The likelihood of HIV infection in men. Is it possible NOT to get AIDS by sleeping with a sick person once? Big risk for women

Unfortunately, not all people use contraceptives during sexual intercourse, preferring sex without a condom. This is allowed only in one case - if your partner is permanent and you are planning the birth of a child with him. If the partner is random, such behavior is unacceptable. Such carelessness is fraught with very serious problems. In particular, you can become infected with a dangerous sexually transmitted infection (STD).

If there was an unprotected sexual contact - the probability of infection vich is? What is this probability? Are there effective measures to prevent the development of HIV infection? Let's talk today on this page www.site on this important topic:

What is the likelihood of infection?

If the partner is a carrier of HIV, then unprotected sexual contact with him is dangerous for the transmission of the virus. The likelihood of infection is quite high. However, according to experts, this route of infection is in third place after blood transfusion from an infected person or transmission of infection from a pregnant woman to the fetus. On average, the possibility of contracting HIV through sex without a condom is much less than the risk of contracting other STDs.

There are official data from the American Center for Disease Control that the probability of contracting HIV during one sexual contact without a condom is: from an infected woman to a man - 0.1 - 0.3%, in the absence of factors that increase the risk of infection (co-factors). These are, in particular, sexually transmitted diseases of one of the partners, inflammation, abrasions, wounds of the mucous membrane, as well as erosion of the cervix, or menstruation.

The risk of infection also depends on the gender of the partners. For example, women are infected several times more often than men, which is associated with their physiological characteristics. With unprotected contact, a large number of viruses enter the female body along with the sperm of an infected partner. In vaginal discharge, their number is much less.

How to prevent infection?

The main method of prevention is the absence of contact with the immunodeficiency virus. Of course, you don't have to give up sex altogether. You should just avoid casual one-night stands, be faithful to one sexual partner in whom you are sure. Be sure to use a condom every time you have sex.

Some believe that infection can be avoided by practicing coitus interruptus (without male ejaculation). Indeed, this measure reduces the likelihood of infection, but infection with HIV through sexual contact in this case is not completely excluded.

Will emergency STD prevention help?

With the help of drug prophylaxis, it is really possible to reduce the risk, and often prevent the occurrence of many sexually transmitted diseases.

The only condition is that you should take the appropriate drug as soon as possible. Usually, the scheme of preventive measures after unprotected sexual contact corresponds to the treatment scheme for the acute stage of an infectious disease.

With the help of emergency prevention of STDs, the development of gonorrhea, chlamydia, syphilis and many other sexual infections can be prevented. However, it will not save you from viral diseases: genital herpes or HPV (human papillomavirus), as well as HIV infection.

Modern medicine does not yet have such medications that can be used independently for the purpose of emergency prevention of HIV infection. However, a doctor can help.

Emergency post-exposure prophylaxis of HIV

If you have had such unprotected sexual contact and you are afraid of contracting HIV infection, contact the AIDS center in your city as soon as possible.

You will be assigned a test that will help determine the likelihood of infection. If there is a high risk of infection, the doctor will prescribe special antiretroviral drugs that will significantly reduce the risk of developing the virus.

The course of taking such funds is designed for a month. But in order for the measures taken to be effective, you should contact a specialist no later than three days after intercourse. Even better immediately or the next day.

After a month of treatment, another examination is carried out. Most of the time everything goes well. However, if the tests show a positive result, you will be given a more complex, detailed blood test. Its results will show the degree of impact of the virus on the immune system, which will help the specialist develop the most effective, individualized treatment regimen.

However, you must always remember that no medicine is a panacea, so you need to take care of safety measures in advance. As we have already said, the best prevention is sex with one partner you are sure of, and regular use of a condom.

If you are a supporter of open relationships without obligations, if you prefer unprotected sexual contact, then there is always a chance of contracting HIV. And this probability is quite high.

What is the risk of HIV infection in men? This question worries many. HIV, or - is a virus that infects the cells of the immune system, as a result of which they cease to perform their functions. It is important for each person to know the mechanism of the development of the disease, its clinical manifestations and methods of infection.

Disease pathogenesis

The virus enters the body and spreads in the blood and lymph.

Gastric juice, saliva, urine contain enzymes that can reduce the concentration of the virus to a minimum (which is why you cannot get infected through these fluids). The virus cannot exist outside a living organism for more than a few seconds, and also immediately dies at temperatures above 70ºС, at 56ºС - after 30 minutes.

When a virus cell enters the body, it integrates into a living cell. It converts its RNA into DNA, then inserts it into the DNA of the host cell, changing T-lymphocytes, causing it to produce similar viral cells and destroy existing ones. It is assumed that the virus responds to certain receptors on T-lymphocytes - CD4 cells.

Clinical manifestations of HIV infection in men

HIV belongs to the genus lentiviruses with a long incubation period.

For this reason, a person may not be aware of an existing infection for many years, as symptoms that are difficult to distinguish from many other diseases.

