School nurses play a key role in ensuring a safe and healthy environment for all students, both individually and for the full school community. The school nurse’s office provides a safe haven, where students can express their concerns, increase their knowledge, and gain the confidence to practice and engage in healthy behaviors.

Studies demonstrate that youth are deeply concerned about their own sexual health, especially sexual health as the “big concern” for people their age. Sexually transmitted diseases (STD), HIV-AIDS, and unintended pregnancies are concerns among youth. Research indicates that four in five adolescents and young adults ¾ including 79 % of those who are not sexually active ¾ say they are personally concerned about how sexual health issues may affect them.

Why is it important for youth to know about HIV-AIDS? Several factors make youth particularly vulnerable to HIV-AIDS. Youth in New York State face health risks every day. Experimentation and risk-taking help youth grow and mature, but can also lead to behaviors that threaten their current or long-term health. Age, biological and emotional development, and peer pressure are often factors leading to risky behaviors.

For young people, a reduction in risky behavior can mean the difference between life and death. Awareness is often the first step in building positive behaviors. Information that is clear, concise and understandable, builds the foundation for awareness and action. The Centers for Disease Control and Prevention has published several of the most frequently asked questions about HIV-AIDS for school nurses and other professionals seeking to assure that their own knowledge base is accurate and current.

Following are sample questions and answers that provide background for school nurses regarding issues that may be important to youth.

What is HIV? HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes. In addition, infected pregnant women can pass HIV to their babies during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

What is AIDS? AIDS stands for Acquired Immunodeficiency Syndrome. Acquired means that the disease is not hereditary but develops after birth from contact with a disease-causing agent (in this case, HIV). Immunodeficiency means that the disease is characterized by a weakening of the immune system. Syndrome refers to a group of symptoms that collectively indicate or characterize a disease.

In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system

A physician using specific clinical or laboratory standards can diagnose AIDS.

How is HIV passed from one person to another? HIV transmission can occur when blood, semen, pre-seminal fluid, vaginal fluid, or breast milk from an infected person enters the body of an uninfected person. HIV can enter the body through a vein (e.g., injection drug use), the lining of the anus or rectum, the lining of the vagina and/or cervix, the opening to the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), or cuts and sores. Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.

These are the most common ways that HIV is transmitted from one person to another:

• by having sex (anal, vaginal, or oral) with an HIV-infected person;
• by sharing needles or injection equipment with an injection drug user who is infected with HIV; or
• from HIV-infected women to their babies before or during birth, or through breast-feeding after birth.

HIV also can be transmitted through receipt of infected blood or blood clotting factors. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world.

How can I tell if I'm infected with HIV? What are the symptoms? The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of infection with HIV:

However, no one should assume they are infected if they have any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.

Similarly, you cannot rely on symptoms to establish that a person has AIDS. The symptoms of AIDS are similar to the symptoms of many other illnesses. AIDS is a medical diagnosis made by a doctor based on specific criteria established by CDC.

Is there a connection between HIV and other sexually transmitted diseases? Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person is also infected with another STD, that person is more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid all STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

• engaging in behaviors that do not involve vaginal or anal intercourse or oral sex;

• having sex with only one uninfected partner; and

• using latex condoms every time you have sex.

Why is injecting drugs a risk for HIV? At the start of every intravenous injection, blood is introduced into the needle and syringe. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing") carries a high risk of HIV transmission because infected blood can be injected directly into the blood stream.

Sharing drug equipment (or "works") can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by:

• using blood-contaminated syringes to prepare drugs;

• reusing water;

• reusing bottle caps, spoons, or other containers ("spoons" and "cookers") used to dissolve drugs in water and to heat drug solutions; or

• reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.

 It is important to know that sharing a needle or syringe for any use, including skin popping and injecting steroids, can put one at risk for HIV and other blood-borne infections.

Can I get HIV from casual contact (shaking hands, hugging, using a toilet, drinking from the same glass, or the sneezing and coughing of an infected person)? No. HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. HIV is not transmitted through shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, or pets. HIV is not an airborne or food-borne virus, and it does not live long outside the body. HIV can be found in the blood, semen, or vaginal fluid of an infected person.

Can I get HIV from getting a tattoo or through body piercing? A risk of HIV transmission does exist if instruments contaminated with blood are either not sterilized or disinfected or are used inappropriately between clients. CDC recommends that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized between clients.

Personal service workers who do tattooing or body piercing should be educated about how HIV is transmitted and take precautions to prevent transmission of HIV and other blood-borne infections in their settings.

If you are considering getting a tattoo or having your body pierced, ask staff at the establishment what procedures they use to prevent the spread of HIV and other blood-borne infections, such as the hepatitis B virus. You also may call the local health department to find out what sterilization procedures are approved in the local area for these types of establishments.

Can I get HIV from kissing? HIV is not transmitted casually, so kissing on the cheek is very safe. Even if the other person has the virus, your unbroken skin is a good barrier. No one has become infected from such ordinary social contact as dry kisses, hugs, and handshakes. Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner and then enter the body through cuts or sores in the mouth. Because of this possible risk, the CDC recommends against open-mouth kissing with an infected partner.

Can I get HIV from oral sex? Yes, it is possible for either partner to become infected with HIV through performing or receiving oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.

Can I get HIV from anal sex? Yes. In fact, unprotected (without a condom) anal sex (intercourse) is considered to be very risky behavior. It is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus.

Can I get HIV from vaginal sex? Yes, it is possible for either partner to become infected with HIV through vaginal sex (intercourse). In fact, it is the most common way the virus is transmitted in much of the world. HIV can be found in the blood, semen, pre-seminal fluid or vaginal fluid of a person infected with the virus.

Can I get HIV while playing sports? There are no documented cases of HIV being transmitted during participation in sports. The very low risk of transmission during sports participation would involve sports with direct body contact in which bleeding might be expected to occur.

The Centers for Disease Control and Prevention provides current information to health professionals about HIV-AIDS. The CDC-NPIN FAX is the fax-on-demand service of the CDC National Prevention Information Network (NPIN), which provides 24 hours a day access to reports, fact sheets, and other documents related to HIV, STD, and TB prevention. To use the CDC-NPIN FAX, call the toll-free CDC-NPIN number, 1-800-458-5231, and follow the instructions to receive a list of materials available by fax or to order specific items. Additional and expanded Frequently Asked Questions are available at: http://www.cdc.gov/hiv/pubs/faqs.htm