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HIV的真相

2010/04/07 留下评论

HIV: THE FACTS
I am very honored to be a regular contributor on the HIV Prevention Forum here at MH. The forum is very busy, and we often get the same inquiries over and over. I figured that putting together a journal entry covering the most popular topics, and just laying out the facts may be helpful. I also invite Lizzie Lou and Teak to share their thoughts, and to cover anything I may have missed.
我很荣幸成为Medhelp艾防社区的定期撰稿人。这个论坛很繁忙,我们经常反复碰到同样的问题。我打算集中做一个能够覆盖大部分问题的流水账,同时告诉对大家有益的真相。我还请Lizzie Lou和Teak分享你们的看法,帮我补充遗漏的地方。
First of all, sadly, there is a very overlinflated view of HIV among a large portion of the general population. I feel this is related to a lot of the “hype” and media around the virus. The FACT is, HIV is a very difficult virus to transmit. Comparable to other viruses (ie influenza), it is a very WEAK and unstable virus that succombs to the environment rapidly. It needs basically a set of near perfect circumstances to allow for infection. Therefore, a person CANNOT get HIV from environmental surfaces, like toilet seats, manicure/barber equipment, shower stalls, drinking glasses, toothbrushes, etc etc. The virus quickly becomes inactive when it is outside of its host (the body). This is why infection from inanimate objects is impossible. This is also why mutual masturbation with exposure to a partner’s gential fluids is also NOT a risk in any way. This also is the case with cuts, abrasions, cracked cuticles, etc. Those things make no difference when it comes to risk, as the virus is outside of its host, rendering it inactive.
首先,不幸的是,普通人群中有很大的一部分人对于HIV的传播的观点过于夸大。我认为这和关于这个病毒“天花乱坠的广告宣传”和媒体报道有很大关系。而真相是,HIV是非常难传播的一种病毒。和其他病毒相比(比如流感),它在外界环境中是非常脆弱和不稳定的。它需要基本上是近乎完美的条件才可能构成感染。所以,一个人是不可能从外界环境表面感染HIV的,比如马桶座,修甲/理发工具,淋浴室,饮料杯,牙刷,等等。病毒在离开寄主(身体)之后很快就失活了。这就是为什么从一个无生命的物体那里感染是不可能的。这也就是为什么暴露于对方生殖器体液的相互手淫无论如何都没有风险。这包括那些手上有口子的,破损的,倒刺等等。这些东西不增加任何风险,因为病毒是在寄主体外的,病毒失活了。
“Delayed Seroconversion”. We have all heard horror stories of people who test negative for YEARS, even decades, somehow being infected without having a POS HIV test. This is a bunch of “you know what”. It doesn’t happen, it is an urban myth. If a person has transmitted the virus, they will test pos, actually quite rapidly (usually within 6 weeks of exposure). 3 months will give a person with an exposure a conclusive result. If a person does not test POS for HIV 3 months after an exposure, then they did not contract HIV. The ONLY exception to this is people who have literally NO immune system who may take longer to produce antibodies. This would include an extremely small portion of the population, and would include situations such as….a person taking anti-rejection meds post an organ transplant, a person on aggressive chemotherapy, or a person with terminal, end stage cancer, again…people who have NO immunity. Even this “delayed” seroconversion among this small population is highly debated among medical professionals. Even people in these categories usually test POS within the 3 month window period, but as a precaution, it is recommended that people with severely compromised immune systems test to 6 months post an exposure. NO ONE ELSE NEEDS TO TEST BEYOND 3 MONTHS. If a person was prescribed PEP (“Post Exposure Prophylaxis), then they need to test 3 months after their LAST dose of PEP.
