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Scientific Data Documentation
Surgeon General's Report On AIDS


                         SURGEON GENERAL'S REPORT
                          TO THE AMERICAN PUBLIC
                         ON HIV INFECTION AND AIDS

 A Message from the Surgeon General

 It began, like so many epidemics, with a few isolated cases, a
 whisper that caught the ear of only a few in medical research.
 Today, that whisper has become a roar heard around the world.
 AIDS--acquired immunodeficiency syndrome--is now the epidemic of
 our generation, invading our lives in ways we never imagined--
 testing our scientific knowledge, probing our private values, and
 sapping our strength.  AIDS no longer attracts our attention--it
 commands it.

 This report is for you, the American people.  It is meant to
 provide you with the facts about the epidemic of HIV infection
 and AIDS and to tell you how to protect yourself and those you

 More than 12 years have passed since people began to die of AIDS.
 About 1 million Americans are now infected with human
 immunodeficiency virus (HIV), the virus that causes AIDS.  That
 is about 1 American out of every 250.  In the next 10 years, many
 more Americans will develop this fatal disease, and more persons
 of all ages will become infected.

 AIDS is already a leading killer of men and women 15 to 44 years
 old in our country.  HIV infection continues to spread, despite
 the fact that most people know how to prevent it.  Too many
 people continue to take chances, and too many of them become
 infected.  Sadly, everyone infected with HIV will very likely
 eventually develop AIDS.

 Some people ask why AIDS is so important compared with other
 diseases.  After all, more people die each year of heart disease
 and cancer than of AIDS.  The issue is not whether AIDS is more
 or less important than any other single disease.  From a public
 health standpoint, the concern is that HIV infection has now
 become an epidemic--transmitted from an infected person to a non-
 infected person, spreading relentlessly, yet able to be
 prevented.  That is why, as your Surgeon General, I have placed
 such emphasis on HIV and AIDS education.

 Adolescents are a special concern.  During the 1990s, we have
 seen our children confronted by issues of sexuality and drugs as
 never before in our generation.  More and more adolescents are
 becoming infected with HIV.  As parents, we cannot stand idly by
 while AIDS threatens our children's future.

 Yes, it is painful to think about the temptations and the dangers
 they face every day.  But sex and drugs are facts of life; we can
 no more ignore them than we can death itself.  We must prepare
 our children to face the reality of AIDS in their lives.

 To face the challenges ahead, our children must have scientific,
 dependable information about HIV and AIDS.  And equally
 important, they must have our understanding and support and

 I continue to hear that "AIDS isn't my problem. . . it's theirs."
 The truth is that AIDS is everyone's problem.  Because so many
 people are infected with HIV, all of us who share our fragile
 humanity are also affected--if not by the virus itself, then by
 those devastating companions of AIDS--fear, loss, sorrow, denial,
 and prejudice.

 We must face our fears squarely and shed our false beliefs about
 HIV and AIDS.  We need to know how deeply HIV and AIDS affect our
 communities.  We must care for those infected with and affected
 by HIV, and we must prevent further infections.

 I believe good health is intertwined with hope and optimism.  We
 know that a positive self-image is a critical part of the healing
 process.  As the nation's doctor, I do not say this lightly,
 because I am in the business of healing and curing.

 So many people with HIV might be prone to say, "What's the use?"
 Let me answer that plea as a doctor, in just one word: LIVING and
 living with dignity.  As a society, we must care not only to
 promote and prolong human life, but equally to promote its
 quality.  Having AIDS does not signal an end to life or to the
 spirit.  Rather, the experience of illness can also inspire.
 Until there is a cure, we must live with AIDS the only way we
 know how: by devoting ourselves to LIFE.

 This report offers no shortcuts or false promises.  It describes
 what we know and what we can do now: getting educated about
 HIV/AIDS and its relationship to sex and drugs; getting the
 benefits of early counseling; going for testing and treatment, if
 HIV infected; monitoring the immune system; eating a
 nutritionally sound diet; getting plenty of rest and exercise;
 reducing stress; and limiting or eliminating the use of alcohol,
 tobacco, and other drugs.

 You may find it difficult to deal with some of the information in
 this report and to convey these painful realities to your family
 and friends.  But remember that coming to grips with the facts of
 life is, in itself, crucial to our well being.

 As members of the American family, we must reach out through our
 local communities to help educate others about AIDS, to help
 those who are ill, and above all, to help erase fear, prejudice,
 and discrimination from our lives.

 Until there is a cure, we must instill hope in those who are
 discouraged, reassure the worried with practical advice, and
 inspire those who are ill with a renewed sense of control over
 their health and well-being.

 Scientists around the world are fighting AIDS with the newest
 methods of modern medicine.  Let us join them by fighting AIDS
 with our minds and hearts.  And, as we do so, let us make
 compassion our constant companion.

                    Antonia Coello Novello, M.D., M.P.H.
                    Surgeon General

 Infection with human immunodeficiency virus (HIV), the virus that
 causes acquired immunodeficiency syndrome (AIDS), is one of our
 country's greatest health challenges.  Today 1 million Americans-
 -1 in every 250--are infected with HIV.  About 1 in 100 men and 1
 in 800 women are now infected with HIV.  Most of them look and
 feel healthy, since it takes an average of 10 years before a
 person with HIV develops AIDS.  For infants and some adults, this
 time may be much shorter.

 The first cases of AIDS were reported in 1981.  By the end of
 1992, more than 250,000 Americans had developed AIDS and more
 than 170,000 had died--nearly three times more Americans than
 those who died in the Vietnam War.  In 1993 alone, from 47,000 to
 66,000 more Americans may die of AIDS; an estimated 40,000 to
 80,000 will get infected with HIV.

