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HIV is a virus that enters lymphocytes within the bloodstream. They get in this position by either a direct inoculation into the bloodstream (perhaps from a blood transfusion or sharing needles with people who are doing intravenous drugs) but the most common event is inoculation into a mucosal area - either the rectum or the vaginal cervical tissue. They enter into cells that are in the mucosal areas and then trafficked into the bloodstream, entering millions and millions of lymphocytes. So most of the HIV in the world is transmitted sexually. This is why there is so much emphasis worldwide on reducing sexually transmitted diseases. Those that cause ulcerations on the genitalia are particularly conducive for transmitting HIV from one individual to another.
HIV is a virus that enters lymphocytes within the bloodstream. They get in this position by either a direct inoculation into the bloodstream (perhaps from a blood transfusion or sharing needles with people who are doing intravenous drugs) but the most common event is inoculation into a mucosal area - either the rectum or the vaginal cervical tissue. They enter into cells that are in the mucosal areas and then trafficked into the bloodstream, entering millions and millions of lymphocytes. So most of the HIV in the world is transmitted sexually. This is why there is so much emphasis worldwide on reducing sexually transmitted diseases. Those that cause ulcerations on the genitalia are particularly conducive for transmitting HIV from one individual to another.
Some people (perhaps 10%) and many with a Scandinavian background may have a mutation in one of the receptors for HIV which protects them. They become infected, but it does not become a productive infection with consequent loss of CD4 cell numbers and immunity, as occurs in other individuals without this mutation.
Individuals who are infected with HIV are most contagious (able to pass it onto other individuals) early on in the disease, either before they've been diagnosed with HIV or even have any symptoms whatsoever because in their blood, they have high viral counts that can be passed on to a sexual partner or someone sharing needles with them. Then after about 6 months or so, their virus goes down in amount and is almost impossible to culture until the end product (which would be Acquired Immunodeficiency Syndrome - people who aren't taking medications) - in the terminal phases of this illness, they are also very contagious then.
I think everyone (every adult) in the United States should receive a HIV test at least once in their life. Those who have risk factors for HIV (for example: gay men who are practicing sex without condoms, intravenous drug users) should have it more often. This extends to people even to the age of 13, where they become sexually active. These individuals should be tested. People should not wait until they feel sick to get this test because the sooner we can intervene with antiretroviral drugs, the better it is for the patient and the better for our community because we reduce the ability of these individuals to transmit it to others.
I think the first step is diagnosis and as we talked about, this is performed by doing a blood test. These are available at virtually every hospital. Every physician can order this test on any individual. Then secondly: if you have HIV, there are a number of avenues which you can pursue. You may have a very knowledgeable primary care physician you want to stay with but I would recommend that at some point you see someone who's specializing in HIV care for the simple reason that the drugs are now so powerful that there also can be problems in implementing them and keeping them going, that at least a visit with a specialist in HIV care once would be important. The economics (if you will) of having an HIV infection may appear daunting, but anyone in the United States should be able to obtain drugs for the treatment of HIV. Those who have no work, no insurance, they can go to a local Ryan White clinic and obtain all of this help. These clinics are available in most big cities.
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