“延迟的血清转化”。我们都听说过很恐怖的故事,比如不知道为什么感染之后几年,甚至几十年一直检测为阴性而检查不出来。这就是一堆“你知道吗?(译注:直译,应该就是以讹传讹的人的开头语)”。根本就没那么回事,仅仅是一个乡间传说。如果一个人感染了HIV病毒,实际来说很快就可以查出来(通常是高危后6周以内)。(译注:美国的版主一样支持6周论)3个月将是最终的结果。如果3个月之后的检查是阴性的话那么这个人没有感染HIV。唯一的例外就是那些免疫系统几乎完全丧失的人可能需要更长的时间产生抗体。这些人包括极小一部分先天免疫缺陷的,和后天免疫缺陷的,比如接受器官移植的采用了免疫抑制药物的,正在接受化疗的,癌症晚期的,还有,没有免疫能力的人。即使这些人血清转化的“延迟”在医学专业领域也饱受争议。即使这些人通常也在符合3个月窗口期之说,但是为了保险起见,还是建议那些有免疫缺陷的人查到6个月。再没有其他人需要查到3个月以后。如果服用了阻断药物(PEP),那要在服用最后一剂PEP的3个月之后检测。
“Autoimmune Disorders”. This is often confused with what I discussed above. Autoimmune disorders (ie rheumatoid arthritis) are completely different from a person with a severely compromised immune system, from chemo, etc. The presence of an autoimmune disorder does NOT change the testing guidelines whatsoever, and it will not affect the test results.
“自身免疫功能紊乱”。这经常和我上面所说的免疫缺陷混淆。自身免疫性疾病(比如风湿性关节炎)和由于化疗等原因造成的严重的免疫系统缺陷完全不同。自身免疫功能紊乱不影响检测时间的指南,也不影响检测结果。
“Blood to Blood Exposures”. We get questions about this all the time. HIV is classified as a “blood borne pathogen”, which is where a lot of this fear comes from. It basically means that the virus has to reach the bloodstream. In sexual exposures, it does this through the mucous membranes of the vagina or anus, which are VERY vascular, with very easy access to the vascular system. In a needle sharing scenario, a person is injecting infected blood DIRECTLY into their bloodstream. These situations are VERY different from a superficial skin “exposure”:
“血液到血液的暴露”。我们总能碰到这样的问题。HIV被列为“血源性病原”,这也就是很多恐惧来源的地方。简单来说就是病毒要进入血液循环系统。性暴露中,病毒通过阴道或直肠的的粘膜,这些粘膜有着丰富的血管,是病毒极易进入血管系统的通道。对于共用针具的情况,就是一个人直接将感染者的血液注入他们的血液循环系统中。这些情况和表皮曾所谓的“暴露”有极大的不同。
Someone has a cut and was exposed to someone else’s cut. This does not pose a risk for many reasons. First, the skin serves as an EXCELLENT barrier to the virus. The skin is comprised of several layers, and injuries, like paper cuts, etc…begin healing IMMEDIATELY from the inside out. Therefore, even if there IS a superficial abrasion/laceration, it will not allow the virus to penetrate deep enough to reach the bloodstream, which is what has to happen for infection. In a VERY severe scenario, there may be a risk….for example, two people being in a car accident with large major hemorrhaging injuries where there is HUGE exposure to the other person’s blood through a very significant (deep) injury. However, again…being exposed to someone else’s blood in small amounts, even with a small cut, will NOT place you at risk.
有些人有个小伤口暴露于别人的小伤口。无论如何这都没什么危险。首先,皮肤是一个阻止病毒的非常好的屏障。皮肤有好几层组成,而一些伤口,比如小伤口等,可以很快地从伤口内部开始愈合。所以,即使是表皮的破损/破口,病毒也不能穿透足够的深度到达血液循环系统,这是构成感染的必要条件。在一些非常极端的情况下,可能会有风险,比如,交通事故中的两个人,身上有比较大流血的伤口,也就是通过很深的伤口暴露于别人血液的之中。然而,再重复一次,暴露于别人很少的血液,即使有个小伤口,也不会有风险。
The Great ORAL Debate. This is probably our most common question. Unprotected oral sex. Is it a risk? The short answer: NO. The long answer….
