Non-sexual HIV exposure or transmission

Twitter

  • Czech Republic: Police drop charges against all 30 gay men with HIV following Prague Public Health ‘witch hunt’ https://t.co/ptDCR0pk2d 17 Nov 2016
  • Commentary: Why should people with HIV always be expected to disclose their HIV status? https://t.co/5wzuh1t9eQ #HIVisNotACrime #BeyondBlame 16 Nov 2016
  • RT @Ruins_Doc: Trial of 11 HIV+ women exposed in #Greece in 2012 begins, Greek health official apologizes in court: https://t.co/B6KapWdA6B… 15 Nov 2016
  • @VictoriaLIVE Thank you for covering life with #HIV so well; timely diagnosis and successful treatment means we cannot transmit the virus! 07 Nov 2016
  • RT @AIDSLAW: We're facilitating a free workshop in #Toronto on "Evaluating Advocacy" Nov. 22, 9am-12pm at Ryerson. Register at https://t.co… 02 Nov 2016
  • RT @FCAA: Your Sentence is Not My Freedom: Feminism, HIV Criminalisation and Systems of Stigma by Laurel Sprague | HIV Justice https://t.co… 02 Nov 2016
  • RT @kenpinkela: Sign Executive Order @POTUS banning reviewing all, new and previous, #HIV related prosecutions #UCMJ @TheSeroProject https:… 02 Nov 2016
  • @LaurelDSprague our Research Fellow in HIV, Gender and Justice explains why 'protecting women' via HIV criminalisat… https://t.co/RsS9eX1Pcm 01 Nov 2016
  • Please sign the @GlobalSexWork petition. @UN_Women, meaningfully include sex workers in policy development! https://t.co/Qb6mSX0o5F 25 Oct 2016
  • RT @CtrHIVLawPolicy: Today is Day of Action to End #Violence Against #Women w/ #HIV! Learn more + take action at https://t.co/wNytobbKqw #p23 Oct 2016
  • HIV criminalisation is another form of violence against women in EECA. Powerful blog by @EvgeniaMaron https://t.co/f0sMmplP5y #EndVAWHIV 23 Oct 2016
  • @PEPFAR @IAPAC Thanks for your leadership on highlighting importance of ending state sponsored stigma e.g. HIV criminalization #IAPAC2016 14 Oct 2016
  • RT @PEPFAR: “Ending stigma and discrimination is key to achieving an #AIDSfreegeneration.” - #AmbBirx @IAPAC 14 Oct 2016
  • RT @benyoungmd: @PEPFAR #AmbBirx: criminalization prevents LGBT populations from using #HIV testing/services in Africa. #iapac2016 @IAPAC @… 14 Oct 2016
  • #IAPAC2016 @benyoungmd "We must challenge state-sponsored stigma, fund fight against HIV #criminalisation and #criminalization of key pops." 14 Oct 2016
  • HIV Stigma: Terrorising women in Russia’s traditional societies, by @EvgeniaMaron in English and Russian… https://t.co/TGPmnZsBNO 10 Oct 2016
  • RT @AIDSLAW: Video and written reports for #BeyondBlame: Challenging HIV Criminalisation at #AIDS2016 are on-line: https://t.co/3T0DPP9Bc1… 29 Sep 2016
  • Zimbabwe: Advocates highlight lack of up-to-date understanding of science in HIV-specific criminal law. https://t.co/YCMiSfrvrT @ZLHRLawyers 27 Sep 2016
  • RT @Martin_A_French: Packed theatre at yesterday's premiere of HIV Is Not A Crime - thanks to everyone who came out! https://t.co/B0HGHZfBn6 21 Sep 2016
  • Check out all the #HIV #criminalisation poster action at #AIDS2016. New blog post by @LaurelDSprague https://t.co/8ShGNwtoNm 08 Sep 2016

Non-sexual acts that most commonly provide the impetus for criminal cases of alleged HIV exposure or transmission include:

  • spitting

  • biting

  • fighting

  • wounding or threatening to wound with HIV-infected needles.

In all of these cases, the critical issue of whether there is any risk of HIV exposure relates to whether there is enough virus in the infectious fluid to potentially transmit HIV to someone.

Spitting

Laboratory studies have found that saliva may contain HIV, and transmission via saliva is therefore biologically plausible. However, there is absolutely no epidemiological evidence to suggest that spitting on someone could expose them to enough HIV for infection to result. Levels of HIV in saliva are not high enough to allow transmission, even if the saliva comes into contact with a mucous membrane such as that of the eye. Spitting into someone's mouth would create the same risk as kissing – zero.

