H. Smilkstein, M.D.
stands for Acquired Immune Deficiency Syndrome. Acquired means you are
not born with it, but get it from someone. As the name implies, this
disease involves a deficiency (destruction) of the the immune system,
which is the system that protects us from infections and cancers.
Because of this breakdown in the immune system, HIV/AIDS can present
with any manifestation of immune deficiency, from sinusitis to cancer.
AIDS was first identified in 1981 among homosexual men in California and
New York City, and was at one time called the "Gay Epidemic". We know
now that HIV can effects anyone, irregardless of sexual orientation.
World wide HIV/AIDS is spread most commonly through heterosexual
contact. AIDS is still considered lethal infection. Through December
1995, 513,486 people in the United States had been reported with AIDS to
the Centers for Disease Control and Prevention, (CDC). Of the 513,486
cases of AIDS reported 318,361, (62%) had died. The annual estimated
number of new HIV infections in the United Stats has decreased from
approximately 100,000 several years ago to 40,000. The CDC currently
estimates that approximately 600,000 to 900,000 Americans are infected
with HIV, although many of them are undiagnosed. The number of people
infected represents only a small fraction of the number of people who
are affected by the epidemic, including family members, friends, and
loved ones of infected individuals
Substance abusers, especially those who inject drugs, are at greater
risk for HIV/AIDS than people who do not use drugs. Individuals who
inject illicit drugs account for 20 percent of cases among men, 50
percent of cases among women and about 55 percent of pediatric cases
(children of mothers who are injecting drugs or mothers who have sex
with males who inject). The type of drug injected does not matter! AIDS
has been diagnosed among injectors of various illicit substances,
including opiates (heroin, morphine,etc), cocaine, amphetamines, and
anabolic steroids. AIDS is also more common among non-injecting drug
abusers, such as alcoholics, cocaine "snorters" and "crack" smokers, who
are infected through sexual contact.
new born babies to senior citizens, there is no segment of the
population that is immune from the HIV/AIDS epidemic. While every HIV
case is a tragedy, the magnitude of that tragedy is amplified when young
people are the victims. We can estimate the financial cost of HIV/AIDS
infections in the our young population, but there is no way to measure
the cost of grief, or put a dollar amount on lost opportunity,
productivity and creativity. The most tragic part of this story is that
HIV is 100% preventable, with solutions that are easy to identify, but
hard to implement. Unfortunately adolescents and teens have been a
difficult group to convince that high risk sexual and drug behavior can
be lethal. The number of reported AIDS cases among teenagers increased
96% between 1988 and 1990.
What is HIV/AIDS?
Human Immunodeficiency Virus, or HIV, is the virus that is responsible
for AIDS. The virus itself is not a very hardy bug. It dies quickly if
exposed to drying by air and common disinfectants kill it with ease. The
problem with HIV is what it does when it is introduced into the human
body. It is in a group of viruses called retroviruses. They reproduce or
technically replicate by using the genetic material of its host (human
beings) cells. The virus targets a type of cell called the T-helper
lymphocytes. The T-helper cells are responsible for identifying bacteria
and viruses and alerting the immune system to make appropriate
antibodies to control the incoming organisms. The loss of these cells
results in the body's inability to control microbial organisms that the
normal immune system controls easily.
result of this break down in the immune system is that even normally
harmless microorganisms suddenly become potentially life threatening
infections. These infections are called opportunistic because they take
advantage of an HIV damaged immune system. When the HIV enters the body
it very rapidly starts this process of T-cell destruction, but it can
take from a few years to over a decade for the immune defect to become
severe enough for the infected person to become aware that they are
the median incubation period between HIV infection, and AIDS diagnosis
is about 10 years, it is clear that many people who were diagnosed with
AIDS in their 20's became infected as teenagers. During this incubation
period, even though the infected person feels perfectly healthy, they
are able to spread the virus to others through sexual contact, IV drugs
rapidity with which HIV moves from asymptomatic infection to full blown
AIDS depends on many factors. There is quite a bit of data that supports
that continued drug use (including cocaine and marijuana), tobacco use,
high stress and poor general health, are all causes of accelerated
progression of HIV/AIDS infections. There is also an association of the
abuse of nitrate inhalants ("poppers") among HIV-infected homosexual men
and the development of Kaposi's sarcoma, a rare skin cancer associated
initial presentation of AIDS may be as unalarming as chronic sinusitis
or a vaginal yeast infections that won't clear up, although clearly most
people with chronic sinusitis and yeast infections don't have AIDS.
is HIV/AIDS Transmitted?
is a great deal of myth and prejudice related to the disease of HIV/AIDS
and how it is spread. When it was first identified in the early 1980's
there was little information about the virus and how it was contracted.
