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informed consent and review the risk factors for HIV infection with the patient and discuss safer sex and safer needle use as well as the meaning of a positive test For persons whose test results are positive, information on available medical and mental health services should be provided as well as guidance for contacting sexual or needle-sharing partners Interventions focused on the importance of HIV-infected persons not putting others at risk have been successful For patients whose test results are negative, clinicians should review safer sex and needle use practices, including counseling not to exchange bodily fluids unless they are in a long-term mutually monogamous relationship with someone who has tested HIV antibody-negative and has not engaged in unsafe sex, injection drug use, or other HIV risk behaviors for at least 6 months prior to or at any time since the negative test Only latex condoms should be used, along with a watersoluble lubricant Although nonoxynol-9, a spermicide, kills HIV, it is contraindicated because in some patients it may cause genital ulcers that could facilitate HIV transmission Patients should be counseled that condoms are not 100% effective They should be made familiar with the use of condoms, including, specifically, the advice that condoms must be used every time, that space should be left at the tip of the condom as a receptacle for semen, that intercourse with a condom should not be attempted if the penis is only partially erect, that men should hold on to the base of the condom when withdrawing the penis to prevent slippage, and that condoms should not be reused Although anal intercourse remains the sexual practice at highest risk for transmitting HIV, seroconversions have been documented with vaginal and oral intercourse as well Therefore, condoms should be used when engaging in these activities Women as well as men should understand how to use condoms so as to be sure that their partners are using them correctly Persons using injection drugs should be cautioned never to exchange needles or other drug paraphernalia When sterile needles are not available, bleach does appear to inactivate HIV and should be used to clean needles Current efforts to screen blood and blood products have lowered the risk of HIV transmission with transfusion of a unit of blood to 1:1,000,000 In the hospital, concerns about nosocomial infection have led to the recommendation for universal body fluid precautions This involves the rigorous use of gloves when handling any body fluid and the addition of gown, mask, and goggles for procedures that may result in splash or droplet spread as well as the use of specially designed needles with sheath devices to decrease the risk of needle sticks Reports of transmission of drug-resistant tuberculosis in health care settings also have had infection control implications All patients with cough in outpatient settings should be encouraged to wear masks Hospitalized HIV-infected patients with cough should be placed in respiratory isolation until tuberculosis can be excluded by chest radiograph and sputum smear examination Primate model data have suggested that development of a protective vaccine may be possible, but clinical trials in humans using gp120 or its precursor gp160 have shown development of neutralizing antibodies to laboratory but not field isolates of HIV and may not be protective of infection.

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