Here's a little test — which of the following is not a means of HIV transmission?

(a) oral sex (b) breast milk (c) mosquito (d) hypodermic needle

If you went with anything but the insomniacal insect, you would be wrong. We are so inundated with HIV/Aids information that we think we know absolutely everything there is to know about the disease. But do we really?

Sure, you know that condoms are good (and abstinence is better); you know that you should get tested; and unless you happen to be the president of the country, you probably know someone who has died from the disease.

But beyond that, there is a hazy void filled with other people's concerns. Concerns which — despite the 'it could happen to anyone' mantra — are never really going to bother you. Sure. But, here's a reality check: have you ever had unprotected oral sex?

Oral sex, like breast milk and used hypodermic needles, is a vehicle for HIV transmission. It makes little difference if other person involved was your spouse, long-term partner or one-night-stand. Unless you have both been tested (recently) or are using protection, you are putting yourself at risk. Infidelity happens.

Now, we're not suggesting you exist in a bubble of celibacy, but rather that you become a little more informed. In the end, the only real weapon the world has against HIV/Aids is information and, judging from the rate of infection, our army could clearly be better educated.

Details, details…

There has been some confusion about the relationship between HIV and Aids, due in large part to Aids denialists who argue that HIV doesn't cause Aids or alternatively that neither HIV nor Aids actually exists.

So, we will put it plainly for you: HIV causes Aids. You cannot get Aids unless you have HIV.

HIV (Human Immunodeficiency Virus) targets the immune system, infecting the cells (CD4 or T-cells) that are supposed to protect the body from illness.

HIV progresses into Aids (Acquired Immune Deficiency Syndrome), when your immune system loses too many CD4 cells. It can take up to 10 years for HIV to cause Aids, even without treatment.

You are officially classified as having Aids when your CD4 count drops below 200 (normal = 600–1500) or when you develop one of the classified opportunistic infections (OI). If you get one of these infections, but are not HIV positive, you do not have Aids.

If you take antiretrovirals and your CD4 count increases above 200, you no longer have Aids (you could be classified as being in remission), but you are still HIV positive.

Condoms = safer sex

HIV is transmitted through blood, semen, breast milk, and vaginal fluids. It is not transmitted through tears, sweat, saliva, urine or faeces. This means that casual contact, sharing eating utensils and kissing are all perfectly safe. Because it is a human virus, it cannot be transmitted via animals such as mosquitoes.

Different sex acts carry with them different risk factors. The most risky is anal sex, which is more risky for the receiving partner. The reason why anal sex is the most risky is because it is the most likely to lead to small cuts or abrasions through which the virus can be transmitted.

Vaginal sex is next in line, with the woman being at greater risk for infection than the man. Oral sex is less risky, but transmission can occur if bodily fluids are swallowed and they come into contact with small sores, slightly damaged gums etc.

Other sexually transmitted diseases (STD) play a large role in the transmission of HIV. You are six to 10 times more likely to pass on or acquire HIV during sex if you have another untreated STD. It is important therefore not only to have yourself tested for HIV but also for other STDs.

Condoms (latex or polyurethane) provide a high level of protection if used correctly from the beginning to end of a sexual encounter. Condoms should only be used with water-based lubricants as oil-based lubricants can caused them to tear.

Couples in which both partners are HIV positive should also practice safer sex. The reason for this is that there are numerous strains of HIV. If you become infected with more than one strain of HIV (super infected), it makes treatment more difficult.

It is important to note that while antiretrovirals may bring your viral load down to undetectable levels this does not mean that HIV is no longer present in your body. You can still pass the virus on to others.

It's not all about sex

Sex is not the only means of HIV transmission. Before blood donors were screened, blood transfusions were also cause for concern. Although blood is now screened, there is always the possibility that the donor was in a window period at the time of the donation and that the virus will not show up in the test. However, Nucleic Acid Testing used by South African blood banks, uses DNA technology which effectively narrows the detection period of HIV to between five and 11 days. In light of this, you should never donate blood in lieu of an HIV test.

You can also contract the virus by sharing needles to inject recreational drugs, steroids or hormones. In any situation where needles are used — at a clinic, dentist or tattoo parlour — you should make sure that the needles are new and not just sterilised.

An often overlooked means of transmission is mother-to-child transmission. Without any intervention, the risk of mother-to-child transmission is between 15 and 30 percent. This can be as high as 30 to 45 percent with prolonged breastfeeding. However, with anitretrovirals (and no breastfeeding) the risk can be reduced by half.

Getting tested

When you get a virus, your body produces antibodies to fight it. Most HIV tests don't test for the actual virus, but for the antibodies. It is assumed that if you have the antibodies, you have the virus. However, it takes some time for your body to produce antibodies and as a result of this there is a testing 'window period' which can last for between three and 12 weeks.

If you have engaged in risky behaviour at some point during the 12 weeks prior to your test, it is a good idea to have another test three months later to ensure that you haven't got a false negative result.

In South Africa you can go for a rapid finger-prick test and get your results on the same day. If you test positive, another test will be taken to confirm the result. It is compulsory to undergo pre- and post-test counselling to ensure that you understand the implications of the test and are able to deal with the results.

The Actuarial Society of South Africa predicted that there will be 5.6 million people living with HIV in South Africa in 2008. Make sure that you're not one of them.

Useful websites

www.aidsinfo.co.za
www.tac.org.za
www.thebody.com