HIV and Safer Sex
November 7, 2017
Table of Contents
Safer sex can be fun, exciting, and very pleasurable. It can make your sex more relaxed and satisfying, by decreasing your worry about getting or spreading sexually transmitted infections or diseases (STIs or STDs). It is also a great chance to add variety to your sex life, and to build trust and intimacy with your partner(s), by talking about each other's desires.
Some health conditions, which may become serious without treatment, can be passed from one person to another through sex. Safer sex is sex that reduces the chances of spreading or getting STIs. It involves certain actions (e.g., using a condom, taking HIV drugs) that prevent person-to-person sharing of bodily fluids that are able to spread STIs. Choosing to have safer sex shows that you care about the pleasure and health of yourself and your sexual partner(s).
For people living with HIV (HIV+), safer sex is important because it can prevent infection with other STIs that can weaken the immune system. If both people are living with HIV, safer sex can also reduce the chances of getting another strain of HIV that is resistant to the HIV drugs you are taking. Taking HIV drugs is also a part of safer sex for people living with HIV. When a person's viral load has reached undetectable levels (not enough HIV in their bloodstream for a test to measure), they cannot transmit HIV to a partner through sex.
Practicing safer sex involves knowing what bodily fluids can spread sexually transmitted infections, what sexual activities are risky for each person, and how you can make that activity less risky. Bodily fluids that can spread STIs include blood (including menstrual blood), vaginal secretions, and semen (cum and pre-cum).
Researchers have also found that hepatitis C can be sexually transmitted through anal sex even when no blood is present.
One part of safer sex is using barriers to prevent passing fluids into another's body. Barriers include condoms (male and female), dental dams (thin squares of latex), and latex or nitrile gloves. Barriers can help reduce the risk of spreading or getting STIs by keeping one partner's fluids from getting into or onto the other partner. There are also several sexual activities that do not pass sexual fluids or blood between bodies and therefore have virtually no STI transmission risk.
Other than barrier methods, which many people or their partner(s) may not wish to use, there are now several more options to protect against getting or spreading HIV during sex. Treatment as prevention, or TasP, refers to ways in which we can use HIV drugs, or HIV treatment, to lower the risk of spreading HIV. After many years of research and evidence, we now know that a person living with HIV who is taking HIV drugs and is virally suppressed (has an undetectable viral load) is unable to transmit HIV to a partner. For much more information on this exciting development, see our Undetectable Equals Untransmittable fact sheet.
For people who are HIV-negative, taking HIV drugs can protect against becoming HIV-positive if they are exposed to HIV. Treatment as prevention for HIV-negative people includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP means taking HIV drugs before potentially being exposed to HIV, to prevent yourself from getting it. It involves taking a pill every day, much in the same way you might take birth control pills. Research has shown that PrEP is a promising tool that women can use to prevent HIV without their partners' knowledge or cooperation. Post-exposure prophylaxis (PEP) refers to taking HIV drugs for about a month immediately after possible exposure to HIV (e.g., unprotected sex, meaning sex without barriers or treatment-as-prevention methods), to prevent HIV acquisition.
Recent research shows, in any act of sex, a partner who is living with HIV and has an undetectable viral load will not transmit HIV to their partner. However, other STIs, or unwanted pregnancies, may be a factor in thinking about safer sex. HIV treatment as prevention cannot prevent STIs besides HIV, and does not keep a partner with a uterus from getting pregnant. Please see our fact sheets on Birth Control and STIs for more information about preventing these conditions.
If you are unaware of your or your partner's viral load, or the viral load is detectable, it can be helpful to know which sexual acts are more risky than others for HIV. The risk for a specific sexual act is determined by what bodily fluids are being exchanged and what part of the body is involved. Below is a list of common sexual activities, their risks, and tips for making them safer:
Receptive vaginal-penile sex, or heterosexual intercourse, refers to sex in which the penis goes into the vagina. It is considered a high-risk activity when barriers or treatment-as-prevention methods are not used. It is the most common way that HIV is spread worldwide. While it is high risk for both women and men, men living with HIV are much more likely to spread HIV to women than women living with HIV are to spread HIV to men.
One effective way to make vaginal-penile sex safer is to use a condom (rubber). There are two main types of condoms: male condoms and female condoms. Most male condoms are made of latex; some are made of polyurethane or polyisoprene (types of plastic) or lambskin. Lambskin condoms can prevent pregnancy; however, they do NOT prevent the spread of HIV. Only latex and plastic condoms prevent the spread of HIV.
Male condoms come in a variety of shapes, sizes, colors, textures, and even tastes. They are generally inexpensive and can be found at pharmacies, grocery stores, and sex stores. Sometimes they are available for free at certain health clinics and HIV service organizations. They are also quite small and easy to carry with you, so that you can always be prepared to protect yourself.
Female condoms are made of latex or polyurethane and can be put inside the vagina or the anus before you begin sexual activity. They usually cost more than male condoms and are often available at pharmacies, grocery stores, and sex stores. They are also available for free at certain health clinics and HIV service organizations.
To make vaginal-penile sex even safer, consider using lubricant (lube). Lube can prevent the condom from breaking and also helps prevent small cuts or tears in the vagina and on the penis during penetration. Lube is good for un-lubricated condoms as well as ones that come already lubricated; sometimes the lubrication on the condoms is not enough. Condoms lubricated with the spermicide Nonoxynol-9 (N-9) are no longer recommended. They have a shorter shelf life, do not decrease pregnancy more than other lubricated condoms, and may cause irritation of the vagina or rectum (which increases HIV risk).
When using latex condoms, use only water- or silicone-based lube. Do not use oil-based lubes like Vaseline, Crisco, shea butter, or baby oil with latex condoms because they weaken the condom and make it more likely to break. Silicone-based lube will last longer than water-based lube. Lube can also make the condom feel better. There are several types and brands of lubes, with a variety of different feels and tastes. Some also contain substances that warm' or enhance sensation. For more information on using condoms, see our fact sheet on Talking to Your Partner About Condoms.
If you are not using a condom, you can avoid getting semen in the vagina by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm or ejaculation. Therefore, having a man pull out before he comes is not a guarantee that you will not get HIV or other STIs spread through male sexual fluids.
Receptive anal-penile sex refers to sex in which the penis enters the anus or butt-hole. It is a high-risk activity when barriers or treatment-as-prevention methods are not used. While the risk for the insertive male partner is lower than for the receptive partner, it is still risky. As with vaginal-penile sex, a highly effective way to make anal-penile sex safer is to use a condom and lube.
When using latex condoms, use only water- or silicone-based lubricant to prevent the condom from breaking and help the condom feel better. Lube will also help prevent small cuts or tears to the rectum, anus, or penis during penetration. Do not use oil-based lubes like Vaseline, Crisco, shea butter, or baby oil with latex condoms because they weaken the condom and make it more likely to break. There are several types and brands of lubes, with a variety of different feels and tastes. Currently, there is research going on to look at which type of lube is best for anal sex. However, there is not enough evidence yet to make recommendations about which lube is safest.
If you are not using a condom, you can avoid getting semen in the anus by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm. Therefore, having a man pull out before he comes is not a guarantee that you will not get HIV or other STIs spread through male sexual fluids.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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