D R . E L R O I
Tuesday, December 23, 2008
Stigma & Discrimination 4
This kind of stigma is very dangerous as it is often "invisible" - family members and friends might not even be aware of the feelings of this person. And as along as societal stigma related to HIV and AIDS exists, self-stigma will be a reality for many people. If we can eradicate societal stigma, we might be able to minimize self stigma!
This form of stigma was what I have experienced and it's really difficult to overcome with. But thank God we have Jesus Christ to save us and give another chance, another new life!
Self stigma is the reason why a lot of people tested HIV positive hides in the closet. If they continue to do this, they will never know what they are missing.
Next post I will discuss the impact of HIV related stigma.
Source: "Channels of Hope" workshop manual.
Friday, December 19, 2008
Stigma & Discrimination 3
We observe people being isolated, insulted, judged and blamed. People talk and conduct themselves in ways that make other people feel devalued, ashamed, worthless, and guilty or discriminated against. This often happens to people who are HIV positive or are battling with HIV related illness.
In some instances not only one person is stigmatized but a whole family can suffer because they are associated with the person who is stigmatized. We call this "stigma by association". Another example of this form of stigma is when a person is discriminated against because of their association with a specific group of people, e.g. the family the person belongs to, or clan, or even the church he belongs to. In the same way, a whole family can experience stigma when one member tests HIV positive. Children often experience stigma when their parents fall ill or die because of HIV.
People can also be stigmatized because of their appearance, what they look like or even their occupation. How often has it happened the people who were falling ill or were losing weight were stigmatized because people thought they might be HIV positive!
And then there is something called "self stigma" which I will talk about on my next post.
Source: "Channels of Hope" workshop manual.
Friday, November 28, 2008
Stigma & Discrimination 2
The word "stigma" is often associated with discrimination, negative feelings and attitudes. Stigma is something negative in your mind but when acted on that something either verbally or physically then that is discrimination.
For instance, when you learned that a person is HIV positive more often than not if you're not educated with the right information on HIV & AIDS and it's mode of transmission probably you would think that this person is promiscuous or a prostitute; that is stigma. When you said something bad towards the person fueled by that thought or you simply avoid him or isolated him then that is discrimination.
There are two types of stigma, the self stigma and societal stigma or stigma by association. I will discuss it on my next post.
Source: "Channels of Hope" workshop manual.
Monday, November 17, 2008
Stigma & Discrimination 1
I applied for a position related to HIV & AIDS in this Christian non-government organization. The result was negative, though it was not final yet according to my friends there, due to my HIV status! At first I was really hurt because for the very first time, I was discriminated against because of my health condition. I cried for a couple of minutes but I asked the Lord why, then I began to understand that perhaps these people are just concerned about my health coz they are afraid I might not able to do all the responsibilities of the position. Apparently, it is still plain and simple discrimination and it's against the RA8504.
I was amazed by the support and trust given to me by my friends there and sooner than I thought, I felt better and trust the Lord that He has something far better for me. So after a few minutes of that negative feeling, I was truly alright and it did not bother me at all.
The Lord only showed me that not all Christians exude true Christianity or Christ-likeness to themselves. It's like a warning to me that I must be really careful to whom I will reveal and entrust my status at the same time. Honestly, I have nothing against with that organization or to any people from that group. In fact, I will be still willing to help them in their HIV & AIDS project and I will treat them the same way I treated them before that incident happened.
Anyway, it is not a closed book yet I guess and only God knows what will happen next. It really feels good to trust God with all my heart. It feels great to know that the Lord will take care of every aspect of my life especially on the areas like this.
Stigma and discrimination will not kill me and should not kill other people living with HIV. The Lord is my strength and my shield. My heart trusts in Him and I am helped. My heart leaps for joy and I will give thanks to Him in song. That is Psalm 28:7. So if you are living with HIV like me and feel stigma and discrimination, I would encourage you and suggest surrendering yourself to Lord Jesus Christ and everything will be alright coz He will take charge.
Next post, what is really stigma and discrimination?
Saturday, October 11, 2008
HIV Prevention Strategies 3 - SAVE
Individuals who know their HIV status are in a better position to protect themselves from infection; and if they are HIV positive, from infecting another. Someone who is HIV positive can be provided with information and support to enable them to live positively. People who are ignorant of their HIV status or who are not cared for, can be sources of new HIV infection.
Empowerment of people with knowledge and skills especially women, protect themselves against HIV infection. It is not possible to make informed decisions about any aspect of HIV or sexual behavior without access to all the relevant facts. Inaccurate information and ignorance are two of the greatest factors driving HIV and AIDS related stigma and discrimination.