关于口交的大讨论。这可能是我们最常见的问题。无保护的口交。有风险吗?简单回答:没有。拆开来说…
There is often a difference in the answers given by the docs in the expert forum vs us. People have to understand that medical professionals and the CDC have a responsibility to be ULTRA conservative when discussing risks. Therefore, there is a MINUTE “theoretical” risk assigned to oral sex. If oral sex was TRULY a “real” risk, there would be new cases all the time of HIV being transmitted in this manner. There absolutely is NOT. And a “theoretical” risk is VERY different from an actual risk. The docs have BOTH said time and time again in the expert forum that neither of them, in their combined DECADES of being specialists dealing with HIV have EVER seen a case of HIV as a result of oral sex, nor have they READ any convincing cases. There is a physiological reason for that. First, the virus isn’t present in the saliva, making infection impossible for the receptive partner (the person receiving oral sex). Secondly, for the person GIVING oral sex, THEIR saliva contains enzymes that inhibit the virus, should they be exposed to infected genital secretions. Secondly, again, the virus has been exposed to the air and elements, rendering it inactive in an oral situation. This debate will continue, but again, for anyone worrying about an oral “exposure”…think of the facts. If it was truly a risk, there would be newly reported cases ALL the time.
通常我们的回答和专家论坛的答案有所不同。大家要明白一点,医学专家和CDC在讨论行为风险的时候有必要保持过度的保守。所以,口交是有一个极小的所谓的“理论”风险。如果口交真有“事实”的风险的话,那么应该总能发现一些通过这种行为感染的新病例。但是绝对没有。同时“理论”的风险和实际的风险有很大的不同。专家版块的两位专家(译注:Dr.HHH和Dr.Hook)经常说,在他们两个作为HIV专家几十年从来没见过一例通过口交感染的例子,和没有看到过任何可信的报道。这里有一个生理学的原因。首先,口水中是没有病毒的(译注:不足以感染的病毒含量)所以口交的接受方是不可能感染的。其次,对以口交的主动方,他们的口水中有多种酶可以抑制病毒,如果他们暴露于感染性的生殖器分泌液。再次,在口交的过程中,病毒已经暴露于外部环境中,已经失活。这个争论还会继续,但是再说一次,如果谁担心口交的风险,那么请想想这些事实。如果真是个有风险的行为,那应该总有新的案例报道。
HIV is classified as an STD, which means, basically, one has to have SEX to be at risk. This leads me to the primary REAL risks of becoming infected. They are UNPROTECTED VAGINAL OR ANAL SEX, sharing IV drug works, and from mother to infant. Sexually, there are certainly higher risks. Homosexual men having sex with other men still remains a higher risk, with a “bottom” anal sex partner having unprotected sex being about the highest risk factor. HOWEVER…despite this information….HIV is still on the rise among heterosexual partners. While it is less of a risk, it is still a risk! And, despite the “odds” out there, it IS possible to get HIV from only ONE episode of unprotected hetero sex. Who wants to take those kinds of chances? Therefore, remember to protect yourself at all costs. ONE moment of pleasure for a lifetime of dealing with a chronic illness? Seems like one heck of an exchange!
HIV被列为性传播疾病,也就是,简单说,要有性行为才构成风险。导致感染的有“实际”风险的高危行为是:无保护的阴道性交或肛交,共用静脉注射吸毒的针具,母婴传播。双性恋者确实有更高的风险。同性恋男性再和其他男人性交也有更高的风险,无保护的肛交的被插入方有着最高的风险。然而,尽管如此,HIV在异性恋人群中的比例仍然在增长。尽管风险低,但仍然有风险!而且,尽管几率很低,但是一次无保护的异性性行为是有可能导致感染的。谁愿意冒这样的风险呢?所以,记住无论如何一定要保护好自己。一时的痛快换来一辈子的慢性病?看起来不是件划得来的交易!
