by Lexy London

Over the past couple of months I've privately answered several questions about sexually transmitted diseases, but this one is serious enough that it deserves to be answered in public. The question comes from a reader in the United Arab Emirates.

I have several questions about AIDS:

I wanted to know that, how someone can understand he/she's got AIDS or not? Are there any signs for this disease? If yes, does it take a long time for them, to appear? Can using a condom guarantee not to get AIDS?

AIDS is an acronym that stands for Acquired Immune Deficiency Syndrome. Acquired means that it is something one can become infected with, rather than something passed genetically by parents. Immune Deficiency describes the action of the disease - it compromises the body's natural immune system. And the word Syndrome is used because it's not like, say, heart disease which has several specific symptoms that add up to a disease. When someone is infected with AIDS, there are many different health problems that person may or may not have. I will discuss those below.

AIDS is caused by a virus called the Human Immunodeficiency Virus (HIV), and it's important to recognize the difference. Someone can be infected with HIV for many years before they develop symptoms of AIDS. When someone is infected with HIV, their body attempts to fight the virus and creates antibodies to attack the virus, but these antibodies don't develop immediately, either. Because an HIV blood test searches for the HIV antibodies, if someone has recently been infected with HIV, they may test negative yet still be passing the virus to others.

When someone is first infected, they may have flu-like symptoms for a couple of weeks while their body tries to fight the virus, including a fever, swollen glands, headache and stomachache. However, not everyone gets these symptoms - many people have no idea they have been infected. During this early period of infection (called "acute-HIV infection"), the infected person has a very high blood concentration of HIV which makes transmission to others as much as 20 times more likely.

After the acute infection passes, the virus remains in the body. The body continues to create antibodies that try to fight the virus. For years, someone who is infected can show no symptoms at all, but their natural immune system is being slowly damaged. Doctors are able to test for immune system damage by measuring the number of T-helper cells in a milliliter of blood. A normal human has between 500 and 1500 T-cells, and as the disease progresses, this number drops. As the number of T-cells drops, the body becomes less and less able to handle everyday infections like colds, flu, and a cold that should last a couple of days may last a couple of weeks.

When the T-cell count drops below 200, a diagnosis of HIV infection becomes a diagnosis of AIDS. With a T-cell count so low, the immune system cannot fight what is called "opportunistic infections." The Centers for Disease Control has an official list of opportunistic infections in AIDS, but the most common are:

- Kaposi's Sarcoma (KS), a specific type of skin cancer
- Pneumocystis pneumonia (PCP), a lung infection
- Herpes simplex, cold sores that appear around the mouth or nose
- Candida, a fungal infection that can affect your mouth, throat or groin area
- Cytomegalovirus (CMV), an eye infection.

These are the classic "symptoms" of someone infected with AIDS, but as I said above, someone can be HIV positive for years before any of these symptoms appear (the average now is 8 to 11 years). Further someone could have one or two of these "symptoms" and not be HIV positive, nor have AIDS. The only way for you to be sure that you or someone else isn't infected with HIV is to be tested. Also, as discussed above, if you are tested soon after being infected, it is possible to test negative because your body hasn't had time to create the antibodies that the test looks for. Doctors call the time between infection and antibody appearance the "Window Period." For about 95% of people infected with HIV, it takes about three months for antibodies to appear, for others it can take up to six months. For this reason, if you fear you could be infected, it is best to be tested twice - six months apart.

So the next logical questions are "How could I be infected?" and "How can I prevent infection?"

HIV is present in blood, semen, vaginal secretions and breast milk, therefore contact with these fluids from an infected person can lead to infection. Activities that can put you into contact with these fluids are:

Unprotected sexual contact
- Vaginal intercourse: HIV can be passed from an infected male to female and an infected female to a male. Tiny, unnoticeable tears can be caused by intercourse, and create a very hospitable place for the virus.
- Anal intercourse: Like vaginal intercourse, small tears can be made in the rectum which may lead to infection. Unprotected vaginal and anal intercourse are considered high-risk behaviors.
- Oral sex: The mouth is generally an inhospitable environment for the virus, but there have been cases of transmission via both oral-vaginal and oral-penile sex. However, this is generally considered a low-risk behavior.

Direct blood contact
- Use of infected needles: intravenous drug users often exchange needles - using the needle of someone who is infected is a high-risk behavior.
- Blood transfusions from infected blood: although the risk of infection via blood transfusion in the United States is now quite remote, I do not have information on the chances in other countries.
- Accidents in healthcare settings.

Mother to child
- Before or during birth.
- Via breastfeeding: because HIV is present in breast milk, in developing countries this is a primary risk for children of infected women.

To prevent infection during sexual activity, the best protection is a latex condom. According to a Center for Disease Control study of uninfected partners of people who were HIV-positive, latex condoms can be 98-100% effective in preventing transmission of HIV when used correctly and consistently. This means using a latex condom whenever the penis comes into contact with the vagina or rectum, and using it throughout sexual contact. It also means using a new condom for each new instance of intercourse, keeping in mind that oil-based lubricants can compromise the integrity of condoms. Be aware that sheepskin condoms do not prevent transmission of STDs, including HIV because they have tiny holes.

For oral sex, a non-lubricated condom can be used for fellatio, and a dental dam or other latex barrier for cunnilingus.

Also, though the chance of HIV transmission via kissing is remote, there have been cases where open-mouthed "deep" kissing has lead to infection, though doctors believe that it is only possible when both partners have some sort of open wounds in the mouth (sores, gingivitis, etc.) that allow blood to blood contact.

Two final notes:
- If you are infected with HIV, you should not assume that it is "safe" to have unprotected sex with someone else who is HIV positive. Though it may seem harmless, there are different strains of HIV, and you could become infected with two different strains which would obviously be very detrimental to your health.

- This question came from a reader in the United Arab Emirates so I am going to comment on the current state of HIV/AIDS in the Middle East. In 2003, Carol Jenkins and David Robalino issued a report titled, "HIV/AIDS in the Middle East and North Africa: The Costs of Inaction." In their report they worry that the official government numbers for HIV/AIDS infection in Arab countries are extremely low estimates, partially due to the fact that the highest risk behaviors for transmission (homosexual sex, intravenous drug use, and sex-for-hire) are illegal under Islamic law. Although some Middle Eastern countries are making efforts to curb the epidemic, more can certainly be done. Finally, I wish that I could give you advice on confidential or anonymous testing in your country, but that information just isn't available. I urge you, and any other reader who is worried they could be infected, to get a test as soon as possible, and practice safe sex every time.