There may be an extremely small risk of HIV exposure if someone is spitting blood – for example, following a punch to the face – and this blood comes into contact with a mucous membrane or open wound. However, even in such a scenario, the blood is likely to be mixed with saliva, which, as discussed above, contains an enzyme that inhibits HIV. No cases of HIV transmission resulting from the spitting of blood have ever been reported.1

Case study: Texas, United States – HIV-positive saliva as a 'deadly weapon.2 In May 2008, a 42 year-old African-American homeless man living with HIV was sentenced to 35 years in prison by a Dallas court. His 'crime' was to spit at a police officer whilst stating that he was HIV-positive during his 2006 arrest for being drunk and disorderly. One of the reasons for the man's extremely long prison sentence was that he had done this several times before. The other reason was that the jury found that – despite scientific evidence presented to the court regarding the impossibility of infection through saliva – he had intended to harm the policeman using his saliva as a deadly weapon. The legal argument, as in most other HIV-related spitting cases in the United States, was focused on his intent rather than the actual harm spitting could cause. In contrast, it should be noted that only four of the United States' HIV-specific criminal exposure laws specify intent as one of the elements for guilt. The case was a cause for great concern for human rights and HIV advocates. Bebe Anderson of US civil rights organisation, Lambda Legal, noted: "Such criminal prosecutions confuse the public about ways in which HIV can be transmitted, and encourage discrimination and violence against those who have been infected with the virus. They also undermine the credibility and effectiveness of the criminal justice system as a central vehicle for encouraging respect for society's laws and protecting members of the public from preventable harm... Misconceptions about the ways in which HIV can be transmitted to another person are harmful for society at large, in part because they result in unfounded fears. Those misconceptions are especially harmful for people living with HIV, who continue to face stigma and discrimination, often based on those types of misconceptions."

Biting

HIV transmission by biting is possible but extremely unlikely. In order for transmission to take place there would need to be both exposure to blood and a route into the body for that blood. Just two case reports have documented infection via this pathway when deep wounds were exposed to a substantial amount of blood in the biter’s saliva.3,4 However, there have been many more case reports where a bite by somebody with HIV did not result in HIV infection.5

Fighting

Bleeding onto intact skin during a fight poses no HIV exposure or transmission risk. If HIV-infected blood comes into contact with broken skin, then HIV transmission is possible but still unlikely. The small number of case reports documenting HIV transmission via this route involved a significant amount of blood from the HIV-positive person, as well as large open wounds in the other person’s skin.6

Wounding with a needle

The risk of HIV transmission from exposure to an HIV-infected needle outside healthcare settings has not been studied. However, despite media reporting that often suggests that the risk is great, there is not a single recorded case anywhere in the world of someone being infected with HIV through an attack with a needle, or by accidental wounding with a needle outside healthcare settings.5

Studies of healthcare workers have found the risk of HIV infection following a needlestick injury to be low. A large analysis of multiple studies estimated a per-needlestick risk of 0.23%, or 1-in-435.7 Risk of infection may be higher if the needle was used in an HIV-positive person’s vein or artery, if the HIV-positive person has a high viral load, if the needlestick injury is deep, or if blood is visible on the device that caused the injury.8

References

  1. Padian N Transmission of HIV Possibly Associated with Exposure of Mucous Membrane to Contaminated Blood. MMWR Morb Mortal Wkly Rep11;46(27): 620-3, July, 1997
  2. Bernard EJ Texas jury concludes saliva of HIV-positive man a “deadly weapon”, sentenced to 35 yrs jail. aidsmap.com, available online at: www.aidsmap.com/page/1430404/, 16 May 2008
  3. Pretty IA et al. Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol. 20(3):232-9, 1999
  4. Bartholomew CF, Jones AM Human bites: a rare risk factor for HIV transmission. AIDS 20 (4): 631-632, 2004
  5. NAT Guidelines for Reporting HIV: supplementary information. London, 2009
  6. Gilbart VL Unusual HIV transmissions through blood contact: analysis of cases reported in the United Kingdom to December 1997. Communicable Disease and Public Health 1: 108-13, 1998
  7. Baggaley RF Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis. AIDS 20(6): 805-812, 2006
  8. Landovitz RJ Clinical practice: postexposure prophylaxis for HIV infection. N Engl J Med 361(18): 1768-75, 2009
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.