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

A MESSAGE FROM THE SURGEON GENERAL

    Suqeon General
Antonia Corllo Novella. M.D.. M.P.H.

It began, like so many epidemics, with a few isolated cases, a
whisper that caught the edr 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 love.

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-transmit-
ted 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 trust.

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 modem 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


CONTENTS

HIV INFECTION AND AIDS - A STATUS REPORT

KNOW THE FACTS ABOUT HIV

How You GET HIV, AND How You DON'T

ARE You AT RISK?

How TO PROTECT YOURSELF FROM HIV INFECTION

RESEARCH ADVANCES ARE PROMISING

LIVING WITH HIV AND AIDS

You CAN HELP STOP AIDS

APPENDIX:    SUMMARY OF CENTERS FOR DISEASE CONTROL
       AND PREVENTION (CDC) AIDS CASE REPORTS

NEED MORE INFORMATION? - TELEPHONE NUMBERS

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How many more?

Photo by Matthew Naythons


HIV INFECTION AND AIDS-A STATUS REPORT

Infection with human immunodeficiency virus (HIV),
the virus that causes acquired immunodeficiency syn-
drome (AIDS), is one of our country's greatest health
challenges. Today 1 million Americans-l 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 frst cases of AIDS were reported in 198 1. 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 15 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 compa-

rable 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

New AIDS Cases Each Year, by Year   percent Of reported AIDS caSeS in
                                        women were attributable to hetero-

of Report, United States, 198 1 - 1992    sexual contact, an increase of nearly

    Number of Cases
6ovooo I

42 percent from 1990 to 1992.

111111
81 82 83 84 85 86 87 88 89 90 91 92

Year


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 popula-
tions 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 cities.

Cumulative AIDS Cases Among Adult
and Adolescent Women Ages 13 and
  Older, United States, 198 1 - 1992

   Number of Cases
7,000 1

6,000
5,000
4,000

3,000

zoo0
1,000

  0      -
  81 82 ; ?! 85 86 87 88 89 90 91 92

Year

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.
Almost 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 sexual transmission have
been reported in the medical literature.

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Children of HIV-infected women
often become orphans.

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.

One in four babies of HIV-infected women
may be infected,

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 transfu-
sions 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.

New AIDS Cases Each Year Among
Children 13 Years of Age and
Younger, United States, 1982- 1992
Number of Cases

lTooo I

800

600

400

200

0 III
   82 83 84 85 86 87 88 89 90 91 92

Year


Teenagers who share needles to inject drugs (includ-
ing steroids) or who have sex without a latex condom
are getting infected. However, most won't show any

j
:.  symptoms of HIV infection or AIDS until they are in
$
4 &  their 20s even though they can still transmit the

  infection to others.

We Now Have Treatments for HIV
E Infection

We now have medical treatments that can delay many
'

of the illnesses associated with AIDS, and more
i

treatments are on the way. There is hope for a
vaccine in the future. However, unless many Ameri-
cans change some of their behaviors, hundreds of
thousands more Americans will become infected
before the year 2000.

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.

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KNOW THE FACTS ABOUT HIV

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 light 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,
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 viruses.

Other common problems that occur when the person
develops AIDS are certain pneumonias (Pneumocystis
carinii) that cause coughing, fever, and difficult breath-
ing, 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 infec-
tion 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.

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How You GET HIV, AND How You DON'T

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 itself.

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, intrau-
terine 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
used correctly and consistently-offers the best protec-
tion against HIV and other STDs.

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Using contaminated needles is risky.

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 grown.


I

Ways You Do !&? Get HIV Infection

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

YOU do @ 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 infor-
mation 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.

No matter what shape you're in,
you can get infected with HIV.

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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.

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 recom-
mended 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 6 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.

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

each blood donation.

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ARE You AT Ii&u,?

4ssess Your OWN Risk

f you answer "yes" to any of the following questions,
IOU could have HIV infection or other STDs.
Have you ever had unprotected sex (anal, vaginal, or
oral) with a man or woman who:

o you know was infected with HIV?

o  injects or has injected drugs?

o  shared needles with someone who was infected?

o  had sex with someone who shared needles?

o  had multiple sex partners?

o  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:

o receive treatment for hemophilia between 1978
through 1985?

o 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 partners.

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
(I-800-342-AIDS).

Can you tell who has HIV infection?

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Facts About the HIV Tests

To know for certain if you are infected with HIV, you
must have your blood tested specifically for HIV infec-
tion, 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 per$ect 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 well.