There are several stages of the development of the virus in the human body:

1. Incubation (from 10 to 60 days). Antibodies to HIV are not produced, it is impossible to determine the presence of HIV in the blood.
2. Acute (several weeks). It can manifest itself with symptoms such as fever, headaches, fatigue, muscle pain, prolonged diarrhea, sudden weight loss, upper respiratory tract infection, herpes.
3. Latent or asymptomatic (on average about 10 years, depends on the immune system). In the absence of therapy, it may not manifest itself in any way or be accompanied only by a painless enlargement of the lymph nodes. If the infection has not progressed to AIDS, lifelong antiretroviral therapy blocks the infection and allows the patient to live into old age. If left untreated, a person can live 9-11 years before the onset of AIDS.
4. Terminal (AIDS). From the moment of diagnosis without treatment, a person can live for about 1 year, dying from tumors or opportunistic (attacking only with severe immunodeficiency) infections that affect almost all body systems.

HIV is diagnosed by a blood test for the presence of antibodies to the virus. The first analysis is carried out in the period from 2 weeks to 3 months after the alleged infection. Six months later, a second test is carried out.

If the second analysis gave a positive result, another one confirming is prescribed. The results of the analysis are communicated personally to the patient and are confidential. Compulsory HIV testing is prohibited, with the exception of testing blood and organ donors to avoid infecting others. All HIV-positive individuals are regularly tested for immune status and viral load to monitor the development of the virus.

Methods of infection with the virus

As described above, the virus cannot exist outside a living organism at high temperatures and is transmitted only from an infected person through blood, breast milk or sexual fluids. You can't get HIV:

1. Through kisses, since saliva contains enzymes that can destroy or reduce the concentration of viral cells to a minimum. In rare cases, there is a small risk of transmission of the virus in the presence of fresh wounds, inflammation in the oral cavity.
2. Airborne (sneezing, talking).
3. Through sweat, tears, urine (handshake, towel, bed linen, shared toilet).
4. When bitten by insects or animals.
5. When swimming in a pool or pond, as the virus dies when it enters the water.

Sexual route of infection in men

About 70-80% of infections in the world occur in this way. There are risk factors that increase the likelihood of sexually transmitted infection:

1. During unprotected intercourse, both men and women are most likely to become infected with HIV, since the virus is contained in semen and vaginal secretions. Proper use of quality condoms can significantly reduce the risk of HIV or STD (sexually transmitted disease) transmission.
2. Anal sex increases the risk of infection, as in this case, there is a high probability of cracking and inflammation of the anus and rectum.
3. The passive (receiving partner) is more susceptible to infection than the active partner in any type of sexual intercourse.
4. The presence of sexually transmitted diseases and STDs increase the risk of infection through sexual contact, since they can often be accompanied by the presence of ulcers and inflammation of the mucous membrane, that is, the protection of the skin is broken, which facilitates the penetration of the virus into the body. The presence of cervical erosion increases the likelihood of infection not only in women, but also in men, since together with the exfoliating cells of the uterus, the virus can enter the body of a man.

Women are 3 times more at risk of infection than men for the following reasons:

• a larger amount of the virus enters the female body with sperm;
• its concentration in semen is higher than in the vaginal secretion;
• due to the anatomical structure, women are more susceptible to inflammation of the reproductive system and infection with STDs, which increases the likelihood of HIV infection.

Other ways of infection

Injection and instrumental method of infection. This route of infection is most common among injecting drug users. The reason is obvious: the use of a shared syringe. In a solution of heroin, HIV lives for about 21 days, in the cavity of a needle - for several days. Infections in this way account for 5-10% of all cases. The instrumental route is infection through non-disinfected instruments for tattooing, piercing, and manicure.

Hemotransfusion and transplantation way of infection. The hemotransfusion route is the transmission of the virus during the transfusion of infected blood, the transplantation route is during organ transplantation. Currently, they account for 3-5% of all cases, as the practice of testing all blood and organ donors for HIV is observed.

Perinatal and milk route of infection. Perinatal (vertical) - the route of transmission of the virus from a pregnant mother to her fetus. Milk - HIV infection in the process of feeding through breast milk. They make up 5-10% of all cases. Currently, when planning a pregnancy, a woman must be tested for HIV, and if the result is positive, therapy is prescribed to reduce the risk of transmitting the virus to the child.

After birth, the baby is tested for the presence of antibodies in the blood, but a reliable result can be obtained only at 1.5 years, when a mandatory re-analysis is carried out.

Professional and domestic way of infection. Occupational exposure to the virus is usually caused by healthcare workers who come into contact with blood, breast milk, seminal or vaginal fluids. This happens only if patients have damaged skin areas. Is less than 0.01%. In such cases, no later than 72 hours after the alleged infection, aggressive antiretroviral therapy is started, and an HIV test is regularly done. In everyday life, the transmission of the virus in rare cases is possible when used with infected shaving accessories, scissors for cutting.

Treatment and prevention of HIV

It consists in the implementation of antiretroviral therapy, which blocks the virus, which contributes to the formation of immune cells in the body. In the presence of concomitant infections, their treatment is required.

