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is a viable means of transmission to infants. The following bodily fluids are NOT infectious:

Saliva Tears Sweat Feces Urine Prevention Abstinence is the only absolute way of preventing sexual acquisition of HIV infection. Persons who have been engaged in a mutually monogamous relationship since the mid-1970s are at extremely low risk of acquiring disease; however, the assurance that both partners have remained faithful is sometimes difficult to confirm. For the majority of sexually active individuals it should be assumed that their partner is seropositive until demonstrated otherwise. Verbal claims of seronegativity should be viewed with skepticism. When a couple, heterosexual or homosexual, is establishing a long-term relationship, it may be recommended that they undergo serologic testing to determine their HIV status. However, the decision to be tested should be of mutual consent and viewed in the context that exposures outside the relationship may lead to seropositivity in the future. In situations in which a decision to engage in sexual activity has been made and the HIV status of the partner is unknown or in doubt, safe sexual practices ("safe sex") should be implemented. Mutual masturbation is considered safe, assuming it is nontraumatic and not followed by ingestion of body fluids such as semen or vaginal secretions. Transmission of HIV has never been documented to occur through saliva; however, no group of patients has ever been studied who engage in deep French kissing as their sole means of sexual activity. Because HIV exists in saliva, albeit in very low titers, deep French kissing cannot be considered absolutely safe even though the likelihood of HIV transmission is extremely low. Condom use is the most effective means of preventing HIV infection among individuals who engage in oral, vaginal, or anal intercourse. To be effective, however, the condom should be made of latex and must be used properly. Natural skin condoms have been shown to leak in laboratory studies, whereas latex condoms maintain their integrity and are more durable. Nonoxynol-9, a spermicide with some

antiviral activity, enhances the protective effects of condoms and should be used in conjunction with condoms either as a spermicidal jelly or impregnated into the latex condom itself. Petroleum-based lubricants enhance the likelihood of latex condom rupture and should be avoided. If needed, water-based lubricants such as K-Y Jelly should be used. Both partners should be knowledgeable about the correct use of condoms. Discussions regarding condom use should occur before the need arises, and ideally, condom placement should be practiced in advance. A new condom should be used for each act of intercourse and each condom should be used only one time. Even under the best of circumstances, a 5 to 15% failure rate has been noted among couples using condoms as their sole means of contraception, and HIV transmission has been reported in discordant couples using condoms. Condom ineffectiveness most often is due to improper placement, falling off during intercourse, and rupture. Therefore, although condom use during intercourse is considered safer sex, it is not absolutely safe.

How does the blood clot? #7 There are two major facets of the clotting mechanism the platelets, and the thrombin system. The platelets are tiny cellular elements, made in the bone marrow, that travel in the bloodstream waiting for a bleeding problem to develop. When bleeding occurs, chemical reactions change the surface of the platelet to make it sticky. Sticky platelets are said to have become activated. These activated platelets begin adhering to the wall of the blood vessel at the site of bleeding, and within a few minutes they form what is called a white clot. (A clump of platelets appears white to the naked eye.) The thrombin system consists of several blood proteins that, when bleeding occurs, become activated. The activated clotting proteins engage in a cascade of chemical reactions that finally produce a substance called fibrin. Fibrin can be thought of as a long, sticky string. Fibrin strands stick to the exposed vessel wall, clumping together and forming a web-like complex of strands. Red blood cells become caught up in the web, and a red clot forms. A mature blood clot consists of both platelets and fibrin strands. The strands of fibrin bind the platelets together, and tighten the clot to make it stable. In arteries, the primary clotting mechanism depends on platelets. In veins, the primary clotting mechanism depends on the thrombin system. But in reality, both platelets and thrombin are involved, to one degree or another, in all blood clotting.

#5Causative Agent and Transmission

HIV is a member of the genus Lentivirus within the Retroviridae family. The virus infects immune cells, such as T cells, which bear the surface molecule CD4. After entry into a permissive cell, a viral enzyme termed reverse transcriptase converts the RNA genome into double stranded DNA. This DNA becomes integrated into the cellular genome by another HIV enzyme, called integrase. Once integrated, the HIV provirus takes advantage of host cell enzymes to transcribe and translate its genetic material into the viral proteins, which assemble into new viral particles and bud from the infected cell. HIV mutates rapidly, and today patients are infected by many different strains. Most broadly, HIV can be classified as HIV-1 or HIV-2. HIV-1 is more virulent than HIV-2, and causes the majority of infections. HIV1 can be divided into several distinct groups, which are themselves divided into subtypes, or clades, that display distinct geographic infection patterns. Treatment is more complicated in regions where more than one clade is circulating because hybrid strains can arise. The extreme diversity of HIV strains presents one of the most important hurdles to the development of new biomedical prevention tools, and to successful treatment programs.

Control measures: To avoid epidemic spread of HIV it is important to educate the people about eliminating the high risk factors. All blood donors should be tested for HIV antibody Myths to be dispelled about HIV HIV is not spread by Sharing meals with an HIV +ve patient Exposures to sneezing, coughing, or other casual contacts.