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HIV Prevention Basic Questions and Answers

June 27, 2014

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HIV Prevention Basic Questions and Answers

Today, more tools than ever are available to prevent HIV. In addition to limiting your number of sexual partners, never sharing needles, and using condoms correctly and consistently, you may be able to take advantage of newer biomedical options such as pre-exposure and post-exposure prophylaxis.


How Can I Prevent Getting HIV From Anal or Vaginal Sex?

Choose less risky sexual behaviors, limit your number of sex partners, use condoms, use medicines to prevent HIV if appropriate, and get checked for sexually transmitted diseases (STDs). The more of these actions you take, the safer you can be.

Specifically, you can:

  • Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming). Sexual activities that do not involve the potential exchange of bodily fluids carry no risk for getting HIV (e.g., touching).
  • Use condoms consistently and correctly.
  • Reduce the number of people you have sex with. The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
  • Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicine daily to prevent HIV infection. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you are HIV-negative and have had a sexually transmitted disease (STD) or any anal sex (receptive or insertive) with a male partner without condoms in the past six months and are not in an exclusive relationship with a recently tested, HIV-negative partner.
  • Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable (see Can I transmit HIV if I have an undetectable viral load?). Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV.
  • Get tested and treated for other STDs and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others. Find an STD testing site.
  • If your partner is HIV-positive, encourage your partner to get and stay on treatment. ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.


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How Can I Prevent Getting HIV From Oral Sex?

Avoid having your partner ejaculate in your mouth, and use barriers such as condoms, natural rubber latex sheets, dental dams, or cut-open non-lubricated condoms between your mouth and your partners' genitals.

Oral sex involves giving or receiving oral stimulation to the penis (fellatio), the vagina (cunnilingus), or the anus (anilingus or rimming). Most types of oral sex carry little to no risk of HIV. Your highest oral sex risk is performing oral sex (fellatio) with ejaculation in your mouth. However, the risk is still low, and much lower than anal or vaginal sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs) (which may or may not be visible).

The risk is lower if the partner with HIV is taking antiretroviral therapy (ART) consistently and correctly, and if the partner who is HIV-negative is taking pre-exposure prophylaxis (PrEP) consistently and correctly. Condoms and HIV medicines can greatly lower the risk of transmitting HIV.

Keep in mind that barrier methods are the only way to protect you from some STDs, including gonorrhea of the throat. And although the chance of getting or transmitting HIV from anilingus (rimming) is small, there is a big chance of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming. There are effective vaccines that protect against hepatitis A and B and human papillomavirus infections. Talk to your health care provider to see if these are right for you, if you have not already been vaccinated.

For more information, see Oral Sex and HIV Risk.


How Well Do Condoms Prevent HIV?

When used correctly and consistently, condoms are highly effective in preventing HIV infection.

Condoms are also effective at preventing sexually transmitted diseases (STDs) transmitted through body fluids, like gonorrhea, chlamydia, and HIV. However, they provide less protection against STDs spread through skin-to-skin contact like human papillomavirus (genital warts), genital herpes, and syphilis.

There are two types of condoms: male and female.


Male Condoms

  • Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies. Natural membrane (such as lambskin) condoms are porous, meaning that infections can pass through them, and therefore do not protect as well against HIV and certain other STDs.
  • Lubricants can help prevent condoms from breaking. Water-based and silicon-based lubricants are safe to use with latex condoms. Oil-based lubricants and products containing oil, such as hand lotion, Vaseline, or Crisco should not be used with latex condoms.


Female Condoms

  • Female condoms are thin pouches made of a synthetic latex product called nitrile.
  • When worn in the vagina, female condoms are just as effective as male condoms at preventing STDs, HIV and pregnancy. Some people use female condoms for anal sex. However, we do not know how well female condoms prevent HIV and other STDs when used for anal sex. But we do know that HIV cannot travel through the nitrile barrier.
  • It is safe to use any kind of lubricant with nitrile female condoms.

Although highly effective when used consistently and correctly, there is still a chance of getting HIV if you only use condoms, so adding other prevention methods can further reduce your risk (see "How can I prevent getting HIV from anal or vaginal sex?").


Can Using a Lubricant Help Reduce My HIV Risk?

Yes, because lubricants can help prevent condoms from breaking.

Water-based and silicon-based lubricants are safe to use with latex condoms. Oil-based lubricants and products containing oil, such as hand lotion, Vaseline, or Crisco should not be used with latex condoms. It is safe to use any kind of lubricant with nitrile female condoms.


Can Male Circumcision Prevent HIV?

Male circumcision reduces the risk that a man will get HIV from an infected female partner, and also lowers the risk of other sexually transmitted infections (STIs), penile cancer, and infant urinary tract infection. Studies have not consistently shown that it prevents HIV among men who have sex with men. Circumcision is only partly effective and should be used with other prevention measures. Men who are considering circumcision should weigh its risks and costs against its potential benefits. For more information on male circumcision and HIV, see CDC's male circumcision site.


Can I Take Medicines to Prevent Getting HIV?

Pre-exposure prophylaxis, or PrEP, can lower the risk of getting HIV by taking a pill every day. It is for people who do not have HIV but who are at substantial risk of getting it.

CDC recommends that PrEP be considered for people who are HIV-negative and at substantial risk for HIV.

For sexual transmission, this includes anyone who is in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous* relationship with a partner who recently tested HIV-negative, and 2) is

  • a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or
  • a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).

For people who inject drugs, this includes those who have injected illicit drugs in the past 6 months and who have shared equipment or been in drug treatment for injection drug use in the past 6 months.

For heterosexual couples where one partner has HIV and the other does not, PrEP is one of several options to protect the uninfected partner during conception and pregnancy.

People who use PrEP must be willing to take the drug every day and to return to their provider every 3 months for a repeat HIV test, prescription refills, and follow-up.

Some people on PrEP may have side effects like an upset stomach or loss of appetite but these are mild and usually go away in the first month.

* Mutually monogamous means that you and your partner only have sex with each other and do not have sex outside the relationship.


Can I Take Medicines to Prevent HIV After Exposure?

Yes. >Post-exposure prophylaxis (PEP) is medicine that can prevent HIV after a possible exposure if started within 3 days.

An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is HIV-positive or whose HIV status you don't know. You take PEP for 4 weeks if you may have been recently exposed to HIV and are not on PrEP. PEP keeps HIV from making copies of itself and turning into infection. To be effective, PEP must begin as soon as possible, but always within 72 hours (3 days) of a possible exposure. Keep in mind that PEP should only be used in situations right after a potential exposure. PEP is not intended for long-term use. It is not a substitute for other proven HIV prevention methods, such as correct and consistent condom use.

You should continue to use condoms with sex partners while taking PEP. If you have repeated exposures to HIV, you should consider PrEP.

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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.
 
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