In order to prevent HIV infection, precautions must be taken: practice protected sex; avoid casual sex; when in contact with liquids containing the virus, observe the necessary protective measures; do not take drugs; visit licensed clinics, dentistry, cosmetic, tattoo and piercing salons, where you can be sure that the instruments are thoroughly sterilized.

HIV infection is quite difficult to catch, but at the same time, people can become HIV-positive even after a single exposure to the virus.

The risk of HIV transmission depends on the amount of viruses contained in the biological fluid of an HIV-infected person with which a healthy person comes into contact. The concentration of the virus is not the same in different periods of infection and in different body fluids in humans - the source of HIV infection.

Biological fluids in which the virus is contained in the maximum concentration (or concentration sufficient for infection):

− Blood;
− Sperm;
- Vaginal, vaginal secret;
− breast milk;
- Cerebrospinal fluid, contact with which can only occur in extreme cases, such as spinal injuries with leakage of cerebrospinal fluid.

Biological fluids that contain the virus in low concentrations and do not pose a danger in terms of infection:

− Urine;
− Tears;
− saliva;
− Phlegm;

Infection of a person with a virus occurs when biological fluids containing HIV at a maximum concentration enter the bloodstream or mucous membranes.

Natural and artificial transmission routes

HIV infection can be transmitted both naturally and artificially.

The natural route of HIV transmission includes:

- Contact, which is realized mainly during sexual intercourse (both homosexual and heterosexual) and in contact of the mucous or wound surface with blood.
- Vertical - infection of a child from an HIV-infected mother: during pregnancy, childbirth and breastfeeding.

− Artifical - during non-medical invasive procedures, including intravenous drug administration; when applying tattoos; when carrying out cosmetic, manicure and pedicure procedures with non-sterile instruments.
− Artifical - for medical invasive interventions in medical institutions. HIV infection can occur through transfusion of blood, its components, transplantation of organs and tissues, use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical devices contaminated with HIV and not processed in accordance with with the requirements of regulatory documents.

HIV is not transmitted

HIV is not transmitted by airborne droplets, water, household contact, through the use of common utensils, one toilet, transport, when attending school, during sports games, swimming in the pool, shaking hands, hugging, kissing.

Blood-sucking insects and arthropods (mosquitoes, bedbugs, lice, ticks) do not participate in the transmission of the virus.

Likelihood of HIV transmission

The probability of transmission of HIV infection in different ways is not the same, data from literary sources on the risk of HIV infection with various contacts are given in Table 1.

Table 1

The greatest risk of HIV infection occurs when the damaged skin comes into contact with HIV-infected blood. Almost 100% probability of HIV infection exists during the transfusion of HIV-infected blood, blood components and transplantation of organs and tissues. The transmission of HIV infection in the world is also recorded when using donor sperm and breast milk. In the Perm Territory, only 1 case of HIV infection was registered during the transfusion of blood components in 2001.

Another variant of the transmission of HIV infection by artificial means is infection through drug use with non-sterile instruments. It is the most common mode of HIV transmission worldwide. Data on the likelihood of contracting HIV vary greatly (from less than 1% to 70%). This is due to the presence of various drug use practices that are risky in terms of HIV infection: sharing needles, syringes or containers for drug use.

The natural routes of transmission of HIV infection include sexual homosexual and heterosexual intercourse and mother-to-child transmission of HIV infection. During sexual intercourse, unprotected anal intercourse is the most risky. The lowest risk of infection occurs during vaginal intercourse between an uninfected man and an HIV-infected woman.

Condoms effectively protect against sexually transmitted HIV infection. The risk of HIV infection can only arise if they are damaged, torn or misused.

The risk of transmission of HIV infection from mother to child with the use of modern highly active chemoprophylaxis regimens can be reduced to 2% or less. In their absence, up to 45% of children become infected.

On the pages of the medical journal Journal of Infectious Diseases, a study that once again clarified the degree of risk of contracting HIV through heterosexual sexual contact. In addition, doctors analyzed and what factors that affect this risk.

Let's start with the main finding: for heterosexual couples in which one partner is infected with HIV, the risk of infection is 1 in 900. That is, on average, there is one infection per 900 unprotected intercourse - this is in order of magnitude consistent with past estimates and slightly exceeds them. Using a condom reduces the risk by about 78%, i.e. to the level of 1 infection in 4000 sexual acts; of the risk factors, the key is the concentration of the virus in the blood of an infected partner. Everything else, that is, age, the presence of concomitant infections or circumcision, are second-order factors. Although, for example, circumcised men become infected almost half as often, and with age, the risk significantly decreases.

The authors of the study, including specialists from both the University of Washington in the United States and their colleagues from medical centers in Kenya and South Africa, separately noted a greater risk of infection in the pair "infected man - uninfected woman", but when asked whether this was due to ratio of roles in sexual intercourse, it was difficult to answer. According to the scientists' article, it is also possible that men, on average, had a high concentration of viral particles, so it is clearly premature to draw conclusions about the supposedly better protection of men from the virus.