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 in-
fected. 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.

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The International Display of the entire NAMES Project AIDS Memorial Quilt.
                          12


                 Photo by Mark Thiessen.

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How TO PROTECT YOURSELF FROM HIV INFECTION

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 commit-
ted to a relationship. If you are not in such a relation-
ship, 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 you.

Sex with a steady, uninfected partner is one of
the surest ways to protect yourself against HIV
infection and STDs.

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 consis-
tently, 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 protec-
tion 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 (I-800-342-AIDS).

14


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. Alway:
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 inside.

o 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.

o 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 OI
grease, such as petroieum jelly, cold cream, baby
oil, or cooking shortening as a lubricant; they
weaken latex and make the condoms break more
easily.

o  Never re-use a condom.

o Never continue using a condom if it breaks
during sex-stop and put on a new condom.

Spermicides

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 supposi-
tory) 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 irrita-
tion 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.

15


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 "cookers."
o If you use drugs, stop using them for your sake and
for the sake of others. Seek drug abuse treatment to
help you stop.

o 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").

o 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 water.
o 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 (1-800-342-AIDS).

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.

16


RESEARCH ADVANCES ARE PROMISING

We have learned a lot about

HIV and AIDS since 198 1.

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

People with HIV infection are living longer.

infection, three medicines (AZT, dd1, 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-
TRIALS-A.

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.

17


Drugs, such as AZT, for HIV infection or its complica-
tions, 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.

18


LIVING WITH HIV INFECTION AND AIDS

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 medica-
tions 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 medicines.

People with AIDS are able to lead normal lirles.

19


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 inter-
ested 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 in-
fected, 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-AIDS).

20


You CAN HELP STOP HIV/AIDS

When people work together, they can do almost any-
thing. When people step forward, and communities
work together to change the behaviors that spread HIV,

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

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 in-
fected and their fami-

lies 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,

We ull must do our part.

where you come from, where you live, you can help stop    use partners about their infection. These actions will help
HIV and AIDS.                     slow the spread of HIV.

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

The new Americans with Disabilities Act (Public Law
10 l-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).

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 understand-
ing, they will be more
willing to get tested,
seek medical care, and
tell their sex and drug-

21


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).

Teach your children
    about AIDS.

Schools Can Help Prevent
HIV Infection

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 educa-

tion 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.

We can make their future brighter.

22


Talk Openly About HIV and AIDS

Social injustice and social intolerance help spread HIV
infection. Respect, understanding, tolerance, and compas-
sion make it possible for those infected or at risk to cooper-
ate 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 (l-800-342-AIDS)
or a local AIDS hotline for more information.

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 organiza-
tions, 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 informa-
tion 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 can.

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.

Trrlk openly about HIV and AIDS.

23


APPENDIX

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:

o  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/Alaska Natives (race/ethnicity is
unknown for 569 persons)

AIDS Cases Reported! to CDC
Through 1992, by Race/Ethnicity

Non-Hispanic
Blacks- 75,997

Hispanic- 42,199

Asians/Pacific
Islanders- 1,6 10

American

.on-&panp
Whites- 132,625

Total*: 253,448

* Includes 569 persons for whom race/ethnicity is not known.

Racial and ethnic minority populations have been heavily aflected by HIV infection and AIDS. 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.

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 l-4 years of
age, and the second leading cause of death for black children in the same age group.

24


Through 1992, a total of 946 cases of AIDS among adolescents (13- 19 years of age) were reported. In 1990, HIV infec-
tion 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 1992.

In recent years, the fastest growing groups of persons reported with AIDS in the United States 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-l,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 has increased 22 percent over the same period (homosexual/bisexual
men- 19,652 in 1989; 23,936 in 1992).

Increases in Reported AIDS Cases
Due to Heterosexual Transmission
of HIV, United States, 1989- 1992
Number of Cases

3,000

2,500

2,000

1,500

1,000

500

  0

2,437

1,677
r

1,172

Heterosexual Contact      Heterosexual Contact

Male               Female
Transmission Category

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 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 percent.

25


NEED MORE INFORMATION?

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:

   o  English service (7 days a week, 24 hours a day)
   1-800-342-AIDS (2437)

   o  Spanish service (7 days a week, 8 a.m. till 2 a.m. eastern time)
    l-800-344-7432

   o  TDD service for the deaf (10 a.m. till 10 p.m. eastern time, Monday through Friday)
    l-800-243-7889

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

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

AIDS Clinical Trials Information Service (ACTIS):
    l-800-874-2572 or l-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

26