Correct, non-judgmental information needs to be disseminated to all; inside and outside of churches. This will assist people to live positively - whatever their HIV status - and to break down barriers which HIV has created between people and within communities. Education also includes information on good nutrition, stress management, and the need for physical exercise.
The acronym "SAVE" provides the added benefit that all religious and non-religious groups can identify with the fact that we want to save lives through multiple prevention strategies for instance, some denominations would not feel comfortable with the promotion or use of condoms and others might find it difficult to promote and distribute sterile needles to injecting drug users. But everyone will be able to identify with some of the strategies included in the "SAVE" acronym.
Let us "SAVE"!
Source: "Channels of Hope" workshop manual.
Friday, October 3, 2008
HIV Prevention Strategies 2
Before I continue with the prevention strategies let me mentioned the local statistics of HIV infection as of July 2008. There were 53 who tested positive to HIV and more than half of it was through homosexual contact. It brings the total since 1984 to 3,358 and according to my doctor; there are 63 who were tested positive in SLH alone this August. You can check the NEC at www.doh.gov.ph and click the HIV icon there for updates.
Our duty is to move from ABC to SAVE. S stands for safe(r) practices, A is for access to treatment, V is for voluntary testing and E stands for empowerment.
Safe(r) sexual practices include all avoidance and risk reduction strategies like abstinence, delay of first sexual experience, mutual faithfulness in marriage, and correct and consistent use of condoms and reduction of number of sexual partners. It also includes policies and procedures to ensure safe blood supply, sterile equipment, adoption of universal precautions, and prevention of mother to child transmission, provision of sterile needles and syringes for injecting drug users and post exposure prophylaxis or PEP. You will notice that ABC is present already within safe or safer practices.
Access implies more than only the availability of medications, and the word "treatment" encompasses more than the word "medication". Therefore "access to treatment" includes the availability of medication, as well as access to the medication and all the necessary support services. It includes the access and availability of medication like ARVs, treatment of STIs and other OIs, treatment - education and support such as access to blood tests for monitoring and adherence as well as counseling, and nutrition for people with compromised immunities or on ARVs.
Access also implies the availability of comprehensive and correct information and education in order to make informed decisions for prevention, care and support. It also implies a supportive environment where stigma and discrimination have been reduced.
Next post I'll talk about the V and E.
Source: "Channels of Hope" workshop manual.
Monday, September 29, 2008
HIV Prevention Strategies 1 - ABC
Most people have heard about the ABC approach which stands for abstinence, be mutually faithful and condoms towards HIV prevention. Its main focus is on preventing HIV transmission caused by sexual intercourse but we also learned that sexual activity is only one way of how HIV is transmitted.
Originally the ABC message was developed in Uganda. It was never meant to be the only answer to HIV prevention. It is therefore essential that we also introduce other acronym in combination with the ABC message to demonstrate that there is more than one way of protecting oneself against HIV. The complexity of the cultural and societal context in which HIV is transmitted demands a multifaceted approach.
A very popular new acronym that manages to capture the multifaceted approach is "SAVE". Even as an acronym, SAVE reflects the underlying purpose of prevention programs; that is our whole purpose - we are here to SAVE lives through education and providing skills.
I will discuss on my next post what SAVE is all about.
Source: "Channels of Hope" workshop manual.
Monday, September 1, 2008
Benefits of ARV
Because of this, ARV prevents opportunistic infections and death. People with AIDS who were terminal and had nothing to live for, recover and go back to work and start to dream again and plan their futures like me. ARV is also very effective in preventing mother-to-child transmission of HIV.
There is no doubt that these drugs are working and that HIV is becoming a manageable disease similar to, for example, diabetes. Again, it's not a cure but a treatment only and you can still infect others if you do not practice safer sex.
Developments such as the initiation of the Global Fund is currently helping Filipinos living with HIV to avail the ARV free of charge. I just hope and pray that it will last for a lifetime.
Source: "Channels of Hope" workshop manual.
Friday, August 29, 2008
Drawbacks of ARV
ARV is very expensive and cannot be afforded by the majority. The estimate cost for one type of drug is around 25,000 PHP per month. Therefore, if the person is taking three combinations of drugs it will cost around 75,000 PHP in a month. Praise God that there is global fund for the Philippines for ARV that all people living with HIV can take the medication for free.
