If you’re taking HIV medication and have an undetectable viral load, you cannot pass on HIV.
If you’re newly diagnosed, you may wonder how likely you are to pass on HIV through sex and how you can reduce the chances.
The good news is that if you’re taking HIV medication and have an undetectable viral load, you cannot pass on HIV.
If you want to talk to someone about HIV and sex there is lots of support available.
Protected sex means using a male or female condom during sex if one of the partners 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.
An infection doesn’t happen every time unprotected sex takes place with someone who has HIV and a detectable viral load, but it could happen any time it takes place.
The more people an HIV negative person has unprotected sex with, the greater the chance one of them might have HIV with a detectable viral load and the greater chance of them becoming infected.
If you have a detectable viral load you will be able to pass on HIV if no protection is used.
However, different types of sex carry different risks of transmission. Unprotected vaginal sex carries a high risk of passing on HIV.
If you have anal sex without protection you have an even greater risk of passing on HIV.
This is because the lining of the rectum is not as tough as that of the vagina, so it’s more likely to bleed during sex.
During unprotected oral sex there’s a low risk (but not no risk) of you passing on HIV.
If you’re having sex with a lot of partners it’s a good idea to have regular check-ups (eg, every three months) at a sexual health clinic - even if you don’t have any symptoms. You should go to a clinic straight away if you notice any signs of an infection such as inflammation, discharge or blisters in your genital or anal area.
Monogamy (sex with only one partner) means having no worries about infections entering your relationship from outside. But monogamy is built on trust, so if one of you breaks your agreement you should tell the other - no matter how uncomfortable that may feel. This is especially important if there is a chance an infection could be passed between you as a result of sex with other people.
An open relationship also relies on trust. You may have an agreement about what kind of sex with other people is allowed (eg, only with condoms to cut the risk of infections). If this agreement is broken, hiding it is dishonest and risks one of you getting an infection.
Regular check-ups for STIs are advised if your relationship is not monogamous.
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:
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.
Read more on telling your sexual partners about your HIV.
Drugs or alcohol can lower your inhibitions and make you more likely to take sexual risks. Support groups and counselling are available to help you with risk-taking related to drugs and alcohol.
For information about sex, drugs and alcohol especially for gay and bi men, visit: www.tht.org.uk/friday-monday
It is also worth bearing in mind that your long-term emotional health is very important and the peace of mind that protected sex brings can help to reinforce this.
And remember - being HIV positive doesn’t mean that you are immune from other infections. Condoms are the best way to stop yourself being infected with other STIs such as Hepatitis C, which can greatly complicate and hinder your treatment.
They will also help to prevent an unplanned pregnancy if no other contraception is being used.
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