 In this second decade of the AIDS epidemic, gay men still account
 for the majority of AIDS cases reported each year and continue to
 suffer an enormous burden.  However, AIDS is becoming more
 prominent in the young and in heterosexual men and women.  AIDS
 is now one of the three main causes of death for women and men 25
 to 44 years old in this country.  It is among the top 10 causes
 of death for children 1 to 4 years old.  AIDS is now becoming a
 disease of families.

 Today, most of the people with AIDS are young adults.  Although
 survival times have improved greatly for people who are diagnosed
 early and receive medical treatment, the disease is usually
 fatal.  Survival times today are about the same for men and women
 when they find out about their infection early and receive
 comparable medical treatment.

 Heterosexual Spread of AIDS
 Although most reported AIDS cases continue to be among men who
 have sex with men and among injecting drug users, cases due to
 heterosexual contact have been increasing over the last several
 years.  In 1992, 9 percent of the total AIDS cases and 39 percent
 of reported AIDS cases in women are attributable to heterosexual
 contact, an increase of nearly 42 percent from 1990 to 1992.

 AIDS Is Increasing Among Racial and Ethnic Minority Populations
 People of ALL races and ethnic groups have been infected with
 HIV, but racial and ethnic minority populations have been most
 disproportionately affected.  Through 1992, 47 percent of all
 reported AIDS cases were among blacks and Hispanics, while these
 two population groups represent only 21 percent of the total U.S.
 population.  Asians and Pacific Islanders and American Indians
 and Alaska Natives account for a small percentage of all reported
 AIDS cases.

 AIDS Is Increasing Outside Big Cities

    Most people with HIV infection and AIDS live in big cities, but
 the number of people developing AIDS in smaller cities, towns,
 and rural areas is growing.  The highest U.S. rates are in the
 Northeast and in Puerto Rico, but the rest of the country has
 been catching up.  Before 1985, more than half of the children
 with AIDS were from New York City, Newark, and Miami; since then,
 the majority of children with AIDS have come from outside these

 More Women Are Becoming Infected

    The Centers for Disease Control and Prevention (CDC) estimates
 that about 100,000 women in the United States are infected with
 HIV.  They comprise 11 percent of all AIDS cases, and the
 percentage increases each year.  Half of the cases of AIDS in
 women have been reported in the last 2 years.

 Women can get HIV infection by having sex with somebody infected
 with HIV or using "contaminated" needles (previously used by an
 HIV-infected person) to inject drugs.  While nearly half of the
 women with AIDS today got infected by using contaminated needles
 to inject drugs, more and more women are becoming infected
 through unprotected sex with infected men.

 There is evidence that, like other sexually transmitted diseases
 (STDs), women may be more likely to get HIV during sex from an
 infected man than a man is to get it from an infected woman.
 However, women infected with HIV can transmit the virus to men.
 Cases among women who have sex only with women have been
 reported, although the number of cases is small: only four cases
 of possible female-to-female HIV transmission have been reported
 in the medical literature.

 Children of the Epidemic

      An added tragedy to the growing AIDS epidemic is the children
 infected with HIV and the thousands of others who will be
 orphaned when their mothers or fathers die from AIDS.  Through
 December 1992, more than 4,000 children were reported with AIDS--
 most of them were infected through contact between the infected
 mother and her child before it is born or during birth; however,
 she can also infect her baby through breastfeeding.

 There are also many more children who are infected with HIV but
 have not been diagnosed with AIDS.  About one of every four
 babies born to infected women will have HIV infection.  In
 addition, a small number of children with AIDS were infected
 through blood transfusions and blood products received before
 testing of blood began in 1985.

 By 1994, an estimated 7,500 children in the United States will
 have developed AIDS from being infected before or during birth,
 or from breastfeeding after birth.  During the next decade, at
 least 125,000 children will become orphans of this epidemic and
 will need to be cared for by family members, caring adults, or
 extended family members--or placed in foster care.  These
 orphaned children, three-fourths of them not infected with HIV,
 will require our care, financially and socially.

 Teenagers Are Getting Infected

     The teen years are often a time of experimentation with alcohol,
 drugs, and sex.  Some teenagers don't believe they can become
 infected with HIV because they rarely see people their own age
 who have AIDS.  Teens need to understand this discrepancy.
 Because the time between getting infected with HIV and developing
 AIDS can be 10 years or more, many people with AIDS who are in
 their 20s (currently 1 of 5 reported with AIDS) were infected
 while they were teenagers.

 Teenagers who share needles to inject drugs (including steroids)
 or who have sex without a latex condom are getting infected.
 However, most won't show any symptoms of HIV infection or AIDS
 until they are in their 20s, even though they can still transmit
 the infection to others.

 We Now Have Treatments For HIV Infection

     We now have medical treatments that can delay many of the
 illnesses associated with AIDS, and more treatments are on the
 way.  There is hope for a vaccine in the future.  However, unless
 many Americans change some of their behaviors, hundreds of
 thousands more Americans will become infected before the year

 HIV Is The Virus That Causes AIDS

     After a person is infected with HIV, the virus gradually weakens
 the disease-fighting immune system of that person.  A weakened
 immune system lets other diseases successfully attack the body.
 When a person's immune system is so weakened by HIV that his or
 her body can no longer fight off serious infections and some
 types of cancer, that person develops AIDS.

 Early Symptoms Are Hard To Spot

     Most people do not have any symptoms when they are first infected
 with HIV.  Because they look and feel healthy, most people with
 HIV infection don't know they are infected until they have an
 HIV test.  However, the HIV is in their bodies and they can
 infect other people.