Context: sex, HIV and risks

The most risky sexual intercourse from the point of view of epidemiologists is anal sex, especially for the receiving partner. Moreover, regardless of sexual orientation, since the permeability of the mucous membrane in both men and women is the same.

The safest act is either oral sex (the risk is about one infection in several thousand), or even mutual caresses with hands.

The study was conducted in sub-Saharan Africa, a region that is rightfully considered the most disadvantaged on the planet in terms of the number of people infected with HIV. Doctors examined 3,297 couples where one of the partners was HIV-positive and collected information on all cases of infection, along the way, collecting all the information that made it possible to identify risk factors.

They, of course, may seem quite obvious, since similar studies have been carried out before. But in the same issue of the Journal of Infectious Diseases there is also a commentary by two third-party experts - Ronald Gray and Maria Waver from Johns Hopkins University in Baltimore (note that both have dozens of publications on the topic of HIV, based on clinical research materials). These experts point out that the American-African group has received the most reliable data to date on how high the risk of HIV infection is in a permanent heterosexual couple.

This knowledge is useful, first of all, not even to epidemiologists, but to ordinary citizens. In Russia, according to various estimates, infected from almost 550 thousand (official data) to one and a half million people; The virus has long gone beyond the narrow circle of intravenous drug users or people who have a large number of unprotected sexual contacts with casual acquaintances. To date, there is no one hundred percent reliable means of protecting against infection, but research shows us how and how much risk can be reduced.

Context: statistics and its reliability

The most disadvantaged countries are Swaziland, Botswana, Lesotho, South Africa, Zimbabwe, Namibia. These African states are characterized by the proportion of HIV-infected adults from 15 to 25%.

Among the least affected by the spread of the virus, according to the CIA directory, are the Central Asian republics, but it is not very clear how much local statistics can be trusted. However, official data from the World Health Organization also directly indicate a spread of estimates within at least a dozen or two percent, even where there is more trust in local health authorities: the number of HIV-positive residents of industrialized countries is estimated at 1.9 to 2.7 million.

We can only confidently say that the proportion of HIV-positive citizens in Russia does not exceed a few percent according to the most pessimistic estimates, and the same statement is true for most developed countries.

Context: therapy and money

On the one hand, modern antiviral drugs already make it possible in some cases to say that it is possible to live with HIV no less than without it - there are examples of patients who, with the help of drugs, have been successfully curbing the growth of the number of viruses in the body for more than two decades.

On the other hand, drugs are expensive, containing the virus costs tens of thousands of dollars per infected person. In Russia, according to the official data of the Ministry of Health and Social Development, in 2012 it is planned to provide 105 thousand people with therapy - those who wish can compare this number with the official number of infected people. In African countries, the situation is even worse: the Zimbabwean economy, with 80% unemployment and a collapsed national currency, is in principle unable to support at least programs to prevent HIV infection of children of HIV-infected mothers.

Context: fidelity and probability

From all the accumulated data on the risks of infection and the number of HIV-infected, several conclusions can be drawn about how high the probability of infection is:

After a year of living together with a single partner (who is about 1% likely to be HIV positive) - about 0.1%

After one casual connection with an HIV-infected person - about 0.11%

After one casual relationship (partner is infected with a probability of 1%) - about 0.001%

For these reasons, it is obvious that abstaining from promiscuity alone is not enough - even people who have never practiced casual unprotected sex are not immune. Some of the new cases are not at all due to frivolous behavior: unless, of course, the very fact that a person could have more than one partner in a lifetime is recorded as such!

What is the risk of contracting HIV?
The degree of risk of contracting HIV varies depending on the type of transmission.

You need to know that transfusion of infected blood, 1 ml of which contains from 1 to 10 infectious doses of the virus, almost always leads to infection and subsequent development of HIV infection in a person. According to existing estimates, the probability of infection after such a procedure exceeds 90%. The causative agent of AIDS is also transmitted by the introduction of cellular blood components, blood coagulation factors (VIII and IX). It is possible to transmit HIV through various biological fluids of the body, during transplantation of organs and tissues. The literature describes cases of HIV infection during kidney transplantation, as well as artificial insemination with the sperm of infected donors.

Exposure to the virus during pregnancy is only slightly inferior to a transfusion of infected blood, with reported rates ranging from 11% to 70%. On average, the risk that an infected woman will transmit HIV to a fetus or newborn is 30-50%.

Sexual intercourse is not the most dangerous way of transmitting HIV in terms of the likelihood of infection. The degree of risk of infection depends on the type of sexual contacts (vaginal, anal, oral, mixed), their number with one or more sexual partners. It has been noted that the likelihood of infection increases due to additional factors, primarily the presence of sexually transmitted diseases in one of the partners, and especially those in which there are all kinds of violations of the integrity of the skin and mucous membranes in the form of ulcers. This is observed, for example, with syphilis, herpes infection, fungal infections, etc. The probability of HIV transmission as a result of one sexual intercourse, according to experts, ranges from 0.1 to 1%. However, due to the large number of sexual acts between healthy and HIV-infected persons, this route of infection dominates the world, as will be discussed below-

The use of non-sterile medical equipment intended for injecting drugs is associated with a slightly higher risk of HIV transmission compared to a single sexual contact with a person infected with HIV (0.5 to 1%). The degree of danger depends on the volume of blood thus transferred.