A limited number of patients like around 5-7% can have very bad side effects such as making too little blood and becoming anemic, damage to the liver, kidney stones, changes in appearance and high cholesterol, skin rashes, etc. Quite a few people experience milder and less serious side effects which often disappear after the first month or so of treatment. Thank God that the only side effect that occurred to me was feeling nauseated.
People have to be very compliant in taking the medicine exactly as prescribed. This is to constantly keep the levels of the drug in the blood high enough to block the virus' growth, remember that ARV does not kill the virus. Missing a dose results in the level of the drug in the blood dropping, thereby giving the virus a chance to build up resistance against these drugs. Once the virus is resistant, there is no turning back. It is therefore very important that a person taking ARV does not skip any drugs at any time, even if they make the person feel ill.
People need to be closely monitored for side effects and resistance. As soon as resistance starts to appear, the person needs to move on to another regimen which is usually more complicated and expensive. As for me, I praise the Lord that my body has tolerated the combination I am taking and I am feeling normal.
Source: "Channels of Hope" workshop manual.
Friday, August 22, 2008
What Is ARV?
ARV or antiretroviral is the drug used to strengthen the immune system of people living with HIV & AIDS. The aim of this drug is to reduce the rate at which the virus multiplies in the CD4 cell or T-helper cell. It is imperative to realize that ARV DOES NOT KILL HIV. What they do is block the virus' growth. If a person stops taking ARV, the virus immediately starts multiplying again. The HIV can quickly build up resistance against one or even two drugs; therefore these drugs are normally used in combinations of three - one non-nuke with two nukes, or one protease with two nukes. This is often referred to as triple therapy, combination therapy or a drug cocktail.
Non-nuke is the short term for Non-nucleoside Reverse Transcriptase Inhibitors. It interrupts the reverse transcriptase process but do so in a different way to the "nukes". Examples of this drug are delaviridine, efavirenz or sustiva and of the three drugs I am taking which is nevirapine.
Nukes are also known as Nucleoside Reverse Transcriptase Inhibitors. These drugs interrupt the reverse transcriptase process. They block or disable the "translator or intrepreter virus". Example of these drugs are d4T or stavudine, ddl or didanosine, ddc or zalcitabine, abacavir and the other two drugs I am taking which are AZT or zidovudine and 3TC or lamivudine.
Protease inhibitors are drugs that foil replication by neutralising the protease enzyme that puts new HIV together. Some of the examples of these drugs are saquinavir, indinavir, nelfinavir, amprenavir and ritonavir.
Entry inhibitors are the newest class of drugs against HIV. They stop the virus from getting into the CD4 cell. While the first three classes of drugs are relatively cheap and widely available, these are very expensive and not easily available. Enfuvirtide or T20 is an example of protease inhibitors.
I'll talk about the drawbacks and then the benefits of taking ARV on my next posts.
Source: "Channels of Hope" workshop manual.
Friday, August 15, 2008
Living Positively 3
Think of a time when you were sick. Can you still see yourself alone, sick and miserable in bed? Aside from medicine, what will help you get well again?
Since when are flowers, SMS, chocolates became medicines? These things will make you feel better is not it? Then these must be some form of medication don't you think?
Positive living is not just about accessing medication, or the government providing free ARVS. It is about having a reason to live - about wanting to be alive.
Health is not about knowing all the facts, it is about wanting to be alive and therefore using knowledge to achieve that.
Would you therefore agree with me that positive living is also about doing the things I always dreamed about, spending sometime with people I love and people who make me laugh and feel good about myself, about claiming control of my life, my future, about being loved and supported, about celebrating life as a spiritual being, etc.?
In my case, I surrendered my life to the Lord Jesus Christ and accepted Him as my personal Lord and Savior and that is positive living! Living a Christian life is living positively.
Each one of us needs this whether we are HIV positive or not.
Source: "Channels of Hope" workshop manual.
Tuesday, August 12, 2008
Living Positively 2
Treat all the opportunistic infections or OIs. Although there is no cure for HIV, the majority of minor OIs can be healed. Ergo it is very important to treat the symptoms of all OIs as soon as it appears. This is to limit the damage it can cause to your body and to relieve you from the symptoms. A simple cold and sore throats could lead to meningitis. Untreated flu could lead to bronchitis or pneumonia. These are chances an HIV positive person should not take.
HIV will remain in the body but that does not mean all of the opportunistic infections also have to!