 Symptoms Of AIDS or HIV Disease Eventually Appear

     It may take anywhere from a few weeks to many years for symptoms
 to appear.  Symptoms of AIDS or HIV disease can take many forms,
 but the symptoms usually include fever, diarrhea, weight loss,
 tiredness, and enlarged lymph glands.  Since HIV destroys the
 immune system, a person with AIDS often gets many types of
 infections, and those infections happen more often and get worse.
 Some infections that may occur include yeast infections in the
 mouth or throat and serious infections caused by the herpes

 Other common problems that occur when the person develops AIDS
 are certain pneumonias (Pneumocystis carinii) that cause
 coughing, fever, and difficult breathing, and a form of cancer
 (Kaposi's sarcoma) that produces purple blotches on the skin.
 Tuberculosis is also a common problem in some areas of the
 country.  Some of these illnesses may not get better even with
 medication or they may come back again and again.  HIV can also
 affect the brain, causing loss of memory or other nervous system
 or mental symptoms.

 Other Symptoms of HIV Infection In Women

     In women, the first signs of HIV infection may be any of the ones
 listed above or repeated serious yeast infections of the vagina.
 Vaginal yeast infections are common in women for many reasons
 other than HIV infection and can be treated with over-the-counter
 medications.  Women with yeast infections that do not readily go
 away with treatment, however, or that happen over and over again,
 should be tested for HIV, especially if their behaviors place
 them at risk.  Women with HIV infection may also be at increased
 risk of cancer of the cervix, and other conditions such as pelvic
 inflammatory disease.  In HIV-infected women, these conditions
 may be more severe or difficult to treat.  All such women should
 get PAP smears at least once a year.

 HIV Is Everyone's Concern

     Your age doesn't matter.  Neither does your race, religion,
 hometown, or gender.  No matter who you are or where you live,
 it's possible you know somebody who has HIV infection or AIDS or
 may be at risk.  It may be a friend or coworker.  It may be a
 member of your family.  It may be you.

 How HIV Spreads

     HIV is in the blood, semen, or vaginal secretions of an infected
 person.  The two main ways of spreading HIV are having sex and
 using contaminated needles to inject drugs.  In addition,
 infected women can pass HIV infection to their newborns.

 Unprotected Sex Is Dangerous

    "Unprotected sex" is sex without a latex condom.  HIV can be in
 semen (including the first drop of fluid, even before
 ejaculation) and in vaginal fluids.  HIV can enter the body
 through the vagina, penis, rectum, and, when engaging in oral
 sex, through the mouth.  Anal sex is especially risky for both
 men and women.  Any form of unprotected sex is risky, including
 oral sex.  Although condoms are not perfect, they are highly
 effective in preventing HIV and other STDs when used consistently
 and correctly.  Condom failure is usually due to a person not
 using the condom correctly, rather than flaws in the condom

 Oral Sex Can Spread HIV

    Getting semen, vaginal secretions, or blood from an infected
 person in your mouth puts you at risk of HIV infection.  The risk
 of getting HIV from oral sex is not as high as from anal or
 vaginal sex, but there is a risk.  Sores or cuts anywhere in your
 mouth would make oral sex even more risky.

 Sexually Transmitted Diseases (STDs) Increase Your Chances of
 Getting HIV
 Some STDs, such as herpes or syphilis, produce open sores or
 blisters on the genitals.  These sores or blisters make it easier
 for HIV to be transmitted during sex.  Other STDs, including
 gonorrhea and chlamydia, place a person at higher risk of getting
 HIV infection.

 Sex With Multiple Partners Increases Your Risk

     If you have sex with more than one person, you increase your odds
 of having sex with someone infected with HIV or other STDs.  The
 more people you have sex with, the greater your risk of getting
 infected.  In a sense, you are also "having sex" with all the
 people your partner has had sex with.

 Contraceptives Other Than Condoms Do Not Protect You

     Birth control pills, sponges, foams, diaphragms, intrauterine
 devices (IUDs), or being sterilized do not protect you from HIV.
 Having sex during your period or while pregnant does not protect
 you either.  No matter what method you use for birth control, a
 latex condom--when worn correctly and consistently-- offers the
 best protection against HIV and other STDs.

 Using Contaminated Needles To Inject Drugs Is Very Risky
 When a person injects drugs into his/her body, some of that
 person's blood remains in the needle or syringe.  If someone else
 then uses the same needle or syringe ("works") to inject drugs,
 he/she could be shooting HIV directly into the bloodstream.  This
 makes using needles or syringes that have been used by someone
 else one of the riskiest things you can do.

 Any Drug Use May Increase Your Risk of Unsafe Behaviors
 When you are under the influence of alcohol, cocaine, heroin, or
 other drugs, you are not thinking clearly.  This can lead you to
 take risks for HIV infection, such as having sex with people with
 whom you would not normally have sex or having sex without a
 condom.  Crack and other forms of cocaine are associated with
 risky sexual activity.  Don't mix sex with alcohol or other drugs
 that affect your judgment.

 Pregnant Women Can Pass HIV To Their Newborn Babies

     Women infected with HIV can infect their newborn babies.  About
 one of every four babies born to infected women will have HIV
 infection.  The time from birth to the development of AIDS for
 these infected children varies from weeks to years.  Most often,
 the mother passes the HIV infection to her baby before it is born
 or during the birth.  However, a baby can also become infected by
 breastfeeding from an infected woman.  In the United States, if
 the mother is infected, the baby should be given formula instead
 of breast milk.

 A baby born to an HIV-infected woman will test positive for HIV
 at birth whether or not the baby itself is actually infected,
 since the positive antibody is transferred from the mother.  If
 the baby is not infected, its HIV test will become negative
 within about a year and a half.  Most of the babies born to HIV-
 infected mothers will not have HIV infection, but they will
 probably become orphans because their mothers and, often, their
 fathers are infected and will likely die before the child is

 Ways You Do Not Get HIV Infection

    There are no reports of HIV transmission from saliva, tears, or
 human bites.

