HIV can be transmitted if one of the following HIV-positive bodily fluids gets into the body of another person:

• Blood, including menstrual blood.
• Sperm and pre-ejaculate.
• Vaginal fluid.

HIV cannot be transmitted through:

• Coughing and sneezing.
• Shaking hands, hugging and kissing.
• Tears, saliva, sweat, vomit, urine and excrement, unless there is blood in it.
• Drinking from the same glass or cup, or eating with the same cutlery.
• Sharing the same sauna, shower or toilet.
• Swimming in the same swimming pool.
• Insect bites.
• Using the same telephone.
• Contact with intact skin without wounds.

When is there a risk of HIV transmission?

In the case of direct blood-to-blood contact and/or blood-sperm contact.

Sexually

• Through unsafe anal, vaginal or oral sex without a condom. Unsafe oral sex means when sperm or blood, for example menstrual blood, enters the other person's mouth.
• If there is an accident with a condom, for example, if it splits or comes off.

A detailed overview of the likelihood of HIV, other STDs and pregnancy as a result of different acts can be found at soaaids.nl.

Needlestick injuries

• As a result of someone pricking themselves on a needle that has been used by someone who is HIV positive.

Cut and bite injuries

• When someone cuts themselves on a blade that has the blood of someone with HIV on it, for example when sharing razor blades.
• If you bite or are bitten by someone with HIV.

Wounds

• When blood from someone with HIV enters the wound of someone else.

Other

• For example when sharing toothbrushes (only in the case of wounds or bleeding gums).
• In pregnancy, during the birth and when breastfeeding, there is a chance that the baby will be infected with HIV.

If you have a sexually transmitted disease (STD) in addition to an HIV infection, the chance of transmitting HIV is bigger. That is because an STD often causes vulnerable mucous membranes with small wounds. An STD also increases the number of HIV particles. And particularly when you have wounds, you have more 'local' immune cells (CD4 cells) right where the HIV is heading for.

The risk of transmitting HIV is much smaller in the case of an undetectable viral load. This is when the number of HIV particles in the blood, as well as in sperm and vaginal fluid, is very low.
If there is a risk that transmission has occurred, always contact your own hospital, the health service (GGD) or the ER from another hospital as soon as possible. They will then assess the level of risk of transmission to determine whether the person who has been put at risk needs to receive PEP (post-exposure prophylaxis) treatment.

Medication to prevent infection after contact with HIV

If you have had unprotected sexual contact or a needlestick injury when the other person is infected with HIV, consult your specialist or general practitioner as soon as possible. If you do not have an HIV infection yourself, you can get post-exposure prophylaxis (PEP) (a treatment with anti-HIV drugs). If you start these right away, you reduce the chance of getting an HIV infection. You must start the treatment at the latest within 72 hours of the sexual contact, but preferably earlier. Blood should also be taken at various points to follow up whether you are infected by HIV. You must continue to use PEP until the result is definitive. The treatment therefore takes a few weeks. Because the treatment also has negative side effects, the risk must be properly assessed. This means that you have to think carefully before you start taking PEP.

When one of the sexual partners has an HIV infection and the other hasn’t, unprotected sexual contact is not advised and unsafe. In the Netherlands, research is being carried out on taking medication in advance in case of unprotected sexual contact, with the intention to reduce the risk of infection between HIV positive and HIV negative partners. This is called pre-exposure prophylaxis (PrEP). The effectiveness and safety of this treatment is still under investigation so please be patient. Besides that, unprotected sex puts you at risk for infections with other STDs.