Exposure to the virus as a result of an accidental needle stick in medical or non-medical settings has the lowest rate of HIV transmission. The chance that an accidental needle stick with an HIV-infected needle will cause an infection is about 0.3%.

Now that the ways of infection with the human immunodeficiency virus and its probability in various situations are known, it is time to assess the situation in the world in general and in Ukraine in particular. It should be noted that there are practically no fundamental differences here. In Europe, sexual transmission accounts for 50.2% of all reported AIDS cases, of which 8.9% is heterosexual transmission of HIV, i.e. from a woman to a man or vice versa, and 41.3% - homosexual - from a man to a man.

A characteristic feature of recent times is the constant increase in the percentage of HIV infections as a result of heterosexual contacts.

The proportion of cases of infection with intravenous drug use exceeds 33%, with blood transfusion to recipients and patients with hemophilia is 6.1%, from mother to child - 1.8%.

Of the 66,000 cases of AIDS in Europe, 2,338 cases were registered among children. Of this number, in 913 cases (39.1%), the infection occurred as a result of the transmission of the virus from mother to child, in 551 (23.6%) - during blood transfusion, in 113 (4.8%) - during the treatment of hemophilia. The group with other types of HIV transmission consists of 761 people, the vast majority of whom (712) are children from Romania who were infected through transfusions of untested blood for HIV or through the use of unsterilized medical instruments.

In Ukraine, the sexual route of AIDS infection accounts for about 60% of all cases, of which heterosexual contacts account for 10%, homosexual contacts - 50%.

How is a man infected with HIV from a woman? Most Dangerous Situations

The retrovirus invades immune cells, depriving them of their ability to fight external stimuli on their own. The danger of the disease also lies in the fact that at the initial stages it is difficult to recognize the symptoms that could signal the need to go to the clinic. No one is immune from infection, so you should remember how HIV is transmitted from a woman to her sexual partner and vice versa?

Can you get HIV from a woman?

The pathogen is found in high concentrations in biological substances - blood, lubrication and semen, vaginal secretions. Therefore, open wounds, traumatized mucous membranes or sexual intercourse with an infected person, which in itself implies the exchange of fluids, are sources of transmission of the disease. In different situations, the risk of catching the pathogen is different. The most common mode of transmission is sexual contact:

• during unprotected intercourse with an infected partner, the risk of HIV infection from a woman is higher than in the opposite situation. This trend has developed as a result of increased sexual activity among the representatives of the stronger sex and a more frequent change of sexual partners. Especially increases the likelihood of transmission of HIV from a woman to a man in cases where she is diagnosed with cervical erosion. In this case, there is "exfoliation" from the cervix of cells that are densely deposited on the glans penis.
• when using contraception. The probability of HIV transmission from a woman to a man exists even with protected sexual contact, although it is negligible. The degree of risk of acquiring immunodeficiency from a partner depends on the thickness of the condom used: the thinner the latex, the higher the risk.

Also, the percentage of HIV infection from a woman depends on the method of sexual contact:

• oral route: the risk of contracting HIV from a woman in a man arises if he is a passive partner - possible cracks and wounds in the partner's mouth can be a conductor in the process of cells containing the pathogen entering the surface of the penis.
• anal way: the probability of HIV infection of a man from a woman with this method of sexual contact is much higher than with vaginal intercourse due to the high possibility of injury to the intestinal mucosa.

Many do not even suspect that there is a problem or prefer to hide it from their partner, which is more often the case for the fairer sex, especially if sexual contact was meant to be one-time. But if a sexual relationship with an infected person occurred only once, is it possible to get infected in this case? It is worth referring to the statistics, which show that within modern society, it is more and more often one-time sexual intercourse with a frequent change of partners has begun to be practiced. So, the answer is obvious - a single sexual contact with the same probability leads to infection with a retrovirus. Therefore, each person needs to know the main principles of disease prevention and adhere to them throughout life.

Main routes of HIV infection for men

Based on the statistics, it can be said that men are more likely to become infected with HIV than women. This is due to the profession, position and lifestyle that representatives of a strong position are exposed to throughout their existence.

What is the percentage of HIV infection of a man from a woman and vice versa?

The percentage of HIV infection in men is much higher than in women. This is due to the fact that they are statistically more likely to inject drugs and have more casual sex. These two factors are the main causes of HIV in men. However, it is easier for a woman from a partner to become infected with a retrovirus due to anatomical features. This difference is justified by the fact that during sexual intercourse, seminal fluid enters the vagina, while spermatozoa containing the pathogen spread a huge number of viral units throughout the small pelvis, which equates the risk of infection to 100%.

What is the likelihood of HIV infection in men?

