A school nurse is providing education to a group of adolescents about HIV. Which of the following risk factors of HIV should the nurse include in the education? (Select all that apply.)

Choice A rationale Unprotected sexual activity, particularly anal or vaginal intercourse, poses a high risk of HIV transmission because the virus is present in semen and vaginal fluid. Lack of a barrier method, such as a condom, allows the exchange of these fluids containing infected CD4 cells and virus particles across mucosal membranes, leading to infection. Choice B rationale Sharing needles, syringes, or other injection equipment when using intravenous drugs is a major risk factor. This practice directly transfers blood from an infected person into the bloodstream of an uninfected person, allowing the direct inoculation of the HIV virus, which has a high concentration in the blood. Choice C rationale Sexual assault significantly increases the risk of HIV transmission due to the potential for the exchange of blood or body fluids and the high likelihood of mucosal trauma (tears or abrasions) during the assault. This trauma provides an easier entry point for the virus into the recipient's bloodstream, facilitating infection. Choice D rationale Exposure to blood or certain body fluids (semen, vaginal and rectal secretions, breast milk, or other body fluid containing visible blood) from a person with HIV is the route of transmission. This includes percutaneous exposure (needlestick), mucous membrane contact, or non-intact skin contact with the fluid containing the virus, which then enters the recipient's system. Choice E rationale Smoking marijuana is not a direct route for the transmission of the HIV virus. HIV is transmitted through specific body fluids, primarily blood, semen, vaginal and rectal secretions, and breast milk, during activities like unprotected sex or sharing needles. Marijuana use does not involve these fluid exchanges.