 You do not get HIV from:
      * Being bitten by mosquitoes or other bugs
      * Being bitten by an animal
      * Eating food handled, prepared, or served by somebody with
        HIV infection
      * Sharing toilets, telephones, or clothes
      * Sharing forks, spoons, knives, or drinking glasses
      * Touching, hugging, or kissing a person with HIV infection
      * Attending school, church, shopping malls, or other public
        places with HIV-infected people.

 You Don't Get HIV From Sports

    Based on current knowledge, participation in sports carries
 virtually no risk for getting HIV.  This is because most sports
 do not involve contact likely to cause bleeding.  If bleeding
 occurs, however, you should minimize contact with an injured
 person's blood.  It is also advisable to remove the injured
 person from further play until bleeding is controlled.  Sweat
 from an HIV-infected athlete will not transmit HIV infection.

 You Don't Get HIV From Kissing

     It has been known for years that a small amount of HIV may be
 present in the saliva of some infected people.  However, the
 amount of HIV in saliva is much less than in blood, semen, or
 vaginal fluids.  Even deep or "French" kissing seems to have
 little risk for transmitting HIV.

 Going To The Doctor Or Dentist Is Safe

     To date, six people are known to have been infected with HIV
 while getting medical or dental treatment, and all six of them
 were infected by one infected dentist.  Even though scientists
 have looked carefully at over 19,000 persons treated by HIV-
 infected health care providers, this is the ONLY time we know of
 where any medical or dental patient was infected with HIV during
 treatment.  Doctors, dentists, and hospitals have been given
 information about how to prevent the spread of HIV infection in
 health care settings.  If you are worried about getting HIV or
 any other infection from your doctor or dentist, share your
 concern and talk to them about it.

 Our Blood Supply Is Among The Safest In The World

     Today, there is very little chance of getting HIV from a blood
 transfusion, certainly not enough to stop you from receiving
 blood if your doctor feels you need it.  Clotting factors
 obtained from donated blood are equally safe.  Nearly all people
 infected with HIV through blood transfusions received those
 transfusions before 1985, the year it became possible to test
 donated blood for HIV.

 Since mid-1983, all blood donations in the United States have
 come from volunteers who are questioned about their risks for HIV
 infection.  People at increased risk of being infected are not
 allowed to donate blood.  Since mid-1985, all donated blood has
 been tested for HIV and other viruses (seven different tests are
 now conducted on each blood sample).  Blood that tests positive
 for HIV is safely discarded and is not used for transfusion.
 Donors are confidentially told that they are infected with HIV,
 and they are not allowed to donate blood again.

 There is NO RISK of getting infected with HIV by GIVING blood
 because a new, sterile needle is used for each blood donation.

 Organ And Tissue Transplants

     Organ and tissue transplants are becoming more common.  As with
 blood transfusions, the Public Health Service and the American
 Association of Tissue Banks have recommended that attempts be
 made to eliminate donors at high risk, that all donors be tested,
 and that organs and tissues from donors testing positive for HIV
 not be used.  Thus, there is very little chance of getting HIV
 from a transplant.

 Artificial Insemination and HIV

     To be safe, sperm banks are requested to test sperm donors for
 HIV at the time of the donation, freeze and quarantine the sperm,
 and test the donor again six months later.  If both HIV tests are
 negative, the sperm can then be thawed and used.  If you are
 considering artificial insemination, talk to your doctor or call
 your sperm bank to discuss the procedures they use to protect you
 from HIV infection.

 Assess Your OWN Risk

     If you answer "yes" to any of the following questions, you could
 have HIV infection or other STDs.
 *    Have you ever had unprotected sex (anal, vaginal, or oral)
      with a man or woman who:
        -  you know was infected with HIV?
        -  injects or has injected drugs?
        -  shared needles with someone who was infected?
        -  had sex with someone who shared needles?
        -  had multiple sex partners?
        -  you normally wouldn't have sex with?

 *    Have you used needles or syringes that were used by anyone
      before you?

 *    Have you ever given or received sex for drugs or money?

 *    Did you or any of your sex partners:
        -  receive treatment for hemophilia between 1978 through
        -  have a blood transfusion or organ transplant between
           1978 through 1985?

 If we are to stop the spread of HIV, we must talk about it openly
 and honestly.  The preceding questions cover the most common
 risks and raise topics that you may not be used to discussing.

 Every person is responsible for his or her actions.  HIV is
 passed from person to person because of what people do.  Not
 because of who they are, where they came from, or where they
 live.  Your actions can keep you at no risk or place you at high
 risk of infection.  Remember, these issues must be dealt with
 frankly and in plain language if we are to stop this epidemic.

 If you answered "yes" to any of the above questions, or if you
 have any doubts about how to answer these questions, it does not
 mean that you have HIV or other STDs.  It does mean you should go
 to your doctor or local health clinic, talk to them about your
 situation, get information, and then decide if you need to be
 tested.  If you are concerned, seek counseling and get tested.
 You may have HIV infection and look and feel healthy.    Early
 diagnosis and treatment can slow the development of HIV infection
 into AIDS and can also help you protect your sex or drug

 If you don't have a doctor, your medical society can refer you to
 one.  Or, you can find a clinic or community health center that
 provides both counseling and testing.  At some sites, you don't
 even have to give your name to be tested, because testing is done
 anonymously.  Some sites will test you for free; others will
 charge a fee.  To find a testing site near you, call your local
 or state public health department or the CDC National AIDS
 Hotline (1-800-342-AIDS).