Transmission of a retrovirus is possible through any contact with an environment that may contain the pathogen. Of course, there are situations with a higher probability of infection, and there are times in which the risk is almost zero.

Life situations with a high probability of infection through sexual contact with an infected person:

Transmission of HIV from a woman to a man: risk in everyday life

Everyday and medical situations in which there is a small chance of catching an immunodeficiency:

Can a man get HIV from a man when sharing household items?

The probability of contracting HIV in men in such a situation is zero, since the virus is not on the surface of the skin, and for its penetration, an entrance gate is needed - injuries, wounds. Infection when using some cutlery for eating food is also impossible. Although it is believed that saliva retains the virus for some time, but such a transmission mechanism has not been confirmed by scientific studies. It is also worth noting that the likelihood of HIV transmission from a woman to a man during a kiss is minimal. Theoretically, this is possible only if two partners have a significant violation of the mucous membranes of the mouth.

The rate at which the infection progresses and subsequent therapy depends on how a man becomes infected with HIV. Therefore, do not neglect prevention and periodic testing for immunodeficiency.

The degree of risk of HIV infection through unprotected contact has been determined

The risk is 1 in 900, but for sex with a condom it's only 1 in 4000

A group of African and American researchers presented a study in the journal of Infectious Diseases, which once again clarified the risk of HIV infection through heterosexual sexual contact. In addition, doctors analyzed and what factors that affect this risk.

Let's start with the main finding: for heterosexual couples in which one partner is infected with HIV, the risk of infection is 1 in 900. That is, on average, there is one infection per 900 unprotected intercourse - this is in order of magnitude consistent with past estimates and slightly exceeds them. Using a condom reduces the risk by about 78%, i.e. to the level of 1 infection in 4000 sexual acts; of the risk factors, the key is the concentration of the virus in the blood of an infected partner. Everything else, that is, age, the presence of concomitant infections or circumcision, are second-order factors. Although, for example, circumcised men become infected almost half as often, and with age, the risk significantly decreases.

The authors of the study, including specialists from both the University of Washington in the United States and their colleagues from medical centers in Kenya and South Africa, separately noted a greater risk of infection in the “infected man - uninfected woman” pair, but when asked whether this was due to ratio of roles in sexual intercourse, it was difficult to answer. According to the scientists' article, it is also possible that men, on average, had a high concentration of viral particles, so it is clearly premature to draw conclusions about the supposedly better protection of men from the virus.

Context: sex, HIV and risks

The most risky sexual intercourse from the point of view of epidemiologists is anal sex, especially for the receiving partner. Moreover, regardless of sexual orientation, since the permeability of the mucous membrane in both men and women is the same.

The safest act is either oral sex (the risk is about one infection in several thousand), or even mutual caresses with hands.

The study was conducted in sub-Saharan Africa - a region that is rightfully considered the most disadvantaged on the planet in terms of the number of people infected with HIV. Doctors examined 3,297 couples where one of the partners was HIV-positive and collected information on all cases of infection, along the way, collecting all the information that made it possible to identify risk factors.

They, of course, may seem quite obvious, since similar studies have been carried out before. But in the same issue of the Journal of Infectious Diseases there is also a commentary by two third-party experts - Ronald Gray and Maria Waver from Johns Hopkins University in Baltimore (note that both of them have dozens of publications on the topic of HIV, and based on clinical research materials). These experts point out that the American-African group has received the most reliable data to date on how high the risk of HIV infection is in a permanent heterosexual couple.

This knowledge is useful, first of all, not even to epidemiologists, but to ordinary citizens. In Russia, according to various estimates, infected from almost 550 thousand (official data) to one and a half million people; The virus has long gone beyond the narrow circle of intravenous drug users or people who have a large number of unprotected sexual contacts with casual acquaintances. To date, there is no one hundred percent reliable means of protecting against infection, but research shows us how and how much risk can be reduced.

Context: statistics and its reliability

The most disadvantaged countries are Swaziland, Botswana, Lesotho, South Africa, Zimbabwe, Namibia. These African states are characterized by the proportion of HIV-infected adults from 15 to 25%.

Among the least affected by the spread of the virus, according to the CIA directory, are the Central Asian republics, but it is not very clear how much local statistics can be trusted. However, official data from the World Health Organization also directly indicate a spread of estimates within at least a dozen or two percent, even where there is more trust in local health authorities: the number of HIV-positive residents of industrialized countries is estimated at 1.9 to 2.7 million.

We can only confidently say that the proportion of HIV-positive citizens in Russia does not exceed a few percent according to the most pessimistic estimates, and the same statement is true for most developed countries.

Context: therapy and money

On the one hand, modern antiviral drugs already allow in some cases to say that it is possible to live with HIV no less than without it - there are examples of patients who, with the help of drugs, have been successfully curbing the growth of the number of viruses in the body for more than two decades.

On the other hand, drugs are expensive, containing the virus costs tens of thousands of dollars per infected person. In Russia, according to official data from the Ministry of Health and Social Development, it is planned to provide 105 thousand people with therapy in 2012 - those who wish can compare this number with the official number of infected people. In African countries, the situation is even worse: the Zimbabwean economy, with 80% unemployment and a collapsed national currency, is in principle unable to support at least programs to prevent HIV infection of children of HIV-infected mothers.

