HIV/AIDS: Etiology and Oral Manifestations

The presence of other sexually transmitted diseases (STDs) increases the risk for HIV transmission, because the infected person may have a much larger number of white blood cells (infected with HIV) present at the sore or infected area(s).

The infected person's immune system may also be less able to suppress or combat the HIV infection. Additionally, the sores or lesions from STDs break down the protective surface of the skin or mucous membrane, which makes the infected person more vulnerable to other infections. More information on STDs can be found later in this course.

Acute HIV infection (the first few weeks after infection with HIV) is a time when a person may not know that s/he is infected. However, the amount of virus (or viral load) in her or his bloodstream can be extremely high. This may make their blood, semen, vaginal fluids and/or breast milk more infectious for HIV transmission. Antiretroviral therapy can reduce a person's viral load, if the correct combination is used and the person adheres to the dosing schedule.

Having multiple partners for drug injection and/or sexual intercourse increases the chances of being exposed to a person infected with HIV. Persons who have unprotected sex with multiple partners are considered to be at high risk for HIV infection. In some studies, the CDC defines multiple partners as six or more partners in a year. However, someone who has one partner may still be at risk if the person is HIV-positive, or if that one partner has sex with multiple other partners.

Case Study #4

Ms. M. was married to her husband for 32 years before he died from complications of coronary artery disease several years ago. It was difficult for her to stop grieving, and for the first year after his death seldom did anything socially with anyone except family members. Eventually she began attending functions at the senior citizen center and met Paul. He was very kind, interesting, funny, and they began dating. A year later, Paul became sick and died.

The senior center hosted a program on life insurance for seniors, and Ms. M. decided to apply for additional coverage for her funeral expenses. Part of the criteria was to have an HIV test, and she agreed to do so. She did not think anything else about the insurance until about one month later when she received a letter from the company denying the coverage and suggesting that she see her healthcare provider for a full examination. She was frightened by the news, and called immediately to make an appointment for the following week. She was convinced she had cancer. Her provider was unable to find anything abnormal on exam or lab tests. With her permission he contacted the insurance company and was faxed the positive results of her HIV test. She had no idea how she was infected. Had her husband been infected with HIV? Did Paul have HIV? Did either of them even know they were infected? Did they know but did not tell her?

Ms. M's provider made an appointment for counseling to help her work through her grief and loss. He also made an appointment with an HIV specialist for further tests and care. He thoroughly evaluated the possibility of self-harm before allowing her to leave his office. Finally, he called a trusted friend with her permission to drive her home.

Use of other substances, including alcohol and non-injected "street drugs," can also put a person at risk for getting HIV. Impaired judgment may increase the likelihood that a person will take risks (having unprotected sex, sharing needles) or may place the person in unsafe situations. Additionally, some substances have physiological and biological effects on the body, including masking of pain and the creation of sores on the mouth and genitals, which can create additional "openings" for HIV and other sexually transmitted diseases.

Lack of power in a relationship can affect a person's ability to insist on sexual protection, such as the use of condoms. Women are often socially and economically dependent upon men in many cultures. This can make them unable to "negotiate" condom use or leave a relationship that puts them at risk.

In some cultures, females are not encouraged to learn about their bodies, sex, birth control, or other sexuality topics. Some cultures promote the value of the male having multiple sexual partners, while discouraging the same behavior in females.