 Facts About The HIV Tests

     To know for certain if you are infected with HIV, you must have
 your blood tested specifically for HIV infection, not just a
 "routine" blood test.  The tests available today to detect HIV
 infection are among the most accurate medical tests known.  Two
 separate tests for HIV (called ELISA and Western blot), when used
 together, are correct more than 99.9 percent of the time.

 When you become infected with HIV, your body makes substances
 called antibodies.  These HIV-antibodies usually show up in the
 test within 3 months after you become infected, and almost all
 people who are infected will show antibodies in their blood
 within 6 months.  The tests detect these antibodies, not the
 virus itself.  If your HIV test is negative, it means no
 antibodies were found and you probably are not infected with HIV.
 However, if you did something risky less than 6 months before the
 test, you may need to be tested again later just to be sure you
 are not infected.

 Remember, testing negative today does not mean you can't get
 infected in the future if you use contaminated needles or have
 sex with an infected person.  Even after a previous negative
 test, if you do something that puts you at risk for HIV
 infection, you could get infected.

 Most people who test negative feel a sense of relief.  If you
 test negative, this is the perfect time to stop doing things that
 may put you at risk again.

 If you test positive, the sooner you take steps to protect your
 health and the health of others, the better.  Early treatment, a
 healthy lifestyle, and a positive attitude can help you stay

 What Has Your Sex Partner Done?

     It's hard to be absolutely sure what risks your sex partner has
 taken.  Don't take someone's word for whether or not they might
 be infected, no matter how well you know them.  Remember, you
 can't tell just by looking at someone whether they are or are not
 infected.  Some people don't understand that something they did
 might have infected them.  Some people don't know if they are
 infected because they haven't been tested.  Some people deny that
 they might be infected.  Some people don't tell the truth.  If
 you're not sure whether your sex partner is infected, ask your
 doctor or someone at your clinic whether you need to be tested.
 In the meantime, the safest thing to do is to avoid having sex
 with your partners until you are sure they are not infected, or
 to use a latex condom correctly each time you have sex.

 What About A Blood Transfusion?

     From 1978 through 1985, a small proportion of the blood used for
 transfusion or blood clotting factor concentrates (used by people
 with hemophilia or "bleeding disorder") was infected with HIV.
 If you received blood or clotting factors between 1978 through
 1985, you could have been infected with HIV and should be tested.

 HIV And Sex

    The surest way to protect yourself against HIV infection and STDs
 is not to have sex at all, or to have sex only with one steady,
 uninfected partner.  It is best for you to wait to have sex until
 you and your partner are committed to a relationship.  If you are
 not in such a relationship, and engage in sex, you should use a
 latex condom correctly every time you have sex.  It's not a
 matter of how much you trust someone, or how well you know him or
 her, or how healthy he or she looks--condoms help protect both of

 Latex Condoms Can Prevent HIV Infection

     A latex condom, used properly, helps protect you and your partner
 from HIV and other infections spread through having sex.  When
 used correctly and consistently, latex condoms are highly
 effective in preventing HIV infection and other STDs.  The latex
 condom, correctly used, stops semen or vaginal fluids, which
 might have HIV in them, from passing from one person to another.
 This is only true for latex condoms; natural membrane (lamb skin)
 condoms will not provide protection against HIV because they
 contain tiny pores or holes.  Always look for the words "latex
 condom" on the package when you purchase your condoms.

 "Female condoms" (pouches that fit into the vagina) are being
 evaluated; one has been approved by the Food and Drug
 Administration (FDA).  Because they have not been fully tested,
 how well they protect against HIV infection is uncertain.

 You and your partner should agree to use condoms before you start
 having sex.  You should not expose condoms to heat or sunlight,
 and you should make sure to check the manufacturer's expiration
 date on the package before use.  If you have questions about
 selecting or using condoms, talk to your doctor, pharmacist, or
 counselor at your health department or AIDS service organization,
 or call the CDC National AIDS Hotline (1-800-342-AIDS).

 The Proper Use of Condoms

    Proper use of a new latex condom every time you have sex--from
 start to finish--is an effective way of protecting yourself from
 HIV and other STDs.  Always have more than one condom available.
      * Be careful when opening the condom.  Do not use your
        teeth, fingernails, or other sharp object to open the
        condom wrapper because you might tear or nick the condom
      * Put the condom on as soon as the penis becomes erect, roll
        it to the base of the penis, keep the condom on throughout
        intercourse, and be sure it stays on until the penis is
        fully withdrawn.
      * If you use a lubricant for vaginal or anal sex, use one
        that is water-based.  Water-based lubricants are for sale
        at any pharmacy.  DO NOT use oil or grease, such as
        petroleum jelly, cold cream, baby oil, or cooking
        shortening as a lubricant; they weaken latex and make the
        condoms break more easily.
      * Never re-use a condom.
      * Never continue using a condom if it breaks during
        sex--stop and put on a new condom.


     Studies show that some spermicides kill HIV in test tubes.
 However, the ability of a spermicide to kill HIV in the vagina
 during sex is uncertain.  Spermicides alone should not be used
 for HIV prevention.  When used with a condom, the spermicide
 (gel, foam, film, or suppository) should be put directly inside
 the vagina according to the directions on the package.  The
 amount of spermicide in a spermicide-lubricated condom is not
 enough to provide protection against HIV.

 Adding spermicide to the inside of a condom does not help.  If
 the condom were to break, the semen (and any HIV) would reach the
 vagina before the spermicide could spread out and cover the
 inside of the vagina.  In addition, spermicides may cause vaginal
 sores or irritation in some women and irritation of the penis in
 some men.  These sores or irritations, like any sore or
 irritation of the vagina or penis, may make it easier for HIV to
 get into the bloodstream.

