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Questions & Answers
What is the risk of infecting my spouse/sexual partner(s) during unprotected sexual intercourse?
The risk varies considerably for different un-protected sexual practices. For example, no risks are involved by casual kissing, touching, massage, masturbation, talking, and fantasy. However, the risk increases with oral, vaginal, and anal intercourse. In anal sex, the risk is great, even with condoms, because of the increased possibility of tears in the mucous membrane of the rectum and in the condom.
Evidence also suggests that infected people may become more infectious with time, as their immune systems deteriorate. And some people are more susceptible to becoming infected than others. A significant number of sexual partners (approximately 10 percent to 21 percent) of HIV-infected persons with hemophilia have also become infected with HIV, and some have already developed AIDS and died. Therefore, it is of great importance that safer sex be used every time you engage in sexual activities.
For more detailed information about sexual behaviors, copies of The National Hemophilia Foundation publications may be obtained from your NHF chapter or treatment center. These publications include:
What is safer sex? How can it reduce the chance of transmitting HIV?
Safer sex means following certain precautions to minimize the risk of exposure to HIV. Safer sex means not allowing the body fluids from an HIV-infected person to contact a partner's mucous membranes. That means using a latex condom along with a spermicidal jelly or foam every time you have vaginal or anal intercourse. To avoid being exposed to your partner's body fluid, a non-lubricated condom should be used if having oral sex on a man. A dental dam or a condom cut open to form a small sheet of latex (used to cover the genitals) should be used for oral sex on a woman. Safer sex also includes limiting your number of sexual partners, and exploring ways of expressing your sexuality without the exchange of bodily fluids.
Safer sex must be practiced if the hemophilia community is to prevent further transmission of HIV from infected persons to sexual partners. If you are practicing safer sex - congratulations. You are part of the solution. If you are having unsafe sex stop now. If you are having a tough time always practicing safer sex, ask for help at your local hemophilia treatment center. Call your chapter or NHF and ask to be put in touch with local representatives from the Women's Outreach Network of NHF (WONN) or Men's Advocacy Network of the NHF (MANN). HIV can and does kill. Be responsible.
If I am a sexual partner of a person with hemophilia who is infected with HIV what should I do?
You should consider being tested for HIV antibodies to see if you have become infected. When you are tested, the results should be kept in confidential files. Because of the latency period between infection and testing positive, you should be tested again in six months. If you are HIV negative, take the steps necessary to remain negative. Remember, HIV disease is potentially fatal. It is important to know that preventive measures, such as safer sex, can and must be taken now.
If your test is positive, you are HIV-infected. You should still use condoms and a spermicide with your sexual partner, since re-exposure to HIV may increase your risk for developing AIDS. You should also have immune function testing done to determine if you should consider drug treatment, such as AZT. Again, we encourage you to read NHF's publications:
If I have not used condoms with my spouse of 10 years, why should I start now if I am using viral inactivated clotting factor?
Over half of all persons with hemophilia were infected with HIV as a result of blood product use before heat treated products were available. An increasing number of sexual partners of men with hemophilia are becoming infected. If you are HIV-infected, at risk for HIV infection as a result of other behaviors such as sharing needles or un-protected sexual intercourse, or have not yet been tested, you are strongly urged to use latex condoms with spermicidal foam or jelly to protect your sexual partner from repeated exposure to potentially infectious bodily fluids, If your partner is not yet infected, use of safer sex practices, or abstinence, can prevent future infection.
Are the people who have casual contact with HIV-infected persons with hemophilia at risk of developing HIV infection or AIDS?
No. Fortunately, HIV is a very difficult disease to transmit. HIV is not transmitted through casual contact such as sharing food, eating utensils, bathroom facilities, sneezing, coughing, or shaking hands. Research on several hundred household contacts of HIV-infected persons with hemophilia shows no evidence of transmission to family members who are not sexual partners. This is also true for family members of AIDS patients. There are no instances in which HIV infection has been transmitted to schoolmates, co-workers, relatives or friends through casual contact.
Is there a risk of HIV infection being passed through saliva by kissing?
