What are the Risk Factors of HIV?
HIV is no longer the rampant epidemic plaguing communities in the 1980s. After three decades of research and public health initiatives, fewer people are being diagnosed with the virus, and novel treatments are reducing its progression.
Still, HIV remains a prominent sexually transmitted infection (STI). Being aware of the risk factors of HIV is vital to reducing the likelihood of infection.
In this article, we'll explore the key risk factors of HIV, including the risk of HIV from blood transfusions and the risk of HIV transmission without ejaculation.
Let's get started.
How is HIV transmitted?
To understand the risk factors of HIV, first, you need to know how HIV is transmitted. HIV (human immunodeficiency virus) is a virus passed from one person to another via bodily fluids, like blood, semen, vaginal secretions, and breast milk.
HIV is never transmitted by:
Saliva
Sweat
Tears
Share utensils
Pool or bath water
Mosquito bites
Toilet seats
While the majority of HIV infections occur due to sexual intercourse, the highest risk of infection comes from sharing needles. HIV can also be transmitted between a parent and child during pregnancy, childbirth, or breastfeeding.
Once contracted, HIV targets the immune cells. After infecting these cells, the virus creates copies of itself, infecting more and more cells. Gradually, this lowers the body's immune defenses, opening the door to life-threatening opportunistic infections. This stage is referred to as AIDS (acquired immune deficiency syndrome).
What are the risk factors of HIV?
Sexual risk factors
All forms of sexual intercourse pose some risk of HIV – unless both individuals are HIV-free. Practicing unprotected sex increases the risk of HIV – even after a single act of unprotected sex.
Furthermore, not all kinds of sex carry equal risk. According to the Centers for Disease Control and Prevention (CDC), the risks from sexual intercourse are as follows:
Receptive anal intercourse: 138 per 10,000 exposures (1.38%)
Insertive anal intercourse: 11 per 10,000 exposures (1.1%)
Receptive penile-vaginal intercourse: 8 per 10,000 exposures (0.08%)
Insertive penile-vaginal intercourse: 4 per 10,000 exposures (0.04%)
Receptive oral intercourse: low risk
Insertive oral intercourse: low risk
As the data demonstratives, receptive anal intercourse – due to the risk of bleeding – significantly increases the risk of contracting HIV. Moreover, the lining of the rectal canal is only a single layer of cells covering the underlying immune cell-rich tissues.
Due to the relative risk of different kinds of sexual intercourse, certain groups are more likely to contract HIV.
"The estimated lifetime risk of HIV diagnosis in the United States is 1 in 6 for all men who have sex with men (MSM) … in contrast to 1 in 241 and 1 in 473 for heterosexual women and men, respectively", according to Up To Date.
Risk of HIV transmission without ejaculation
Because HIV is transmitted through body fluids, reducing exposure to such fluids should theoretically reduce an individual's risk of HIV. Is the risk of HIV transmission without ejaculation less, therefore?
The answer is not straightforward.
While semen contains the virus, pre-seminal fluids ("pre-cum") also carry the virus in roughly the same concentration. So, if an insertive partner pulls out before ejaculation, they can still expose their partner to HIV.
Determining how pre-seminal fluid affects the risk of HIV without ejaculation is tricky. The volume of pre-seminal fluid varies considerably among males – particularly after a period of abstinence. We can, therefore, say that "pulling out" does not prevent the transmission of HIV; it may reduce the risk by decreasing the overall volume of HIV-infected bodily fluids.
Pulling out should not be used as a method of HIV prevention.
Injection risks
Injecting drugs or receiving a blood transfusion from an infected person substantially increases your risk for HIV. Sharing needles, syringes, and other drug paraphernalia is a highly effective way to transmit HIV between individuals – especially when one person has a high viral load. According to the CDC, the HIV infection risks are as follows:
Blood transfusion: 9,250 per 10,000 exposures (92.5%)
Needle-sharing during injection drug use: 63 per 10,000 exposures (0.63%)
Percutaneous (needle-stick): 23 per 10,000 exposures (0.23%)
The risk of HIV from a blood transfusion is by far the greatest risk. Because the blood isn't filtered, any viruses contained inside are transmitted from one person to the next. To reduce the risk of HIV from blood transfusions, all blood is tested for HIV, and certain at-risk groups are prevented from donating.
Clean needle exchange programs have successfully reduced the rate of HIV since the 1990s. By distributing clean syringes to drug users, they've minimized the use of dirty or contaminated syringes.
Healthcare professionals, meanwhile, who experience a needle-stick incident (where they are stabbed by a contaminated needle) must contact the relevant authorities and commence HIV post-exposure prophylaxis (PEP).
Let's recap
HIV is a highly communicable viral infection passed from one person to the next via body fluids. The majority of infections come from sexual intercourse, followed by the sharing of contaminated needles.
The risk factors of HIV include unprotected sex, sex with multiple sexual partners, anal sex, and sharing contaminated syringes. The risk of HIV transmission without ejaculation is potentially lower than otherwise but still carries some risk due to pre-seminal fluids. Meanwhile, the risk of HIV from blood transfusions is greatest at 92.5%.
If you find yourself in a high-risk group, ensure you practice protected sex. You can also commence pre-exposure prophylaxis – either in oral or injectable form – which can reduce your risk of HIV by as much as 99%. All groups should try to minimize their risk factors for HIV – and ensure you get tested routinely to prevent disease progression if you do contract the virus.