 HIV And Drug Use

     Injecting drugs, including steroids, can spread HIV from one
 person to another when injection equipment is shared or re-used
 by another person.  HIV may be found in a variety of items used
 for drug injection, including needles, syringes, cotton, and
      -    If you use drugs, stop using them for your sake and for
           the sake of others.  Seek drug abuse treatment to help
           you stop.
      -    If you can't stop injecting drugs, never share your
           equipment with anyone, or re-use equipment used by
           someone else.  Don't share, borrow, or rent injection
           equipment ("works").
      -    If you share or re-use injection equipment, clean and
           disinfect it between uses.  To do the best cleaning job
           possible, flush needles and syringes with water until
           the equipment is at least visibly clear of blood and
           debris.  You should then completely fill the equipment
           SEVERAL TIMES with full-strength household bleach.  The
           longer the syringe is completely full of fresh bleach,
           the more likely that HIV will be killed (some suggest
           that the syringe should be full of bleach for at least
           30 seconds).  After each bleach filling, rinse the
           syringe and needle by filling several times with clean
      -    Remember, however, that cleaning injection equipment
           with cleaners, such as bleach, does not guarantee that
           HIV is killed.  If you cannot stop injecting drugs, use
           only sterile needles and syringes.

 For more information call the CDC National AIDS Hotline (1-800-

 How To Protect Others

     If you have HIV infection, you must take steps against infecting
 others.  The safest way not to transmit HIV is not to use drugs,
 not to share drug injecting equipment, and not to have sex.
 Don't let anyone else use your needles or syringes, and don't use
 anybody else's.  If you do have sex, your sex partner needs to
 know that you are infected with HIV, and a latex condom should be
 used every time you have sex.

 If you have HIV infection you should tell anyone with whom you've
 had sex or shared needles.  People that you may have infected, or
 who may have infected you, may not know they have been exposed to
 HIV.  They may be infected and can continue to infect others
 without knowing it.  Let them know about your test results so
 they can talk to their doctor and be counseled and tested.  If
 you are uncomfortable talking to your present or past sex or drug
 use partners, ask a counselor from your health department to help
 you, or even to speak for you.  Health department counselors are
 trained to do this carefully, without revealing your name.

 Health Care Workers Can Reduce Their Risk

     A small number of health care workers have been infected on the
 job, usually by being stuck with a needle already used on an HIV-
 infected patient.  This risk can be reduced if health care
 workers follow "universal precautions," treating all blood,
 semen, or vaginal secretions, no matter whom the fluid comes
 from, as if it contained HIV.  Health care workers must wash
 their hands between patients; wear gloves, masks, gowns, and eye-
 wear when doing some procedures; dispose of used needles and
 other sharp medical tools by putting them in special containers;
 and disinfect or sterilize appropriate equipment.

 New medical devices that reduce the chances of cuts or needle
 sticks are being developed.  These precautions are for your own
 protection.  You should support all health care workers in taking
 these precautions with everyone.

 We have learned a lot about HIV and AIDS since 1981.  We know
 that HIV causes AIDS by weakening the immune system and how HIV
 is, and is not, passed from one person to another.

 People Are Living Longer

     Because of what we have learned, people with HIV infection and
 AIDS are living longer.  They are also healthier and able to live
 active lives for a longer period.  Although we still do not have
 a cure for HIV infection, three medicines (AZT, ddI, and ddC)
 that fight HIV are already available.  Other medicines that
 prevent or treat many of the illnesses which accompany AIDS are
 also available.  Antibiotics and other newer medicines can be
 used both to prevent and to treat several of the common illnesses
 seen with HIV infection and AIDS.  Additional medicines are being
 developed and tested.

 Drug Approvals Are Faster

     The Food and Drug Administration (FDA) has made the review
 process faster for AIDS drugs.  The FDA now makes available some
 promising drugs, still being tested, to those who have no other
 drugs to take.  Many of the changes made to speed up the review
 of AIDS drugs are also being used to speed the approval of drugs
 for other serious diseases.  For more information call 1-800-

 Early Treatment Helps

     Doctors can diagnose many illnesses that occur in people with HIV
 infection.  Treatments can be started early in the illness, when
 they are most effective.  By monitoring the immune system,
 doctors can give medicines that help prevent persons with HIV
 from getting severe infections.  Researchers are also working on
 ways to strengthen the immune systems of people with HIV
 infection, delaying or preventing many illnesses.  Because early
 diagnosis, counseling, and treatment can improve the length and
 quality of life of AIDS patients, it is important for persons who
 might be infected to be evaluated by their doctor long before
 they become sick.

 Drugs, such as AZT, for HIV infection or its complications, work
 just as well for blacks and Hispanics as they do for whites.  In
 addition, these drugs work as well for women as they do for men.
 How well these medicines work does not depend on race or gender
 but on such things as the physical condition you are in when you
 start taking the drug, how soon treatment is begun, and how well
 you follow the course of treatment.

 Vaccines Are Being Tested

     Steps are being taken to find vaccines to prevent HIV infection.
 More than a dozen potential HIV vaccines are in the early stages
 of human testing right now.  If these small-scale tests show
 promise, we can begin tests involving larger numbers of people.

 Two ways of using HIV vaccines are being tested.  One use is to
 prevent infection or disease in a person not already infected, as
 measles and polio vaccines have done for those illnesses.  Early
 trials of vaccines have begun, but much more research must be
 done before we will know if any of them will work.

 The other possible use of a vaccine is in treatment for people
 already infected with HIV.  Use of such vaccines may strengthen
 the immune system and help the body defend itself against HIV.
 Although several vaccines of this type are being tested now, we
 do not yet know if any of those being tested today will be of
 benefit for those infected.  If you are interested in
 participating in a clinical trial, please call 1-800-TRIALS-A.

