Low risks, theoretical risks and impossible routes

Theoretical risks, such as the danger of people treading on syringes washed up on the beach, are distractions from the common routes of transmission and common dangers. The apparent abandonment of common sense in many people's assessment of the risks of HIV transmission suggests that fears of death, contamination and sexuality are being triggered.

All the evidence suggests almost all people with HIV acquire their infection through the routes that are well established and understood (unprotected sex, sharing needles, mother-to-child, etc.). Of over 34,000 HIV diagnoses in the UK from the beginning of the epidemic to 1997, there were only 19 recorded cases of transmissions in 'unusual circumstances'. Eleven of these involved medical facilities abroad where infection control procedures may not have been followed correctly.¹

While most people have worries and anxieties about their health from time to time, some people experience them on an ongoing basis. The psychiatric diagnosis for severe and persistent anxiety about health is 'hypochondriasis', or may be described as 'severe and persistent health anxiety'.

People who suffer from health anxiety find themselves preoccupied by health concerns and often seek reassurance from doctors and others. They may avoid things which remind them of illness, scan their bodies for signs of their feared illness, request unneeded medical tests and investigations, or seek out health information from the internet, the media and health professionals.

However, not everyone who is concerned about acquiring HIV from behaviours that are extremely low risk for HIV transmission is suffering from health anxiety.

In fact, accurate knowledge of how HIV is transmitted has actually declined in recent years in the UK. In a 2007 survey,² one in five members of the general public did not think that HIV could be passed on during sex without a condom between a man and a woman, and one in four did not think it could be passed on during unprotected sex between men. Even more were not aware that HIV could be transmitted through blood transfusions and injecting drug use. More people thought it could be transmitted through biting (18%) than through breastfeeding (14%).

A similar survey carried out in 2000 had found higher levels of knowledge.

In 2007, a worrying minority of people believed that HIV could be passed on during the following activities:

• Biting (18%)
• Spitting (5%)
• Kissing (4%)
• From a public toilet seat (2%)
• Sharing a glass (1%)
• Coughing or sneezing (1%)

Women knew more than men, and people who had had a new sexual partner in the last two years had better knowledge than other people. People aged 65 and over had particularly low levels of knowledge, but people aged 16 to 24 were not generally more knowledgable than other adults under 65.