Although HIV can be present in the saliva of HIV-infected persons, there is no evidence that HIV is transmitted by kissing. If it were, researchers would find that many family members of persons with AIDS or HIV infection would also develop HIV infection. This has not occurred among the family members of persons with hemophilia who have now been followed and tested for years.
While many people continue to focus on risk groups, it is more important to focus on risk behaviors, since casual contact with an infected person from any risk group does not cause HIV infection. Again, it is suggested that you obtain copies of the NHF publications mentioned in question 27 to understand more fully the behaviors (such as certain sexual activities) that put individuals at risk.
My partner and I are hoping to conceive a child soon. Since I am HIV-infected, is my partner, the pregnancy, or the child at any risk?
Yes. A woman who is HIV-infected can pass HIV to her unborn child during the pregnancy or birth. Some women partners of HIV-infected men with hemophilia became infected with HIV prior to or during the pregnancy. A number of their children were diagnosed with HIV disease shortly after birth. Some of those children have progressed to AIDS and have died. Therefore, it is recommended that serious consideration be given to avoiding pregnancy. A woman can become HIV- infected while having sexual intercourse to become pregnant. The potential risk of HIV transition from an infected woman to the fetus is 25 percent to 30 percent. You and your partner should talk to professionals at your treatment center and read and discuss NHF's publication "What Women Need to Know about HIV V Infection, AIDS and Hemophilia." HIV antibody testing and immune function studies of you and your partner may be used as part of an overall assessment of risk of HIV transmission when considering pregnancy issues.
The decision against a desired pregnancy can be an extremely painful one. This decision-making process may increase anxiety levels for persons with hemophilia and their sexual partners. Discuss the risk of pregnancy with your partner and treatment center staff, and with other men and women at your chapter. NHF's Medical and Scientific Advisory Council (MASAC) recommends that pregnancy be delayed. You may want to consider alternatives such as adoption or, if the woman is HIV negative, artificial insemination with a non-HIV-infected donor. These options are safe and will not put your partner, or unborn child, at risk for HIV infection.
If both my spouse/partner and I are HIV-infected, do we still need to practice safer sex? Why?
Yes. People infected with Hemophilia may become more infectious over time. Any unsafe sexual practices will increase the exchange of HIV to each other through semen or vaginal secretions. This may make you progress to AIDS faster.
If I am not HIV-infected, should I engage in protected sexual behavior with my spouse/sexual partner(s)?
NHF urges that everyone, including persons with hemophilia who are not HIV-infected, continue to behave in a mature and responsible way in relation to sexual practices. HIV can be acquired through sexual intercourse, thus safer sex remains an important way to avoid HIV infection.
If both my spouse and I have tested HIV- negative every time, does this mean we can pursue a planned pregnancy without the risk of HIV transmission to our newborn child?
You and your partner are highly unlikely to be HIV-infected, and thus your child would not develop HIV infection. But there are no absolute guarantees -- only relative risks based on current scientific information.
If I am HIV-infected but have no symptoms of HIV disease, do I still have to be concerned about transmitting HIV to my spouse/ sexual partner?
Yes. If you are HIV-infected you have the virus ill your body and can transmit it to others. HIV has been transmitted from some men with hemophilia who had no symptoms of HIV disease, to their sexual partners. Approximately half of all persons with hemophilia and other similar bleeding disorders arc HIV-infected. About 67 percent of those with moderate/severe hemophilia are HIV-infected. Repeated exposure to semen or vaginal secretions from an HIV-infected person (unsafe sex) increases the partner's risk of developing HIV infection. The National Hemophilia Foundation recommends the use of latex condoms and a spermicide containing nonoxynol-9 by all HIV-infected persons as the most effective barrier for seminal fluid or vaginal secretions. Safer sex will decrease transmission of HIV to partners.
Note: Nonoxynol-9 bas been known to cause irritation in some people. See your doctor if this appears to be a problem.
If I am HIV-infected, should my past and current sexual partners be tested? Yes. If you have had any unsafe sex since 1978, your partners are at risk for HIV infection. All current and past partners should be tested to learn their HIV status. This will allow them to limit further transmission of HIV and provide them with the possibility of treatment options if they have become infected. Your hemophilia treatment center and local health department can help you notify previous sexual partners.
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