Out of this lack of information and AIDS paranoia many misconceptions,
fears and in turn prejudice arose. Over the past 20 years a great deal
has been learned about the virus and the disease of AIDS, but the AIDS
paranoia has been slower to change. Here is what we know about how
HIV/AIDS CAN NOT be transmitted.
individual infected with HIV, the virus can be found in blood, semen,
vaginal fluid, breast milk, saliva and tears. Contact with saliva and
tears has never been shown to result in transmission of HIV.
Living, working or socializing with an HIV infected person is not a
risk. There have been no instances of non-sexual transmission of HIV in
studies of thousands of households where families daily share kitchen,
laundry and bathroom facilities, meals, eating utensils, drinking cups
and glasses with AIDS patient. If HIV is not transmitted in these
household settings, it is even less likely that it would be transmitted
in less intimate work and social settings. Despite these facts, HIV/AIDS
infected individuals are still denied access and admittance to some
schools, clubs and social organizations.
HIV is not transmitted by insects.
Closed mouth or social kissing does not put a person at risk for HIV.
The CDC recommends against open mouth kissing with an infected
individual because of the potential for blood/saliva contact, although
they have never had a documented case of HIV spread from any kind of
There are only three ways that HIV can be transmitted:
intimate sexual contact
exposure to infected blood or blood products
from an infected pregnant mother to her fetus
unprotected sexual contact which involves the exchange of bodily fluids
can theoretically transmit the HIV virus. The highest risk type of
contact is anal intercourse. The high risk associated with anal sex is
due to the trauma (multiple small tears and bleeding) that occur in the
rectum and anal area. The lining of the lower intestine is made up of a
type of cell that is easily damaged during intercourse, thus allowing
for the easy passage of the HIV viral particle from an infected person
to an uninfected individual. It is also significantly more likely,
during normal heterosexual intercourse, that HIV will be transmitted
from an infected male to an uninfected female, than from and infected
female to an uninfected male.
condom is used, and used correctly every time, it can prevent 99% of
unwanted pregnancies and HIV/AIDS infections.
potential modes of sexual transmission of HIV, such as oral-genital sex
and open mouth kissing are recommended against by the Center for Disease
Control (CDC), although as noted above no documented cases of HIV
transmission have reported from any kind of kissing.
HIGH, GET STUPID, GET AIDS: HIV transmission and drugs
can increase the risk of acquiring HIV in three ways:
Through shared dirty (HIV contaminated blood) needles
Impaired judgment leading to increased incidence of unplanned and/or
unprotected intercourse with an infected individual
Drug addicted individuals selling sex for drugs, or money to buy drugs.
This is both a risk for the seller as well as the purchaser
most common way for drug abusers to become infected is by sharing
needles and syringes. Direct inoculation of blood containing HIV occurs
when someone injects themselves or another person with heroin, cocaine,
amphetamines, steroids or any other injectable drug after an
HIV-infected person has used the same needle.
Facts about IV drug users
They comprise less than 1% of our population
They account for nearly 1/3 of all AIDS cases in this country
They account for 20 percent of HIV/AIDS cases among men
They account for 50 percent of HIV/AIDS cases among women
They account for about 55 percent of pediatric HIV/AIDS cases
(children of mothers who are injecting drugs or mothers who have sex
with male injecting drug abusers)
Drugs, Sex and HIV/AIDS
all drug related AIDS cases are due to injecting drugs. A large and
increasing number of cases are the result of sexual intercourse with
infected individual. The association of alcohol and/or drug use at the
time of their last sexual intercourse among teens is as high as 35% in
one study. A 1991 report from the National Commission on AIDS stated
that there was a clear association between non-injectable substances,
such as alcohol and crack, and the practice of unsafe sexual activity
which can result in the spread of HIV. Partying with drugs and alcohol
increase the risk of contracting all STD's (sexually transmitted
disease) with the consequences ranging from life long recurrent sores
(herpes), to potential infertility (clamydia), to death (HIV). It has
been shown that kids who are high or intoxicated are more likely to have
unplanned sex and not use a condoms during sexual intercourse.The
National Institute on Drug Abuse targeted young adults in its ad
campaign, "Get High, Get Stupid, Get AIDS," after its studies confirmed
that many young adults use alcohol and other drugs to lose their
inhibitions with members of the other sex, combining two high-risk
behaviors for contracting HIV.