Antiretroviral treatment or ARVs or ART. Despite our attempts to strengthen the immune system and to keep the body generally healthy, there does come a time when the immune system is not strong enough to provide sufficient protection to the body and then it is advised that people should start taking ARVs. It's a strong medication that directly attacks the virus in the body and suppresses the multiplication of the virus. With fewer viruses or lower viral load, the attack on the CD4 cells is reduced and this gives the CD4 cells the opportunity to recover and multiply again. A higher CD4 count implies a stronger immune system.
Source: "Channels of Hope" workshop manual.
Sunday, July 27, 2008
Living Positively 1
One of the most paralyzing myths regarding HIV and AIDS is that there is nothing we can do about it. Part of the message of hope that we need to spread is that albeit there is no cure for HIV, it is possible to live a healthy and productive life despite HIV infection. It is possible to take some control of our lives and equip our selves as well as our immune system with strategies of coping better with HIV.
Now let's talk about the different treatment options. Remember that treatment is different from cure. When we refer to the term "cure", it means a type of medicine that will completely heal us or take away a specific disease. When we use the term "treatment", we use it in the context of medication and general health guidelines that help a person to manage a disease or illness. The purpose of this treatment is not to remove the disease, but to help the person to manage and limit the effect of the disease on his body.
Remember this virus weakens the immune system, which is responsible for the body's defense against other diseases and infections. With a proactive approach to treatment we need to aim at reducing the negative impact of the virus as far as possible. How can this be done?
First is strengthening the immune system, next is treating all the opportunistic infections and then taking ARV or antiretroviral treatment. Let's take a brief look at each of these individually on my next post.
Source: "Channels of Hope" workshop manual.
Thursday, July 10, 2008
From Diagnosis to Acceptance 4
The first move towards acceptance is to realize: I am still here! The person realizes that he is HIV positive but is not going today or next month.... and has a life and family and people around. The person can make the choice to remain sorry for him or herself or can start to live and love again. This implies that he starts to appreciate life and live it to the full, appreciating every small detail life can offer!
One of the biggest problems of HIV and AIDS being a slow but progressive disease is that the infected person loses the will or ability to dream about the future. The challenge is to think beyond next year - to think what you would like to do with your life if you were not HIV positive.
On hearing that they are HIV positive, a person might start to "eat, drink and be merry because tomorrow we die!" But as you accept the fact that you have a life-threatening illness, you change this into a healthy lifestyle - not fatalism but of appreciating life and the people around you.
Currently, I am in this phase of my life and I am so happy that I have accepted the Lord as my personal Lord and Savior. God has turned this nightmare into a beautiful dream that is gradually becoming a reality. I have prayed for a ministry and God has given it to me. Being an advocate for HIV and AIDS and de-stigmatization and promoting Christian living to stop the spread of HIV is an honor for me and I am happy where I am now. God is truly working on my life now and walking beside me every step of the way. Yes, there are still struggles but with the Lord, I can take control of them and not the other way around. Teaching HIV & AIDS and de-stigmatization to faith or church leaders is a wonderful experience and a privilege to me as well. I'll talk about it next time.
Source: "Channels of Hope" workshop manual.
Thursday, July 3, 2008
From Diagnosis to Acceptance 3
During this phase the HIV positive person is struggling with himself. This person might be questioning his own lifestyle and while questioning his own lifestyle, the person becomes very sensitive to any judgmental attitudes from people around him.
What is the first question person normally ask when they hear someone is HIV positive? The answer would be: "Where did he get it?" Why do we ask this? People normally want to determine: Guilty or not guilty? Who we are to judge? Have you never made any choices in your life that you now regret? What difference would it make to know how the person got infected? It could only lead to stigma, discrimination and a judgmental attitude. The fact is: the person is now HIV positive - he now needs to know that we will not reject him. This is the last question you should ever ask.
Source: "Channels of Hope" workshop manual.
Saturday, June 21, 2008
From Diagnosis to Acceptance 2
This brings on another set of emotions which could again range between anger and becoming very emotional. As the shock phase fades, and the person starts to realize the implications of his HIV positive status, they become very open to help from the outside. There is a desperate need for information and to talk to people with similar experiences or people who would be able to provide good advice. This could be a doctor, nurse or counselor. But very often a person needs to talk to someone outside the medical profession. All HIV positive people wish they could tell the people closest to them; their family and friends. But very often they are so afraid that they will lose these valuable pillars of support, that they do not have the nerve to tell them.
But at the same time, while open for help, the person is also hypersensitive in two ways: On the one hand the person might trust some people with the fact that he is HIV positive, but now he fears that those people will suddenly start to treat him differently than before. But it goes beyond people knowing your HIV status. One HIV positive person said: "It feels as if my HIV status is written on my forehead, as if everybody knows!"