Context: fidelity and probability

From all the accumulated data on the risks of infection and the number of HIV-infected, several conclusions can be drawn about how high the probability of infection is:

After a year of living together with a single partner (who is HIV-positive with a probability of about 1%) - about 0.1%

After one casual connection with an HIV-infected person - about 0.11%

After one casual relationship (partner is infected with a probability of 1%) - about 0.001%

For these reasons, it is obvious that just abstaining from promiscuity is not enough - even people who have never practiced casual unprotected sex are not insured. Some of the new cases are not at all due to frivolous behavior: unless, of course, the very fact that a person could have more than one partner during his life is not recorded as such!

Man and woman. AIDS and love

Tamara Lyalenkova: In the history of mankind, there were not so many diseases, only from the mention of which people were thrown into a fever or icy chills beat. It is no coincidence that AIDS was called the plague of the twentieth century, which from a medical point of view was incorrect, but very accurately conveyed the attitude of society towards this disease. After HIV was transferred to the category of infectious, dangerous, but no more than some other diseases, the fear subsided. However, every disease has its own, not only medical history. If until some time the risk group was made up of people who inject drugs, homosexuals and commercial sex workers, today the most vulnerable part is women. And I asked Tatyana Shimonova, an epidemiologist at the Moscow City AIDS Center, to tell me why.

Tatyana Shimonova: The fact is that the ways of infection for men and women are the same, but if in the past the route was mainly narcotic, then at present there is a tendency towards an increase in the heterosexual route. Most women become infected through heterosexual sexual intercourse, the source is a man. Most often this is a random discovery. People come, of course, in a state of severe stress, because when such a diagnosis is announced, an unprepared person perceives everything quite emotionally. The situation is especially unpleasant when a woman comes who was examined in the antenatal clinic, she is pregnant, and she is diagnosed with HIV infection. For a normal woman, this is a huge stress. She is already thinking about how this threatens the life and health of her unborn child, in general, the situation is quite difficult psychologically. We explain to women that antiviral therapy currently exists, that this disease does not pose a threat to the life of the unborn child. If a woman comes to us on time, gets registered at the dispensary, she is prescribed preventive treatment in three stages, in this case there is practically no risk for infection of her child, it comes down to about 2-3 percent.

Tamara Lyalenkova: But here there is such a delicate moment: in order to give birth to a child, it is necessary to conceive it in a natural way or in a test tube ...

Tatyana Shimanova: No doctor will go for IVF, knowing that a woman is infected with HIV. We are talking about a threat to the life of the unborn child.

Tamara Lyalenkova: This means that at least a man will be needed who will become the father of this child, respectively, he is either already infected or is at risk if he comes into contact.

Tatyana Shimanova: It should be noted here that healthy men from women during heterosexual contacts rarely become infected with HIV infection, much less often than women from men. This is due to the physiological characteristics of the structure of women and men. It is quite possible to conceive a child, and at the same time the man does not become infected. We explain how to minimize the risk. It must be understood that infection occurs only under certain conditions, and the virus does not penetrate through intact skin mucous membranes. Women become infected more often due to the fact that they have diseases such as cervical erosion, it is sometimes hidden, a woman may not know about it. Again, the integrity of the mucous membranes is violated, and this leads to more frequent infection of women.

Tamara Lyalenkova: When it becomes clear that there is a disease, who is thinking about whom at that moment?

Tatyana Shimonova: Men are worried, of course, about their condition: what should he do, how should he continue to live. Women are more stable due to their physiological characteristics, due to the fact that they are destined to preserve the family and be mothers, understanding that a great responsibility lies with them. I would like to say that another moment arises, also psychological: when a woman finds out about this diagnosis, another moment arises here - to experience betrayal. For women, what is the biggest blow? Not even that they are sick, but that the person with whom they live, whom they love, whom they trust, in fact, has betrayed them. I had a lot of conversations on this topic with women. Well, how is it to be understood that a person did not say that he was sick with a rather serious chronic disease, and infected a woman?

It can be very painful to watch when a couple arrives, a woman is pregnant, and her pregnancy is quite long - 38 weeks, and she has antibodies to the virus. She does not have a positive result, but a doubtful one, that is, the infection occurred recently, no more than 3-6 months ago, that is, almost already during pregnancy. And her husband is sitting with her, and when I start a conversation with them, I try to find out if he could be a source of infection, I find out that he could be a source of infection, but it’s impossible to tell a woman about this, because I must observe medical secrecy and I have no right to tell her "your husband is infected." Moreover, the man is concerned that it so happened that a child desired for him and for her can be put at risk of infection, because preventive measures have not been taken, that is, there is a rather high risk of having a child with HIV infection. I see his anxiety, but I still can't understand the psychology of this act.

