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Contact with HIV+ Patient

Question: 

Hi there,

I volunteer in an ER and I am concerned because I was not aware that a patient was HIV+ when I was helping them with their meal. I don't remember any substantial contact with the patient besides him touching my arm with his hand. Would there be risk of infection if he had blood on his hand and touched my skin if I had a small open cut? Or if where he touched me with the blood I then touched my eye or mouth? I don't remember seeing a large amount of blood but I was wondering if it takes an actively bleeding wound from the HIV+ person to enter the actively bleeding wound of an HIV- person/ large splash in mouth or eye. Please let me know your thoughts! Thank you so much

Answer: 

Hello, Thank you for your inquiry. From what we gather from the question, you were asking about your risk of acquiring HIV while volunteering in a hospital and helping a individual living with HIV with their meal. From the information given, this scenario is determined to be No Risk (transmission of HIV is not possible in the given scenario).

The scenario mentioned above does not meet the three components of the transmission equation(1). It does not satisfy the equation because:

  • For transmission to occur the three components of the HIV Transmission Equation must be met: there must be HIV present in a bodily fluid (ie: in blood, semen or rectal secretions), direct access to the bloodstream (ie: inside of the vagina, anus and other mucous membranes) paired with a high risk activity (ie: unprotected anal or vaginal intercourse, sharing needles, mother to child)(1).

  • HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host(2).

  • HIV is not transmitted through casual contact. For example, handshakes or hugging or kissing(3).

  • Superficial wounds, meaning wounds similar to a paper cut, are not deep enough to provide direct access to the bloodstream.

  • Saliva contains enzymes that inhibit the transmission of HIV(3).

In the scenario that you provided, you were helping a individual living with HIV eat their meal during a volunteer shift at a hospital. You are concerned about acquiring HIV through casual touch if blood were present and the individual touched your arm. You are also concerned about your risk of acquiring HIV if you then touched your eyes or mouth. This scenario has been assessed as No Risk for you acquiring HIV. As we learned above, HIV does not survive long outside the human body (such as on the surfaces), and it cannot reproduce outside a human host(2). For you this means that any bodily fluids (ie: blood) that you may have come into contact with, had been outside of the body, exposed to external environmental factors, was not able to reproduce, and was thus unable to transmit to you. HIV is not transmitted through casual contact(3) like that which had while helping an individual with their meal. Simply touching your eyes or mouth does not provide direct access for HIV to enter your bloodstream, and saliva contains enzymes that inhibit the transmission of HIV(3). Remember as well that any bodily fluids on your hand while touching your eye or mouth, have been outside of the body, exposed to external environmental factors and unable to reproduce. You were concerned that if you happened to have a small wound on your arm that this may be a vehicle for you to acquire HIV. The small, open cut that you described we can liken to a 'superficial wound', like that of a paper cut. Superficial wounds are simply not deep enough to provide direct access for HIV to enter your bloodstream. This scenario has been assessed to be No Risk.

As for your question regarding an actively bleeding would of one person touching the actively bleeding wound of another person, or blood splashing into the mouth or eyes, remember that HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host(2). There are many "what ifs" in this hypothetical scenario. For transmission to occur the three components of the HIV Transmission Equation must be met: there must be HIV present in a bodily fluid (ie: in blood, semen or rectal secretions), direct access to the bloodstream (ie: inside of the vagina, anus and other mucous membranes) paired with a high risk activity (ie: unprotected anal or vaginal intercourse, sharing needles, mother to child)(1). We can give this hypothetical scenario a Negligible Risk assessment. This means that there are no evidence or no documented cases of transmission. However, there is a theoretical possibility. We will assume that you are asking about this scenario for if it were to happen within a healthcare setting while you are on shift in your volunteer position. Within a Healthcare setting, "The risk of health care workers being exposed to HIV on the job (occupational exposure) is very low, especially if they use protective practices and personal protective equipment to prevent HIV and other blood-borne infections. For health care workers on the job, the main risk of HIV transmission is from being stuck with an HIV-contaminated needle or other sharp object. However, even this risk is small. Scientists estimate that the risk of HIV infection from being stuck with a needle used on a person with HIV is less than 1%."(3)(4)

We would also like to say thank you for getting involved in your community and taking the time to volunteer at your local hospital. We have linked below some great resources about HIV Transmission, and HIV in Healthcare settings. Individuals living with HIV frequently encounter a certain amount of stigma associated with HIV. This could be a great opportunity for you to meet with your volunteer supervisor, discuss your experience and make a plan to educate other volunteers about HIV transmission and HIV in healthcare settings. Feel free to ask us any questions you may have in the future, or direct other volunteers our way for HIV/AIDS related information that they can trust. Keep up the great work!

Recommendation: No need for HIV test with the scenario provided, refer to the resources we have linked below to learn more about HIV and HIV transmission. Refer to your healthcare professional for other health related questions .

Regards, AIDS Vancouver Helpline/Online, Hilary