On the other hand, you know that you are HIV positive. You know you will become ill at some stage but you do not know when. This suddenly causes the HIV positive person to be hypersensitive about his health. Any small illness or symptom becomes a major concern.
Confidentiality is a major concern for any HIV positive and his family. Nobody has the right to share any information about your HIV status. This becomes a major issue for any HIV positive person. They always wonder: Who knows and what do they know? Where did they find out? It is very easy to say that people should be open about their status. Remember, each person's situation is very different from the next person's situation. For some people it can be very dangerous to talk about their HIV status. We must respect a person's right to confidentiality.
Source: "Channels of Hope" workshop manual.
Thursday, June 19, 2008
From Diagnosis to Acceptance 1
We do not always understand what emotional impact HIV has on an individual's life. There are four potential phases a person might experience from diagnosis to a phase of acceptance and rebuilding. The phases we will cover will refer to the HIV infected person who is still healthy like me.
The first phase is the shock phase. When a person hears that he is HIV positive, there is normally some kind of shock reaction. This reaction differs from person to person. Mostly the first shock reaction includes some kind of emotional reaction. This could include anger, crying or a feeling of total numbness.
In this initial shock phase people might be so shocked that they say or do things they would not normally say or do; things they would later regret and this is called irrational behavior. For instance, a person might walk out of the doctor's office and start to spend money - buy everything he always wanted. Other people might say to themselves or to others: "I'm not going to die alone - why must I be infected - I am going to take some others with me."
Fortunately the initial shock phase does not last long, usually a few hours to two days.
The most important thing to remember if you should ever have to tell a person that he is HIV positive is to realize that this person is very often shocked upon hearing the news that anything said after hearing this tends to fade from their memories. Counselors or doctors sometimes forget this and would then try to provide all the possible information and prevention messages - but at that stage the person is not absorbing anything. Proper post-test counseling however is very important. It will help the person to think about the consequences of the news, how they will cope up in the next few hours, whom they will tell - if they want to tell, etc.
Source: Channels of Hope workshop manual.
Monday, June 16, 2008
Living With HIV & AIDS
Sometimes people become very negative when they hear about the realities of HIV and AIDS - the rejection, stigma and suffering associated with the illness is very real. But although it is a reality that cannot be ignored, the challenge is to see the other side of this disease; and there is another side. If we start to care for the people infected and affected by HIV and AIDS, and if we can help people to change their attitudes towards people living with HIV and AIDS or PLWHA, the other side will become clear.
With the prevalence of HIV, however, there is a possibility that somebody you love might tell you that he or she is HIV positive. It might even have been a reality to you. What would you say? How would you feel? What is the first thing that you would ask this person - "Where did you get it? From whom?"
When the person we love dearly tells us that he is HIV positive, we are shocked, angry, disappointed and ask "Where did you get this?" The reaction is always negative. But when WE test positive, we only want encouragement and support.
This is what often happens in the real world. That is why it is so difficult for HIV positive people to come out and share their status.
As human beings, we all have a need to be valued and accepted for who we are. During difficult times in our lives, this need becomes even more prominent. It is also impossible to contend with difficult situations without the support and encouragement of people close to us believing in our abilities and affirming our value.
Unfortunately, during good times we tend to become very self-sufficient and self-righteous. We find it much easier to judge and condemn a person with HIV or AIDS than to reach out to him with understanding and acceptance. We'd like to believe that such a person is reaping the fruit of their behavior and that something like that would never happen to us because we know how to behave. This might indeed be true and maybe you or I will never contract HIV. The fact is that we can not foretell the future. We don't know what calamity awaits us round the next corner, when we desperately in need of other's acceptance and compassion.
Most people support the principle: "Do to others what you want them to do to you." Unless we put ourselves in the shoes of another person, it's very difficult to understand what our needs would be in a similar situation. This is not something we automatically do. It requires a conscious decision to postpone judgment and instead try to understand the world of the other person. Only then will we know what we would have liked others to do to us in a similar situation. Choosing to value another person as a special God-created being adds value and worth to your life. AIDS is but one opportunity to put this into practice.
Source: Channels of Hope workshop manual.
Tuesday, June 10, 2008
How HIV Is Not Transmitted
HIV cannot be transmitted by using the food and eating utensils used by the HIV infected person. The HI virus has a thin protein layer that protects it against the outside world; if that protein layer is destroyed, the virus is destroyed. So if you eat any food that contains the virus, that virus will end up in your stomach with the food. The protein layer around the virus will be digested by the acidic gastric juices and the virus will be destroyed immediately.
