I am infected with HIV. I have a six-year-old child. The problem lies with my brother and sister-in-law. Their seven-year-old daughter used to spend the night here sometimes. They recently found out about my HIV and are concerned I may have put their daughter at risk. I am very careful, as I do have my own child to worry about too. How can I minimize their fear? My brother is a paramedic and my sister-in-law is training to become a nurse, and they feel they know all about the virus. They say that it is transmitted through ALL body fluids but that the CDC does not release that information because such a low percentage become infected through any means other than sex or blood.

S.B.

Although we have covered similar questions on this site in the past, I believe your question is important enough that we address the topic again. HIV (human immunodeficiency virus, which causes AIDS) is generally transmitted through sex and through contact with blood or blood products. In this country, and in the world, sex is the major mode of transmission. The virus is not transmitted through casual contact. It has not been shown to be transmitted though handshakes, kissing on the cheek or touching the skin. It is considered unlikely, but possible, to transmit the virus through prolonged open-mouth kissing.

When one person in a household has HIV, it is a common worry that he or she will spread it to family or friends -- and this is a natural concern. What is reassuring is that it is very unusual for a family member (other than a sex partner) to become infected. While I do not recommend sharing toothbrushes, it would be unlikely for the virus to be transmitted in this manner. Likewise, it has never been reported that a patient has been infected through hugging, sharing drinking glasses or food or through their pets.

Your brother's statements regarding HIV in body fluids is not quite right. Yes, HIV can be found in saliva, urine and body fluids. However, the level of virus is not high except in blood, semen and vaginal fluid. In the other fluids, the level is too low to transmit the virus effectively. That is why contact with urine or saliva is considered very low risk for acquiring the infection.

I recommend that your brother talk to his own doctor, who will undoubtedly tell him what I have just written. In addition, refer him directly to the U.S. Centers for Disease Control webpage on HIV and AIDS. This webpage is an excellent resource for anyone wondering how HIV is transmitted.