Protection. HIV is a 100% preventable disease. Condoms work. Therefore, condoms used consistently and correctly will almost guarantee a future free of HIV. Whether a person chooses to use condoms for oral sex is a personal decision. It certainly is adviseable to protect against other STD’s, which are far more prevalent, and easier to transmit via oral sex. When engaging in a sexual relationship, follow a few rules. First, have open conversations with a prospective partner about their history, and flat out ask their history, whether they have been tested, etc. ANYone who is evasive about their answer, or refuses to answer….walk away. UNLESS you have been mutually tested with a monogamous partner…unprotected intercourse should NEVER be an option. Men, choose condoms that are the right fit, and use only ONE condom at a time. Some people think that 2 condoms at a time offers double protection. To the contrary, they increase the risk of condom failure. Use plenty of WATER based lubrication, like KY jelly, and if you question the quality of a condom, use another one. Make sure the condoms are not expired, as that also increases the risk of condom breakage. When condoms break, they do so CATASTROPHICALLY. There is no doubt. Therefore, if you use a condom, and it is WHOLE after the act, the condom worked. Always remember to hold onto the condom on withdrawl, this will prevent slippage, which overall isn’t a risk for HIV, but may expose you to other STD’s. The fact that HIV virus can penetrate an intact condom is also an urban myth. The ONLY exception to this is lambskin condoms…they are not efficient against HIV. Use latex or polyurethane condoms only to protect against HIV.
保护措施。HIV是可以100%预防的疾病。安全套是有用的。所以,坚持正确使用安全套几乎可以担保一辈子都与HIV无缘。口交过程中是否使用安全套由个人决定。安全套也是推荐用来预防其他性病的措施,这些性病要流行的多得多,而且很容易通过口交感染。当发生性行为时,遵守一个规则,首先,和对方开诚布公地谈一下彼此的交往史,尽量问清楚他们的过去,是否检测过等。谁要是逃避这个问题,或者拒绝回答,那么请你走开。除非双方都检测过的一夫一妻的性行为,否则无保护的行为绝不可取。男性,选择一款合适大小的安全套,一次只使用一只安全套。有些人认为两只安全套提供双重的保护。恰恰相反,两只安全套增加了安全套失效的风险。使用水性的润滑剂,比如KY果冻;如果怀疑安全套的质量就换一只。确定安全套没有过期,因为这也会增加安全套破裂的风险。如果安全套破裂,是有风险的。这是无疑的。所以,如果你使用一只安全套,在性行为结束之后,安全套是完整的,那么安全套的保护是有效的。还要记住一点,在抽出的时候用手握住安全套,者可以防止滑落,这个和HIV的风险无关,主要是考虑预防其他性病。HIV病毒可以穿透完好的安全套也是一个相见传说。唯一的例外是羊皮套,它不能预防HIV(译注:估计很多人见都没见,不用管他)。只有乳胶或聚亚安酯安全套可以预防HIV。
Medical Exposures. You cannot and will not EVER be infected by a medical procedure, like having your blood drawn, or an IV inserted. Medical professionals do NOT re-use needles, period. Mainly because if they did, they would be placing themselves at risk for all kinds of infections, and they simply wouldn’t do that. Secondly, most of the needle products out there today allow for a ONE time use only, and have safeguards in place to prevent re-use. If you are worried about this…put it out of your mind, it is irrational.
医疗暴露。像抽血和静脉注射是不可能感染的。目前,医疗专业机构不会重复使用针具。主要是因为如果他们用的话,他们将要面对更多其他疾病的感染风险,所以他们不会那样去做的。其次,现在绝大多数的针具都是一次性的,上面有防错措施保证不能被重复使用。如果你担心这些,请把它抛之脑后,这是不可理理喻的。
Lastly, if you feel you’ve had a risk, then get tested. There is NO reason not to. Anxiety is NO excuse not to get tested. “Not knowing” doesn’t change your test result…it just delays possible life-saving treatment, not to mention, may keep you from the likely relief of a negative result. HIV education is vital….and in this day and age, not ONE more person should be getting infected. It is completely avoidable.