Tamara Lyalenkova: Indeed, it is somewhat strange to explain such very serious actions of adults by Russian “maybe”. Moreover, in men, as in women, the first reaction to a confirmed diagnosis is: “Will I be able to have children?” I asked Igor Gerasimov, another epidemiologist at the Moscow City AIDS Center, to try to explain this attitude of men towards their own illness.

Igor Gerasimov: According to the answers of our patients, it again depends on the educational qualification, on many other factors - hedonism, that is, pleasure is put in the first place. "I don't get all the sensations that there could be." “But you can infect them.” “Well, why should I? I will interfere. Why do I need this condom? Let her think of herself." And so on. Perhaps such a position is closer to marginals. It is necessary, of course, to separate people. Now, after all, the sexual way prevails, not narcotic, but we are all subject to love, so now all of our own get into it.

Tamara Lyalenkova: Is there any difference, behavioral, psychological, when men and women come to you?

Igor Gerasimov: Among men in our country, as well as all over the world, a certain part are intravenous drug users. Drug addicts, I think, would not be interesting to discuss, because the idea is distorted here. They are at different stages of their illness, they are drug addicts, some are in remission, it is difficult to characterize them. And if we take ordinary people who have been sexually infected, so to speak, belonging to the intelligentsia, among men the reaction is either external bravado, followed by fear, or a pre-depressive state, a person is frightened.

Tamara Lyalenkova: The fact is that for Russian men, then the sexual lifestyle also changes, because they are forced to think about it.

Igor Gerasimov: Oh sure. For many, this is the end, now there will be no children, that's all. There is a certain part. But the majority is not only calm, but this moment is of little interest to them, even despite this illness. That is, the assessment of oneself as a source of infection is irrelevant for many, perhaps against the background of fear. In further communication, perhaps, it would have opened up, surfaced. But certain people are afraid, first of all, “but how will I have children now,” when you talk about a condom. When you say that "you can infect a woman, there is an article in the Criminal Code" - less effective. We explain how you can make sure that there are children and the woman does not get infected. Then the people who asked the question, they do not just calm down, but understand that life is really not lost.

For women, even among drug addicts, the first thing that scares them is: “Is it HIV? I'll infect the child!" For them, life itself with a condom is not as scary as it is for men. But they are concerned about the issue of childbearing. When they learn that it is possible to conceive and make sure that the child does not become infected during childbirth, this brings them to life much faster than men, back to normal. Here it is very interesting to observe when they come to us, everyone listens to this. The diagnosis is considered preliminary at the first visit. We take blood again, because some small fraction is not confirmed, there are mistakes. And when you inform them, almost everything starts anew: “What did they find on me? And how will I live? Even though they had heard it all the day before.

Among women more than among men, the first reaction is: “What will happen to the child? Will I infect the child? when he is old enough. “What will happen to my relatives?” Yes, women more than men have developed a thrifty attitude towards others. Men are more, of course, selfish, the main thing is his feelings - of course, general psychological tendencies and patterns manifest themselves here, as in any other critical situation. Recently, women are more likely to become infected and come to us.

Drug addicts are, as it were, a reservoir, a repository of infection. That is, those who stopped using drugs, they gradually return to life, start working, become socially active and instantly fall into the sphere of interests of young women. And when you start asking them how it happened, you learn very interesting things. The woman knew about the status of her partner, he told her: "I have HIV infection." They began a relationship, as the doctor ordered, indeed, being protected. But after a month and a half, the condom is not used. And when you ask a woman why, you hear the following answer: “When we were unfamiliar, we used protection, and when I realized that I loved him, I stopped.” - "But why? He told you that he has HIV infection.” “Don’t you understand, when people love each other, a condom is distrust.” Not so often, of course, but there are couples when he is our patient, infected, and she is his wife, his legal wife. And you ask a woman: “Do you use protection?” - "Not". - "Do you want to get infected?" - "Well, what are you, how can you..." - "Why don't you protect yourself?" - "This is my husband". Well, how can such things be done with my husband… That is, the psychology of people has remained as in the pre-virus era.

Tamara Lyalenkova: Are there any psychological changes?

Igor Gerasimov: For example, I remember a patient who came in and was very upset that she was found to have an infection, and when her partner (he did not infect her) found out about the infection, he left her. And it was a great misfortune for her that she had an illness, that her loved one left her. But some time passed, and she, passing by, came to me and said: “You know, thanks to my illness, I understood a lot in life. Because now I have met a person who really loves me, to whom my illness is not important, I am important to him. And that person turned out to be, I later found out, very bad. And I could get married and live with him all my life, and give birth to children from him. That is, the disease put everything in its place. There are such cases, yes.

Tamara Lyalenkova: If we try to deduce a trend from the numerous cases known to the doctors of the Moscow City AIDS Center Tatiana Shimonova and Igor Gerasimov, then it boils down to the following: the disease now spreads mainly through heterosexual contacts, and women are more at risk of contracting HIV infection due to anatomical and physiological characteristics. In addition, the stereotypes accepted in modern Russian society play an important role: men rarely fully realize their responsibility, and women put love and marriage above any illness.