 You Can Still Lead An Active Life

     Life does not end with HIV infection.  Many people with HIV have
 received early treatment, have continued to stay healthy, and are
 able to lead productive lives.  Even if you are infected, you are
 still an important member of your family and your community, and
 you can still contribute to society.

 You have much living yet to do, many things to enjoy.  Knowing
 you are infected with HIV is not easy, but many people in
 national, state, and local organizations are working to make
 things better for you.  There are many people who care about you
 and are working to combat HIV infection.  In the meantime, you
 need to help us by taking care of yourself physically,
 spiritually, and emotionally.

 Understanding The Immune System

    CD4+ cells (also called T-helper cells or T4 cells) are very
 important in fighting infection.  Unfortunately, HIV attacks
 these cells.  In a person not infected with HIV, the number of
 CD4+ cells remains constant over time.  In an HIV-infected
 person, as months and years go by, the number of CD4+ cells
 drops.  Your CD4+ cell count is a measure of the damage to your
 immune system by HIV and of your body's ability to fight
 infection.  Your doctor uses your CD4+ cell count to help decide
 what medical treatments are best for you.

 Get Treatment

    There are several medicines approved by the FDA for the treatment
 of HIV infection.  Some of these medications may help slow the
 development of HIV infection to AIDS.  Some have serious side
 effects.   You should discuss all medications with your doctor or
 pharmacist before taking them.  Other medicines may prevent or
 delay some of the diseases that attack your body as your immune
 system gets weaker.  More medicines are being tested.  Research
 is also going on to find the best doses and combinations of

 Many new medicines and some old ones used for other diseases are
 being tested to see if they can safely kill or control HIV, boost
 the immune system, or help fight other illnesses.  Some of these
 experimental medicines may be available to you.  Talk to your
 doctor and call the AIDS Clinical Trials Information Service (1-
 800-TRIALS-A) if you need more information or are interested in
 participating in a clinical trial.

 Get Checked for TB

     Tuberculosis (TB) is a serious infection of the lungs (and
 sometimes other organs such as the brain or spine).  TB germs are
 spread from people with active TB of the lungs or airways to
 other people, usually during close contact that lasts for a long
 time.  TB germs can be spread through the air when a person with
 TB coughs or sneezes.  TB can be both prevented and treated.

 Not everybody infected with TB germs gets sick with active
 tuberculosis.  In most people who become infected, the TB germs
 remain inactive and do not cause sickness.  However, due to
 damage to their immune system, people with both HIV infection and
 TB germs are much more likely to get sick with active TB than
 people with TB germs who are not infected with HIV.  For this
 reason, people with HIV need to be evaluated regularly for TB.

 If TB is recognized early, you can be given medications to
 prevent you from getting sick with TB and spreading it to others.
 Active TB can usually be cured, but it takes a long time, at
 least 6 months.  If you are infected with both HIV and TB, you
 may have to take medications for a longer time.  Without
 treatment, HIV and TB work together to shorten your life.  For
 more information call the CDC National AIDS Hotline (1-800-342-

 When people work together, they can do almost anything.  When
 people step forward, and communities work together to change the
 behaviors that spread HIV, their actions speak louder than words.

 All of us have a job to do in stopping the spread of HIV and in
 caring for those infected and their families and friends.  We
 need to learn how to prevent HIV infection and then teach others.
 We need to help each other stay healthy.  And we need to reach
 out to those who are affected by, and infected with, HIV--to men,
 women, children, entire families--to all in need of help.  No
 matter who you are, where you come from, where you live, you can
 help stop HIV and AIDS.

 Help Prevent Discrimination

     You can help by treating people with HIV infection or AIDS the
 same way you would want to be treated if you were in their place.
 Because this problem is a very personal, emotional one, you need
 to understand that what you think and feel makes a difference to
 people around you.  If you understand HIV and AIDS and help
 others understand, it will make a real difference.  People with
 HIV infection and AIDS need to be protected from discrimination
 on the job, in housing, in schools, or in getting health care.

 If people feel they will be treated badly if others know about
 their infection, they may try to keep it a secret or even avoid
 finding out if they are infected.  These actions only let HIV
 spread faster.

 However, if people feel they will be treated with respect and
 understanding, they will be more willing to get tested, seek
 medical care, and tell their sex and drug use partners about
 their infection.  These actions will help slow the spread of HIV.

 The new Americans with Disabilities Act (Public Law 101-596)
 helps fight discrimination against people with disabilities and
 can protect people who are infected with HIV or are believed to
 be infected with HIV.  Businesses and employers have been made
 aware of this law.  For more information, call the CDC National
 AIDS Hotline (1-800-342-AIDS).

 The Family And HIV

     Families play an important role in stopping HIV.  Families
 nurture children, provide a supportive environment, and teach
 values and discipline.  Parents should teach their children how
 to protect themselves against HIV infection and other STDs as
 soon as their children are able to understand.  There is no
 substitute for the concerned attention of a parent, caring adult,
 or extended family member.  For a free brochure on how to talk to
 children about HIV infection and AIDS, call the CDC National AIDS
 Hotline (1-800-342-AIDS).

 Schools Can Help Prevent HIV Infections

     Many schools have excellent AIDS education programs that also
 teach children how to protect themselves against HIV infection.
 The most effective programs support and reinforce the AIDS
 prevention messages given at home.  They are part of a
 comprehensive health curriculum for every grade.  Schools must
 ensure that students receive AIDS/HIV education appropriate to
 their age and their needs.  They must not discriminate against
 children with HIV and must support the right of HIV-infected
 children to attend school.

 Talk Openly About HIV and AIDS

     Social injustice and social intolerance help spread HIV
 infection.  Respect, understanding, tolerance, and compassion
 make it possible for those infected or at risk to cooperate with
 those who would help them.  This approach helps all of us prevent
 the spread of HIV infection.

