modes of HIV transmission include the following (CDC, 2019c): ● Performing oral sex—rare but theoretically possible if a man with HIV ejaculates into his partner’s mouth ● Receiving blood products or transplants contaminated with HIV. ● Infants ingesting food from an HIV-infected caregiver’s mouth that contaminates the food with blood while prechewing. ● Being bitten by a person with HIV—if the biter’s mouth is bloody and the skin is broken. ● HIV-infected blood or blood-contaminated body fluids contacting broken skin, wounds, or mucous membranes. ● Deep, open mouth kissing when both partners have open sores or bleeding gums. Healthcare Consideration : There exists a common misconception that HIV can be transmitted through saliva; however, it is imperative to clarify that HIV is not transmitted via saliva. Nevertheless, it is important to acknowledge that the virus can potentially be transmitted during deep, open mouth kissing, but only if both individuals involved have open sores or bleeding gums and blood from the HIV-infected person comes into contact with the bloodstream of the noninfected person. Healthcare professionals, including nurses, should prioritize educating patients and colleagues within the healthcare sector about the fact that saliva does not carry the HIV virus, but transmission can occur through blood exchange in the context of deep, open mouth kissing between partners with relevant conditions. There is also a correlation between HIV and other sexually transmitted infections (STIs). An HIV-negative person who has an STI is about three times as likely to get HIV if they have unprotected sex with someone who is HIV positive. Conversely, a person who has both HIV and another STI is about three times as likely to spread HIV via sexual contact (CDC, 2020k). Viral load, or the amount of HIV in the blood of an infected person, must also be considered when discussing HIV transmission. The higher a viral load, the greater the chance of transmission. Those with a very low viral load (viral suppression) or an undetectable viral load (the amount of HIV in the blood is so low that it cannot be measured) are less likely to transmit HIV (CDC, 2020k). Charlotte's HIV diagnosis has profound emotional and psychosocial implications. She must grapple with the shock of the diagnosis, feelings of guilt about her past behavior, concerns about her family's well-being, and the fear of a potentially life-threatening condition. Her demanding career and family responsibilities further complicate her ability to process the diagnosis. Upon confirming the diagnosis, Charlotte's nurse practitioner initiates a comprehensive medical management plan. This includes consultations with infectious disease specialists, initiation of antiretroviral therapy (ART), and regular monitoring of her viral load and CD4+ T-cell count. Charlotte receives counseling on the importance of treatment adherence and safer sexual practices. Recognizing the psychological toll of the diagnosis, Charlotte's healthcare team involves a mental health counselor to help her navigate her emotional journey. Counseling aims to address the fear, stigma, and guilt associated with the diagnosis and equip Charlotte with coping strategies.
Box 1. Body Fluids That Transmit HIV • Blood • Semen • Preseminal fluid • Vaginal fluids • Breast milk
HIV cannot be transmitted through (CDC, 2020m): ● Airborne mosquitoes, ticks, or other insects. ● Saliva, tears, or sweat that is not contaminated with blood. ● Hugging, shaking hands, sharing toilets, sharing dishes, or closed mouth kissing with someone who has HIV. ● Sexual activities that do not involve the exchange of body fluids (e.g., touching). For transmission to occur, these infectious fluids must meet a mucous membrane or damaged tissue or be directly injected into the bloodstream. In the U.S., HIV is most commonly transmitted through these ways: By anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (CDC, 2019c). Anal sex carries the highest risk of transmission, particularly when the individual is the receptive partner of the infected person. The rectum has a very thin lining that allows easier transmission. However, the partner who is inserting is still at risk for transmission through the urethra; foreskin; or lesions anywhere on the penis (CDC, 2019c). Vaginal sex carries less risk for HIV transmission. However, without protection, HIV can be transmitted to either partner. In women, HIV can be transmitted through the mucous membranes of the vagina and cervix. HIV is transmitted to men through the urethra and foreskin or lesions along the shaft of the penis (CDC, 2019c). The second most common transmission type is sharing needles or syringes, rinse water, or other equipment used in IV drug use with an HIV-infected person. A syringe contaminated with HIV can spread the virus up to 42 days because it is not exposed to air—but this timeline is grossly dependent on environmental factors (CDC, 2019c). Less common modes of transmission are from mother to child during pregnancy, childbirth, or breastfeeding and from sharps sticks with HIV-contaminated needles. Rare Case study 1: Charlotte Charlotte, a 30-year-old wife and mother, presents herself as a reformed individual with a demanding career and significant family responsibilities. During an annual wellness visit with her nurse practitioner, she candidly shares her past, disclosing a history of risky sexual behavior during her college years, including inconsistent use of safe sex practices. During the wellness visit, Charlotte recounts her past, revealing a series of casual sexual encounters without adequate protection. She expresses relief that those days are behind her and that she has not experienced any apparent sexually transmitted infections. In response to Charlotte's disclosure, her nurse practitioner decides to recommend comprehensive lab work, which includes HIV screening, as a precautionary measure. The lab results take Charlotte by surprise, revealing that she is HIV positive. The initial shock and disbelief give way to a wave of fear and uncertainty. Charlotte, who believed she had left her past behind, is now confronted with a life- altering diagnosis that she never anticipated.
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