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PREVENTING TRANSMISSION OF HIV INFECTION: UNDERSTANDING HOW HIV IS SPREAD: PRINCIPLES OF CONTAGION
Preventing transmission begins with understanding the principles that govern how infections are transmitted. These principles are called the principles of contagion.
The terms infectious diseases and contagious diseases refer to different things. Infectious diseases are caused by microbes; microbes are viruses, bacteria, fungi, and parasites. Contagious diseases can be spread from person to person. Some diseases, like toxic shock syndrome or
Legionnaires’ disease, are infectious but not contagious. HIV infection, however, is both infectious (it is caused by a microbe) and contagious (with specific kinds of contact, it can be spread from one person to another). This article will begin by comparing HIV infection to another infectious and contagious disease most people know well from firsthand experience: influenza.
The microbe that causes influenza is a virus found in the nose, throat, and lungs of the person who is infected. Influenza is spread when secretions from the nose, throat, or lungs of the infected person are passed to another person. When an infected person coughs or sneezes on another person, or touches another person, these secretions and the virus they carry are transmitted.
People can be either susceptible or not susceptible to an influenza virus. If they have been infected with that particular virus or a closely related one before, or if they have been vaccinated against the virus, they already have antibodies against it, so they are not susceptible and will not get influenza. If they do not have these antibodies, they are susceptible and will get influenza.
Whether susceptible or not, the person will not become infected if the type of contact is wrong. Specific viruses can live only on specific tissues within the body. An influenza virus on the skin of your hand will not give you influenza; the same virus on the membranes of your nose, throat, or lungs will. If the virus is on your hand and you bring your hand to your mouth, however, you may get influenza.
Given susceptibility and the right type of contact, some viruses are more likely than others to be spread from person to person, that is, some viruses are transmitted with greater efficiency than others. Some viruses are difficult to spread; for others, like the influenza virus, even very brief contact with a person who is infected is likely to result in transmission. Highly efficient transmission accounts for the annual epidemics of influenza.
The efficiency with which a virus is transmitted also depends on the number of viruses a person is exposed to, or the inoculum size. Living with a person with influenza is obviously more likely to result in successful transmission than simply working with that person in the same office. And being sneezed upon poses a greater risk than passing someone in a hallway. In short, how efficiently a virus is transmitted depends both on the number of influenza viruses and the type of contact.
A person, once infected, may continue to feel well for a day or two but, during this time, can still pass the virus to others. This early period between infection and the beginning of symptoms is called the incubation period.
HIV, like influenza, follows the same general principles of contagion. An infected person is the source of HIV. HIV is contagious if a person is susceptible and the contact is of the kind necessary for transmission. And HIV has a certain efficiency of transmission and a certain incubation period. There the resemblance ends.
This point deserves emphasis. Much of the misunderstanding about AIDS is based on the assumption that HIV is transmitted like other common infectious diseases. It isn’t. In brief, for HIV, the types of contact are very specific, transmission is inefficient, and HIV’s incubation period is very long.
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