contact is also a common route of transmission between drug abusers and
sexual partners. The trading of sex for drugs or money has played a key
role in the spread of HIV/AIDS, just as it has with other sexually
transmitted diseases. The AIDS epidemic has had a profound effect on
minority communities, particularly African Americans and
Hispanic/Latinos. One half the individuals who have IV drug related AIDS
are African American and 29% are Hispanic/Latinos. Woman represent
another group where HIV/AIDS is taking a notable toll. Most woman
contract HIV through sexual intercourse, although IV drug use is a
significant contributing factor. AIDS is now the fourth leading cause of
death among women of childbearing age in the United States.
Preventing HIV/AIDS from drug abuse
confuse treatment with prevention. While there are several drug
combinations that are significantly altering the course of HIV disease,
there are no cures, and AIDS is still considered to be 100% lethal.
There also does not seem to be hope for a reliable vaccine in the near
future. Because there is no reliable cure or vaccine for HIV infection
the only effective method for slowing the spread of HIV infection is
through education to alter risk behavior. The methods of prevention are
easy to identify and very difficult to implement. Among IV drug abusers,
the most effective way to avoid infection is to stop injecting drugs and
avoid sexual contact with individuals who may be HIV-infected. Former
drug abusers and individuals in Methadone maintenance therapy have a
lower incidence of HIV/AIDS than their drug abusing counterparts on the
street. The National Institute on Drug Abuse (NIDA) is very active in
research on methods of rehabilitation and disease prevention among drug
addicts. These programs have reached tens of thousands of drug abusers
and their sexual contacts and has changed drug abusing behaviors in many
individuals. The success of many of the programs have met with limited
success, including HIV serological test, counseling about HIV infection,
and partner notification projects. IV drug abusers by their nature exist
on the fringes of society and have limited access to health care and
limited motivation to change their behavior or protect others from
potentially risky behavior.
Outreach efforts to identify infected drug users and encourage them to
enter treatment is still an important part of AIDS prevention.
Controversial efforts such as needle exchange programs are not intended
to change the drug abusing behavior, but only decrease the spread of
HIV, Hepatitis B and C. HIV is the number one cause of death in IV drug
users, and Hepatitis C is now the number one cause of liver transplants
in the United States. AIDS prevention is helped by general prevention
efforts aimed at reducing levels of alcohol consumption and eliminating
illicit drug use.
Preventing HIV/AIDS through sexual transmission
cannot tell someone has the HIV virus by looking at them. A blood test
is the only way to be sure, and even there a blood test done too early
in the course of the infection may be falsely negative. Avoiding sex all
together, or at least avoiding unprotected sex is the key to prevention.
The role of alcohol and other drug use in contributing to high risk
sexual behavior is the focus of education campaigns directed at
particular risk populations, including teenagers, young adults, and
homosexuals. Teenagers and young adults tend to enter into risky
behavior at a higher rate than the adult population in general. Research
suggests that the relationship of alcohol and other drug use with sex
may be different among young people than among adults. Much like driving
a car, novices tend to make more mistakes, and adolescents and young
adults learning about drinking and sexual activity are no exception. The
combination of experimentation with drugs, alcohol and sex in the era of
HIV is Russian Roulette. Unfortunately this group is one of the most
difficult to reach in terms of the HIV prevention message.
Unprotected sex with an infected partner is the most common way to
contract HIV. When it comes to HIV, you are in effect having sex with
everyone who that individual has had unprotected sex with, or everyone
who that individual may have shared a needle with, or that persons
previous partners partner who may have shared a dirty needle with who
knows who...The more sex partners you have, the more chance you have of
avoid the risk of HIV
There are only two sure ways to avoid the AIDS virus -- not having
sex and not sharing needles
you choose to have sex, always use a condom to help reduce the risk
of getting AIDS
Know ahead of time how you will respond to pressure to have sex.
This pressure may be from a boyfriend, girl friend, or the crowd you
The first thing to remember is you're in charge of your body and
what you choose to do with it
The second thing to remember is there is a lot at stake -- a
decision about sex can have consequences that last a lifetime
helps to Make a Plan and Stick to it
Then if someone offers you drugs or suggested sex, you'll know
what to do
Plan not to use drugs so you can keep a clear head
Plan how to say no, to be careful, and to think about what to do
The time to make your plan is when you have a clear head.
to make a plan
Think about who you are and what's important to you
Think about how using drugs and having sex could affect that
When you have a plan it's easier to handle situations where you want
to have fun with friends but don't want to use drugs or have sex
Know what your response to pressure will be ahead of time
If someone pressures you about drugs you can say nicely but
firmly, "I'm not interested," or, "I don't use drugs."
