HIV transmission: guidelines for assessing risk - Canadian AIDS ...

HIV TRANSMISSION: Guidelines for Assessing RiskQuick ReferenceCategories for Assessing HIV Risk1. No riskTo our knowledge, none of the practices in this categoryhave ever been demonstrated to lead to HIV infection.There is no potential for transmission since all of the basicconditions for viral transmission are not present.Potential for transmission . . . . . . . . . . . . . . . . . . . . . NoneEvidence of transmission . . . . . . . . . . . . . . . . . . . . . NoneExamples: Kissing (no blood); non-insertive masturbation;receiving unshared sex toys; contact with feces or urine(unbroken skin); injecting with unshared needles; usingdrugs with new pipe or straw; sadomasochistic activities(with universal precautions); tattooing, piercing, electrolysisand acupuncture with sterilized and new equipment;manicures or pedicures.2. Negligible riskAll of the practices assigned to this risk level present apotential for HIV transmission because they involvean exchange of body fluids, such as semen (includingprecum), vaginal fluid, blood or breast milk. However, theamounts, conditions and media of exchange are such thatthe efficiency of HIV transmission appears to be greatlydiminished. There are no confirmed reports of infectionfrom these activities.Potential for transmission . . . . . . . . . . . . . . . . . . . . . . .YesEvidence of transmission: . . . . . . . . . . . . . . . . . . . . . NoneExamples: Receiving fellatio or cunnilingus; performingfellatio or cunnilingus with barrier; anilingus; fingering;fisting; using shared sex toys with a condom; using disinfectedsex toys; sadomasochistic activities; contact with fecesor urine (on broken skin); vulva-to-vulva rubbing; docking;taking breast milk into the mouth; using drugs with sharedpipe or straw; tattooing, piercing, electrolysis and acupuncturewith shared equipment; fighting; sharing toothbrushesand razors.3. Low riskAll of the practices assigned this risk level present a potentialfor HIV transmission because they involve an exchange ofbody fluids such as semen (including precum), vaginal fluid,blood or breast milk. There are also a few reports of infectionattributed to these activities (usually through individualcase studies or anecdotal reports, and usually under certainidentifiable conditions).Potential for transmission . . . . . . . . . . . . . . . . . . . . . . .YesEvidence of transmission: . . .Yes (under certain conditions)Examples: Kissing (with exchange of blood); performingfellatio or cunnilingus without barrier; intercourse (penileanalor penile-vaginal) with barrier; injecting with cleanedneedles; tattooing with non-professional equipment; takingblood in the mouth; occupational exposure.4. High riskAll of the practices assigned this risk level present a potentialfor HIV transmission because they involve an exchangeof body fluids, such as semen (including precum), vaginalfluid, blood or breast milk. In addition, a significantnumber of scientific studies have repeatedly associated theactivities with HIV infection. Even when the exact mechanismof transmission is not completely clear, the results ofsuch studies conclude that activities in this category are highrisk.Potential for transmission . . . . . . . . . . . . . . . . . . . . . . .YesEvidence of transmission . . . . . . . . . . . . . . . . . . . . . . .YesExamples: Penile-anal or penile-vaginal intercourse withoutcondom; receivng shared sex toys; injecting with sharedneedles.Quick Reference5