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Multiple sex partners

telling casual partners

No matter how many sexual partners you have, protected sex is important. One thing you may not realise is that HIV treatment – which can be used by HIV positive and negative people – is a form of protection.

It's crucial that everyone understands what it means to have protected sex.


What is protected sex?

Protected sex means using a male or female condom during sex if one of you has HIV and a detectable viral load.

Condoms should be used with water-based lubricant as oil-based lube weakens them.

HIV treatment is also a form of protection.

How HIV treatment stops HIV being passed on:

  1. A person with HIV who is taking effective treatment and has an undetectable viral load cannot pass on HIV. It can take up to six months on HIV treatment to become undetectable.
  2. Pre-exposure prophylaxis (PrEP) is a course of HIV drugs taken by an HIV negative person to lower the chance of infection. When taken correctly, PrEP significantly reduces the chances of becoming HIV positive.
  3. Post-exposure prophylaxis (PEP) is a month-long course of HIV medication taken by an HIV negative person after possible exposure to reduce the chance of getting HIV. When started in time, PEP can stop HIV infection after sex without a condom (or other exposure) with someone who is infectious - but it does not work every time.

Sex without a condom can also result in an unplanned pregnancy if other contraception is not being used.


Should I worry about STIs?

The more sexual partners you have, the higher your risk of catching a sexually transmitted infection (STI).

If your viral load is detectable you can also pass on HIV.

STIs can be harder to treat in people with HIV and, until you are treated, may push up your viral load (the level of HIV in your body) by small amounts. If STIs make the viral load detectable, this could make it more likely for you to pass on HIV if you have unprotected sex.

However, the PARTNER study looked at people on treatment who had viral loads below 200 copies/ml and found no HIV transmissions in that group regardless of the presence of STIs.


What else do I need to keep in mind?

There are many reasons why people have lots of sexual partners, including enjoying the thrill of the chase or the need to feel desired. It may also be because they use drugs or alcohol which lower their inhibitions.

But drug and alcohol use can have a very negative impact on your body, as your immune system already needs help to keep you healthy because of your HIV status. Some drugs and heavy drinking can affect how well your immune system fights infections.

Drugs or alcohol can also make it more likely you will have risky sex and make decisions you wouldn’t normally make in these situations. If your judgement is being clouded then you might have unprotected sex.


Telling your partners about your HIV status

If you’re having protected sex there’s no law saying you must tell people that you have HIV - it’s your choice whether you tell your sexual partners.

However, in England and Wales there is a risk of being prosecuted for reckless transmission of HIV if:

  1. you had sex with someone who didn’t know you had HIV
  2. you knew you had HIV at that time
  3. you understood how HIV is transmitted
  4. you had sex without a condom, and
  5. you transmitted HIV to that person.

The law in Scotland is largely the same, except that a case can also be brought if transmission hasn’t taken place but someone has been put at risk of transmission without their consent or knowledge.

Our pages on unprotected sex and viral load and infectiousness have further details.


How can I further reduce my sexual risk?

If you have having sex with lots of different partners, protected sex and not having sex under the influence of drugs or alcohol are all good steps to take. Remember that condoms will protect you from other STIs even if you have an undetectable viral load.

There’s more good advice in the Reducing sexual risks section.

You can also get advice and support from a counsellor or support groups - speak to our Online Counsellor for more information.

Gay and bisexual men who are worried about sex, dugs and alcohol can visit Friday/Monday.


More on HIV and safer sex:


Next: Viral load ››

‹‹ Back to: Reducing sexual risks

 

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The Information Standard: Certified member

This article was last reviewed on 10/4/2015 by Anna Peters

Date due for the next review: 8/4/2018

Content Author: Richard Scholey

Current Owner: Health Promotion

More information:

HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy, Mujugira A1, Celum C, Coombs RW, Campbell JD, Ndase P, Ronald A, Were E, Bukusi EA, Mugo N, Kiarie J, Baeten JM; Partners PrEP Study Team
National Center for Biotechnology Information
US National Library of Medicine
2016 Aug 15;72(5):579-84. doi: 10.1097/QAI.0000000000001019

HIV treatment as prevention and HPTN 052, Cohen MS1, McCauley M, Gamble TR
National Center for Boiotechnology Information
US National Library of Medicine

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy, Journal of the American Medical Association: Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD1; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD, JAMA. 2016;316(2):171-181. doi:10.1001/jama.2016.5148

Pre exposure prophylaxis, Roger Pebody, NAM, Aidsmap, October 2016

Can post-exposure prophylaxis (PEP) stop me getting HIV?, NHS Choices, September 2015

Impact of coinfections on viral load, iBase, January 2016

Viral load, Michael Carter, Greta Hughson, NAM, Aidsmap, March 2014

More confidence on zero risk: still no transmissions seen from people with an undetectable viral load in PARTNER study, Gus Cairns, NAM, Aidsmap, July 2016

Open your eyes to STIs, NHS Choices, Nov 2015

When sex goes wrong, NHS Choices, Nov 2015

The effect of sexually transmitted infections on viral load, Gus Cairns, NAM aidsmap

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11% of Men Have Multiple Sex Partners American Journal of Public Health (2007)

Lewis, J.E., Miguez-Burbano, M. & Malow, R.M. HIV risk behaviours among college students in the United States College Student Journal June 2009 (2009)

Sullivan, P.S., Salazar, L., Buchbinder, S. & Sanchez, T.H. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities AIDS 23 (2009)

Yan, H., Chen, W., Wu, H., Bi, Y., Zhang, M., Li, S & Braun, K.L. Multiple sex partner behaviour in female undergraduate students in China: A multi-campus survey BMC Public Health 9:305 (2009)