While there is a theoretical risk of HIV transmission from an HIV infected player to an uninfected player during athletic practice or competition, most experts agree that the risk of sports-related HIV transmission is so small that it can be ignored. Universal precautions should be taken on the sports filed though. If a player is bleeding, take him off the field and treat him. If there is no free-flowing blood, there's no chance of infection.
Again, if one considers the conditions needed for the virus to survive, the chance of getting infected through toilet seats is impossible. If the virus gets onto a toilet seat, it would be in contact with air, become dry and die. Also remember that the concentration of HIV in urine is too low for any infection.
People are still worried about a mosquito sucking blood from an HIV infected person and then biting them, thus infecting them. HIV cannot be transmitted by a mosquito or any other insect bite. The HI virus is not capable of getting from the stomach of the mosquito into its bloodstream or from the bloodstream into the salivary glands. Mosquitoes can thus not pass HIV from one person to another. Malaria is a different case.
Many people think that you can contract HIV by being bewitched. This is impossible, as you need the conditions of transmission which includes an HIV positive person.
The last example of a situation in which HIV cannot be transmitted is one of the most important to remember, the physical contact. People always wonder how they should treat an HIV positive person. It's easy, absolutely normally! Remember that you cannot be infected through casual contact and that to the person who is HIV positive, it means a lot to have normal contact with others. People with HIV need positive contact as much as they need the most advanced ARV therapies. They need normal and healthy lives that include love, companionship, family and friends' support, medical care, housing, access to job, social, educational and recreational facilities, and access to places of worship.
If your friend or a member of your family is HIV positive, show friendship and love simply by being there for that person. Make physical contact by hugging him. Your friendship will not only mean a lot to that person but you will become richer person in the process.
Source: Channels of Hope workshop manual.
Monday, June 9, 2008
HIV Transmissions - Certain Actions / Situations
Let's first take a look at blood. When infected blood comes into contact with another person's blood, the virus can be transmitted. The following three ways a person can be infected through blood are blood transfusions, needle pricks and injecting drug use.
The rapid escalation of the HIV epidemic is placing pressure on blood transfusion services to keep the blood supply safe. The blood transfusion services however, take all possible precautions to ensure that nobody who is HIV positive donates blood. Injecting drug users very often share needles or a shot of drugs amongst one another. The infected blood within the syringe that they use is then injected into the next person. Most people still have irrational fears about blood. If you practice universal precautions when dealing with any person's blood in the event of an injury, there is no risk of infection. Remember that in all cases, direct blood exchange must occur for infection to take place.
The next "action" that can result in infection is when an HIV positive mother is pregnant or has a baby. HIV transmission occurs directly from the mother to the baby. It can occur during pregnancy, breastfeeding and during birth.
During pregnancy, the mother and baby do not share the same blood system. The baby receives nutrition from the mother via a process of osmosis through the placenta. No direct contact takes place so infection very seldom occurs during pregnancy, approximately 5-10% of babies born to HIV positive mothers would have been infected during pregnancy. However, if the mother is at the stage where she has a very high viral load there is then also a great chance that the baby will be infected.
Most infections which are about 10-15% of babies born to mothers with HIV occur during birth. During the birth process there might be direct blood contact in various ways: Blood exchange between mother and child when the placenta separates from the uterus wall, blood or vaginal fluid contact with the eyes or mouth of the baby as it moves through the vagina during the birth process, and blood or vaginal fluid into broken skin if instrument delivery had to be performed. If caesarean section is performed before the onset of labor, this can greatly reduce the risk of infection.
Approximately 5-20% of babies, who are born HIV negative, become infected through infected breast milk. Breastfeeding is believed to be more risky when the mother has a high viral load, the mother's nipples are cracked or she has abscesses and other breast diseases, and the baby has sores in the mouth or an inflamed gut.
But in the end, the main culprit in spreading HIV from one person to next is unprotected sexual activity! Most people still think that it will never happen to them. Ask any HIV positive person, he or she did not think it would happen to him or her either! People forget that if you are having sex, you are not having sex with that one person only.
You are in a sense having sex with everyone that person had sex with before, and with all their former sexual partners! If they had unprotected sex that could mean up to 30 or 40 other sexual partners whose HIV status you do not know. So if you're into orgies or group sex, this number could be doubled or tripled.
Note: Information was excerpt from the "Channels of Hope" manual.