最后,如果你认为你有过高危行为,那么就去检测。没有理由不去。焦虑不是去检测的理由。“不敢去检测”也不能改变检测的结果。而这仅仅是拖延了救命的时间而已,更别提在绝大多数的情况下这只是让事实阴性的你在恐惧中煎熬的更久而已。HIV的宣传教育很重要,就目前来说,不应该有更多的人被感染。这完全可以避免的。
If you have been tested, and your result is NEG at 3 months, you do NOT have HIV, despite any “symptoms” you are sure you have. One can NEVER EVER gauge a risk by physical symptoms. Newly infected people many times do not experience any ARS symptoms, not to mention that ARS symptoms are also VERY consistent with thousands of other common, non-HIV illnesses, infections. If you have had a NO RISK situation, or have tested NEGATIVE at 3 months, or both…and you simply CANNOT move on, cannot convince yourself that you do not have HIV, then it is time to seek professional help for yourself. HIV phobias/anxiety is sadly pretty common. One can see that by reading either of the HIV forums here on MH. Continuing to search the internet is the absolute WORST thing you could do in that situation. That would be synonomous with a person with a severe snake phobia throwing themselves into a snake pit day after day.. Doesn’t make much sense, does it?
如果你检查完了,3个月的检查结果是阴性的,那么你没有被感染,尽管许多“症状”然你觉得你感染了。不要用身体的症状来判断你的风险。大多数的新近的感染者是没有任何急性期症状的,更别谈所谓急性期症状和其他成千上万的普通,非HIV的感染相似。如果你的行为没有风险,或者说3个月之后的检查是阴性的,或者两者都是,而你却不能脱恐,不能说服自己没有感染HIV,那么是寻求专业人士帮助的时候了。恐艾症如此普遍令人感觉遗憾。大家可以看看我们的两个论坛就知道了(译注:支持版块和专家版块)。不断搜索网络可能是在这种情况下你所能做的绝对是最糟糕的事。相当于一个惧怕蛇的人日不一日地反复把自己扔进蛇窟的愚蠢的行为。这有意思吗?
The “HIV Prevention” forum here at MH is to help people assess a risk. The forum has rules in place because of the nature of the high levels of anxiety related to the subject. People get a little upset with us when we tell posters to “move on”, but it is absolutely a necessity. We HAVE to maintain order in the forum, and once we have advised a poster that they have not had a risk, or they are conclusively negative, there isn’t much more we can tell them. There are hundreds, thousands of posts to search. We cannot provide constant emotional support, that just isn’t whay the forum is there. Of course we recognize that people coming to us are highly anxious and of course we are compassionate, but there comes a time when enough is enough. No one else would get their ?’s answered if we allowed every person to continue on and on, asking the same question in a different way. Therefore, it deserves mention…if YOU are one of these people, be courteous to the other posters in the forum, and please follow the rules. Again, the search option is available to you, you can review MANY threads discussing the same topic.
Medhelp的艾防论坛是帮助人们评估风险的。针对高度焦虑相关的问题这个论坛有它的适当的规则。在我们告诉发帖者“可以脱了”的时候,人们往往还是有一点不安,但是这绝对没有必要。我们要保持论坛的秩序,当我们告诉发帖者他们没有风险,或者他们完全排除了,我们就不会再说什么了。这儿有成千上万的帖子可以搜索。我们不可能提供持续的心理辅导,那不是论坛存在的目的。当然我们知道来这里咨询我们的人们都很焦虑,而我们有深表同情,但是不可能没完没了。如果我们回答某个人的问题并且告诉他可以安心生活了,而他还在变着法子问同一问题的时候我们将不再予以答复。再说一次,网站的站内搜索功能对你都是可用的,你可以看到成千上万讨论相同问题的帖子。
Hopefully, this information will help those who are looking for some insight into HIV and its risks.
非常希望,这些信息可以帮助那些正在深入研究HIV及其风险的人们。