If someone pressures you about sex you could let them know where
you stand by saying: I'm not ready for it yet," or, "Maybe it
feels right for you, but it's not for me."
HIV/AIDS fact sheet for Teens and Adolescents In the U.S.
AIDS is still the sixth leading cause of death among people 15-24.
1995 there were 405 reported AIDS cases among adolescents 13-19 and
2,432 cases among adolescents aged 20 to 24.
Sexual contact, (either male-to-male, or heterosexual) accounted for
37% of reported AIDS cases in 1995 among adolescents 13 to 19 years
old. In adolescents age 20 to 24, sexual contact, (either
male-to-male or heterosexual) accounted for 65% of the cases in
Through December 1995, 513,486 people in the United States had been
reported with AIDS to the Centers fro Disease Control and
the 513,486 cases of AIDS reported 318,361, (62%) had died
The annual estimated number of new HIV infections in the United
Stats has decreased from
approximately 100,000 several years ago to 40,000
The CDC currently estimates that approximately 600,000 to 900,000
Americans are infected with HIV
The number of people infected represents only a small fraction of
the number of people who are affected by the epidemic, including
family members, friends, and loved ones of infected individuals
The population most affected by AIDS in the United States, continues
to be men who have sex with men, (42% of all new AIDS cases in 1995)
Injecting drug users, also a high-risk group, accounted for 26% of
all new AIDS cases reported in 1995
The the number of HIV / AIDS cases in the United States caused by
heterosexual transmission is increasing
The proportion of AIDS cases among women, racial/ethnic minorities,
and children has increased while the
rate of AIDS among men who have sex with men has remained relatively
AIDS knows no boundaries, and can be prevented only by eliminating
The percentage of adolescents reporting condom use at their most
recent sexual intercourse increased from 46% in 1991 to 54% in 1995
The average age of first sexual experience among U.S. Adolescents is
16 and approximately three-fourths of high school students have had
sexual intercourse by the twelfth grade
in 62 high school students in a CDC study reported having injected
an illegal drug
Every year approximately 3 million American teenagers contract a
sexually transmitted disease (STD). STD's facilitate the
transmission of HIV
Studies published in 1994, and 1995 revealed that in New York,
Pittsburgh, and San Francisco, 9%, 7%, and 9% respectively of males
who have sex with males 13 to 25 were HIV positive. These rates are
20 times greater than the estimated rate among overall population,
Often adults worry that promoting safer sexual activity encourages
promiscuity. In fact several studies have show that levels of sexual
activity among young adults decreased or remained the same after sex
education programs which included information about condoms.
It is the role of health educators, parents and physicians to educate
young people about HIV/AIDS and how to protect themselves from
infection. Specifically we need to educate adolescents and teens about:
The causes of HIV/AIDS
The high risk behaviors that can lead to HIV infections
The need to develop good decision making skills concerning high risk
The facts...so that teens don't need to experience unnecessary fear
related to this serious illness
AIDS Coalition for Education. Colorado Responds to HIV/AIDS. Denver,
The American National Red Cross. Living with HIV Infection. 1993.
The American National Red Cross. Teenagers and HIV. 1992.
The American National Red Cross. Women, Sex, and HIV. 1992.
Planned Parenthood of the Rocky Mountains. Planned Parenthood Fact
Planned Parenthood Federation of America, Inc. Sexually Transmitted
Infections: The Facts. New York, NY. 1997.
Department of Health and Human Services. Centers for Disease
Control. What About AIDS Testing? Atlanta, GA. 1988.
Public Health Service
National Institutes of Health
For more information call 1-800-662-HELP.
HIV and AIDS resource center. One of the best single information
resources on HIV/AIDS on the web. Up to date resource, links,
articles, chat and more.
The HIV/AIDS Surveillance Report contains tabular and graphic
information about U.S. AIDS and HIV case reports, including data by
state, metropolitan statistical area, mode of exposure to HIV, sex,
race/ethnicity, age group, vital status, and case definition
category. It is published semi-annually by the Division of HIV/AIDS
Prevention, National Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention (CDC).
Teens with HIV
personal look at AIDS from the view point of teens. Some good
general information links
Statistical sites for HIV/AIDS: