Malawi PMTCT Trainer Manual

Frequently Asked Questions (FAQs)

This section reviews questions that are often asked about HIV and related topic areas. It is intended to be used as a resource for healthcare workers who provide counselling and education for patients. It can also be handed out as a general information sheet.

What is HIV?

The Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system. Over time, the virus multiplies and weakens the body’s immune system by destroying white blood cells. This process makes the body weak and unable to fight infection.

How does HIV make someone sick?

With a weakened immune system, the body cannot protect itself from germs in the environment. Common germs can cause serious infections in people with HIV. These infections are collectively known as HIV-related conditions. After a person who is HIV-positive has an HIV-related condition, he or she is said to have AIDS. Medical intervention is necessary to help support the weakened immune system of a person with HIV.

Where did HIV come from?

Scientists have different theories about the origins of HIV, but none have been proven. We know that the virus has existed in the United States, Haiti and Africa since the late 1970s. At the beginning of the epidemic, healthcare workers noticed rare forms of pneumonia, cancer and other illnesses that were not normally found in healthy people. These findings prompted the first research into the virus that has become known as HIV.

How is HIV transmitted?

HIV is found in the blood (including unscreened blood transfusions[1]), semen, vaginal secretions, and breast milk of an infected person. HIV can be transmitted by having unprotected vaginal, anal or oral sex. Sharing needles or syringes with a person with HIV infection can also transmit the virus. An HIV-infected mother can also transmit the virus to her infant. You can protect yourself by abstaining from high-risk activities, such as unprotected sex that may result in contact with another person’s body fluids.

How can I protect myself from contracting HIV?

You can protect yourself from contracting HIV by abstaining from sex, or being faithful to one partner (if both you and your partner have tested HIV-negative) or correct and consistent use of condoms (if you or your partner has more than one partner). Also, exercise your right to sterile needles if you are getting an injection in a healthcare setting. Avoid use of needles, knives, razors or other sharp implements—previously used by someone else—for any procedure or rite that pierces the skin. This would include injecting drugs (or other substance such as medicine or vitamins) as well as ceremonial rites such as scarification.

Can a woman give HIV to a man during vaginal intercourse?

Yes. If the woman is infected, HIV is present in vaginal and cervical secretions (the wetness in a woman's vagina) as well as blood and can enter the penis through the urethra (the hole at the tip) or through cuts or abrasions on the skin of the penis. The presence of other STIs can increase the risk of transmission. The correct use of a latex male or female condom can reduce the risk of transmitting HIV during vaginal intercourse.

Can I get HIV from oral sex?

We should always remember that exposure to semen, pre-ejaculatory fluid, vaginal secretions, blood, or breast milk in the case of infants, poses a risk for HIV transmission. The small risk of transmission through oral sex is increased by the presence of sores, poor dental hygiene and/or bleeding gums.

Can I get HIV from kissing?

Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Forms of kissing with an open mouth, sometimes called “French kissing,” may provide a potential for contact with blood. However, the risk of acquiring HIV during open-mouth kissing is believed to be very very low.

Should I be concerned about getting infected with HIV while playing sports?

There are no documented cases of HIV infection acquired through participation in sports. Risk of HIV transmission would only occur in sports with direct body contact where bleeding may occur; even in these sports, the risk of transmission is very low. In the event of an injury that causes bleeding, a sports match should be interrupted until the wound stops bleeding, is antiseptically cleaned, and securely bandaged. There is no risk of transmission through sports activities where bleeding does not occur.

Can I get HIV from casual contact, such as shaking hands, hugging, or drinking from the same glass as an HIV-infected person? What about using a public toilet? What about if someone with HIV coughs or sneezes near me?

No. HIV is not transmitted by day-to-day contact in the home, workplace, school, or in social settings. HIV cannot be transmitted through shaking hands, hugging, or by social kissing. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. HIV is a fragile virus that cannot survive outside of the human body. HIV cannot be carried in the air by a cough or sneeze or in food.


Can I get infected with HIV from mosquitoes?

No. Studies have shown no evidence of HIV transmission through insects, even in areas with high HIV prevalence and large populations of biting or bloodsucking insects such as mosquitoes. There has always been concern about transmission of the virus by insects, but the lack of outbreaks related to exposure to mosquitoes supports the conclusion that HIV cannot be transmitted by mosquitoes. If mosquitoes were responsible for spreading HIV, then people of all ages would be infected and this is not the case. HIV lives in cells of the human body but, unlike malaria, does not live in the cells of insects. Mosquitoes and other insects are not suitable homes (or hosts) for HIV.

How long can the HIV live outside of the body?

Scientists agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. In order to obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive under precisely controlled and limited laboratory conditions, CDC studies have showned that drying of even these high concentrations of HIV reduces the number of infectious viruses by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed—essentially zero.

HIV is very fragile, and many common substances, including hot water, soap, bleach and alcohol, will kill it. HIV is also sensitive to fluctuations in temperature and the presence of oxygen. One place that HIV has been know to survive in is drug injection syringes since these are airtight and often contain blood from the injector.[2]

Is there a risk of HIV transmission when having body piercing or visiting the barber?

Yes, but transmission of infectious diseases can only occur if instruments contaminated with blood are not sterilized in between uses. There are no documented cases of HIV transmission from piercing or tattooing, but the risk of Hepatitis B and C is considerable. Those who carry out body piercing should follow Universal Precautions, such as cleaning and sterilizing all instruments. When visiting the barber, there is no risk of infection unless the skin is cut and infected blood gets in a wound. Using disposable razors is recommended because not all barbers sterilize their razors.

What is the connection between HIV and other sexually transmitted infections (STIs)?

Having a sexually transmitted infection (STI) can increase a person's risk of becoming infected with HIV. The chance is increased because, typically, STIs cause sores or breaks in the skin or mucous membranes of the vagina. These openings make it easier for HIV to enter the body during sexual contact. STIs can cause microscopic breaks in the skin that are not visible. It is very important to ask all patients about their risk for STIs and to test and treat aggressively.

How effective are latex condoms in preventing HIV?

Several studies have demonstrated that latex condoms are highly effective in preventing HIV transmission when used correctly and consistently. The studies examined uninfected people involved in sexual relationships with HIV-infected persons and found that even with repeated sexual contact, 98-100% of those people who consistently used latex condoms remained uninfected.

Can oil-based lubricants (such as Vaseline) be used as a lubricant with condoms?

No. Most condoms are made from a rubber known as latex, which is chemically reactive with oil- and petroleum-based substances. Many types of oils or lubricants can cause latex condoms to break or tear during sex, which makes them useless in preventing pregnancy, HIV and other STIs. Always use a water-based lubricant (such as KY Jelly or lubricants specifically designed for use with latex condoms) if a lubricant is needed during oral, anal or vaginal sex.

What is the difference between opt-in and opt-out approaches to HIV testing?

In the opt-out approach all women receive HIV testing and counselling unless they specifically decline to be tested or “opt-out”. HIV testing is offered as a routine part of standard care much like syphilis screening. The client is given information about the HIV test and an opportunity to decline the test. This information may be provided individually, as in pre-test counselling, or in a group. The opt-out approach emphasizes that HIV testing is an expected part of care. However, testing is still voluntary under the opt-out approach—the client has a right to decline testing.

In the opt-in approach, the client also receives information about HIV testing. After receiving the information, the client is given the choice of refusing or consenting to an HIV test. This option is presented in a neutral, supportive manner. Only women who specifically request to be tested or “opt-in” are tested, and their informed consent—written or verbal—must be clearly given or stated. The opt-in approach requires an active step by the individual client to agree to be tested.

Why is the Ministry of Health recommending that all pregnant women be tested for HIV?

A woman with HIV infection can pass the virus to her infant during pregnancy, birth, or breastfeeding. If a pregnant woman knows that she is infected with HIV, she can take medicines to lower the chance of infecting the infant. HIV testing and counselling provide an opportunity for all pregnant women to learn their HIV status. If infected, a pregnant woman may gain access to treatment to help delay disease progression and reduce the risk of transmitting HIV to her infant. HIV testing and counselling can also provide uninfected women with prevention information to reduce the possibility of future exposure to HIV.

How can I tell if I am infected with HIV?

Many people who are infected do not know they are infected since people with HIV infection can remain without symptoms for many years. The only way to know if you are infected is to have your blood tested. You cannot rely on symptoms to know whether or not you are infected with HIV.

How do people get tuberculosis?

Tuberculosis (TB) infection in a person with HIV is very dangerous; worldwide, TB is the leading cause of death among HIV-infected people. TB is primarily an airborne disease, it is spread from person to person in tiny microscopic droplets when a TB sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active disease are contagious.

It usually takes lengthy contact with someone with active TB before a person becomes infected. On average, people have a 50 percent chance of becoming infected with TB if they spend eight hours a day for six months or 24 hours a day for two months working or living with someone with active TB (the percentage may be higher for people living with HIV as they are particularly vulnerable to developing active TB when they are first infected with the TB germ). However, people with TB who have been treated with appropriate drugs for at least two weeks are no longer contagious and do not spread the germ to others.

People with TB may have a new infection, i.e. an infection that was recently transmitted from another person, but often times PLHIV actually have reactivated TB. That is, they had TB much earlier in life, but the infection went into remission many years. The TB bacteria become active only because of their weakened immune system.

HIV-positive persons with active TB should be encouraged to seek medical care and take all of their medications. Close clinical monitoring is necessary to avoid potential interactions between TB medication and ARV treatment.

How long after a possible exposure to HIV should I get tested?
When do you know for sure that you are not infected with HIV?

HIV tests look for antibodies produced by the body to fight HIV. Most people will develop detectable antibodies within 3 months of infection; on average a person will develop antibodies within 2-3 weeks of infection. In rare cases, this process can take up to six months. The period between infection to the time the antibodies are detectable is called the “window period.” During this time, the HIV test may not give an accurate result. It is very important to note that HIV can still be transmitted to another person during the “window period”, even if the antibodies are not detectable. Until you have been tested for HIV 3 months or more after possible exposure, you cannot be certain about your status. It is very important to protect yourself and others from further exposure to HIV during the window period, and beyond, to stay free of infection.


How do I know that my HIV test is accurate?

HIV tests are extremely accurate. Every HIV-positive test result is confirmed by at least one other HIV test before the test result is delivered. If you think you might have an inaccurate positive result (“false positive”) you can return to the health centre for another HIV test in 3 months. You must avoid possible exposure to the virus during this time.