 Do you have relatives, friends, or coworkers who may be at risk?
 Talk to them about HIV infection and AIDS.  Even people who have
 difficulty listening to loved ones or authorities often will
 listen to friends.  Get them to call the CDC National AIDS
 Hotline (1-800-342-AIDS) or a local AIDS hotline for more

 Communities Can Stop HIV

     Community action is a very powerful weapon.  The strongest
 educational and prevention efforts are those that involve all
 parts of the community; businesses, schools, civic and volunteer
 groups, religious organizations, and individuals.  Community-
 based organizations in many areas are already actively involved
 in HIV education, services, and health care--and in raising money
 to pay for these activities.

 The CDC has started a program called "Business Responds to AIDS"
 to provide businesses and workers with information about how to
 prevent work disruptions and new HIV infections among their
 employees, their families, and their community.

 What Can You Do?

     Does your community, club, organization, or religious group have
 a program to teach HIV prevention and help people with AIDS?
 Does your employer have an HIV education program?  If so, support
 those programs.  If not, start a program or talk to somebody who

 There are many things you can do.  You can make time to talk to
 people about HIV infection.  You can help someone with AIDS.  You
 can run errands for someone sick with AIDS.  You can cuddle an
 HIV-infected baby with no parents.  Even if all you do is improve
 the way you talk about people living with AIDS, you are taking a
 step in the right direction.


        Summary of Centers for Disease Control and Prevention (CDC)
                             AIDS Case Reports

 Through December 1992, CDC had received 253,448 reports of AIDS
 cases.  These included:

 *     221,714 cases in men, 27,485 cases in women, and 4,249 cases
      in children.
 *     132,625 cases in non-Hispanic whites; 75,997 cases in
      non-Hispanic blacks; 42,199 cases in Hispanics; 1,610 cases
      in Asians/Pacific Islanders; and 448 cases in American
      Indians/Alaskan Natives (race/ethnicity is unknown for 569

 Racial and ethnic minority populations have been heavily affected
 by HIV infection and AIDS.  In 1992, 47 percent of all reported
 AIDS cases were among blacks and Hispanics, while these two
 population groups represent only 21 percent of the total U.S.

 Although black and Hispanic women are 16 percent of all U.S.
 women, they are 74 percent of U.S. women reported with AIDS since
 1981.  Nearly 84 percent of children with AIDS who were infected
 before, during, or after birth are black or Hispanic.  In New
 York State, AIDS has been the leading cause of death since 1988
 for Hispanic children 1-4 years of age, and the second leading
 cause of death for black children in the same age group.

 Through 1992, a total of 946 cases of AIDS among adolescents
 (13-19 years of age) were reported.  In 1990, HIV infection and
 AIDS was the sixth leading cause of death among 15- to 24-year
 olds in the United States.

 Among adolescents reported with AIDS, older teens, males, and
 racial and ethnic minorities are heavily affected.   Among
 adolescents with AIDS the proportion of women has increased, from
 18 percent of all cases in adolescents in 1987 to 29 percent in

 In recent years, the fastest growing groups of persons reported
 with AIDS in the U.S. have been women and men who acquired HIV
 through heterosexual contact.  The new cases reported annually in
 these population groups have more than doubled since 1989 (women-
 1,172 in 1989, 2,437 in 1992), (men-782 in 1989, 1,677 in 1992)}.
 New AIDS cases reported annually in men who have sex with men
 have increased 22 percent over the same period
 (homosexual/bisexual men-19,652 in 1989; 23,936 in 1992).

 Through December 1992, 27,485 AIDS cases were reported among U.S.
 adult and adolescent women.  Nearly three-fourths of those cases
 were directly or indirectly associated with drug injection--50
 percent (13,626) of these women reported injecting drugs
 themselves, and an another 21 percent (5,896) reported having sex
 with men who injected drugs.

 Although most women reported with AIDS were infected through
 shared needles and syringes, women who were infected through
 heterosexual contact have the highest rate of increase.  HIV has
 been transmitted both from men to women and from women to men and
 has occurred mainly through vaginal intercourse.  AIDS cases
 among U.S. women increased 17 percent between 1990 and 1991;
 among men, the increase during the same time period was 4

 In addition to this report, there are many other publications on
 HIV and AIDS, including guides for teaching HIV prevention and
 caring for AIDS patients.  Many of them are available at no
 charge.  To get copies, to find out what programs are available
 in your local area, or just to ask questions about HIV or AIDS,
 call the CDC National AIDS Hotline.  The call is free and
 confidential, and you do not have to give your name to get your
 questions answered.

 CDC National AIDS Hotline
      * English service (7 days a week, 24 hours a day) 1-800-342-
        AIDS (2437)
      * Spanish service (7 days a week, 8 a.m. till 2 a.m. eastern
        time) 1-800-344-7432
      * TDD service for the deaf (10 a.m. till 10 p.m. eastern
        time, Monday through Friday) 1-800-243-7889

 National Institute on Drug Abuse Hotline:
           English service     1-800-662-HELP (4357)
           Spanish service     1-800-66-AYUDA (662-9832)

 National Clearinghouse for Alcohol and Drug Information:
           1-800-SAY-NO-TO     (1-800-729-6686)

 AIDS Clinical Trials Information Service (ACTIS):
           1-800-874-2572 or 1-800-TRIALS-A

 If you need more information about programs and services in your
 area, you can also call your local American Red Cross chapter or
 your state or local health department.

 Further information can also be obtained from:
           CDC National AIDS Clearinghouse
           P.O. Box 6003
           Rockville, MD  20849-6003

This page last reviewed: Thursday, January 28, 2016
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