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Protected sex and HIV

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Decisions you make about the sex you have will control your risk of getting HIV and other sexually transmitted infections (STIs).

How is HIV passed on during sex?

HIV is a virus found in an infected person’s body fluids. In order to infect someone, HIV has to enter someone’s body either through the bloodstream or the mucous membranes. These are found in the delicate and absorbent mucous skin of the penis, vagina, rectum and sometimes the mouth or throat. If these areas have any cuts or abrasions this can make it even easier for HIV to get into the body.

Only in the following fluids is there enough HIV to infect someone:

Women:

  • vaginal fluid
  • breast milk
  • blood
  • anal mucus, the lining covering the inside of the rectum.

Men:

  • semen
  • ‘pre-cum’ (the clear liquid that comes from a man’s penis when he is sexually excited)
  • blood
  • anal mucus, the lining covering the inside of the rectum.

If during sex any of these fluids get from the body of someone with HIV into the body of a person who doesn’t have HIV, that person can also become infected.

During oral sex this could potentially happen if the mouth, gums and/or throat of the person giving oral sex has cuts and sores or is inflamed or infected – but oral sex has a low risk of HIV transmission.

There’s not enough HIV to infect others in:

  • tears
  • sweat
  • saliva (spit)
  • urine and faeces (poo)

What is protected sex?

‘Protected sex’ (sometimes referred to as ‘safer sex’ or ‘safe sex’) is sex that doesn’t allow body fluids to go from one person into another. This means sex using a condom or a Femidom.

Protected sex reduces the spread of HIV. It also lowers the risk of other STIs and can prevent an unwanted pregnancy.

Penetrative sex is when a penis enters a mouth, vagina or anus. Unless a barrier (eg, a condom) is used, HIV can be spread this way.

Vaginal and anal sex are types of penetrative sex with the highest HIV risk: a male or female condom is the best barrier protection.

Oral sex is penetrative sex but with much lower HIV risk. If you’re worried about oral sex, a barrier such as a condom can be used.

Any object entering another person is also penetrative sex and could carry body fluids (with HIV or other infections in them) from inside one person into another. To stop the spread of these infections, sex toys such as vibrators and dildos need covering with a fresh condom for each person they enter.

Sex without penetration is also considered 'protected'. Masturbating your partner is an example of low risk, non-penetrative sex that lots of people enjoy.


What if someone has an undetectable viral load?

If someone has an undetectable viral load there is an extremely low risk of someone with HIV passing the virus on through sex, as long as:

  • their viral load has been undetectable for the past six months
  • they are on HIV treatment
  • neither they nor their partner has an STI.

A large study called PARTNER has been looking at over 1,000 gay and straight couples where one partner is HIV positive and one is HIV negative. The study won’t finish until 2017 but early results have shown that where the HIV positive partner had an undetectable viral load and was on treatment, there were no cases of HIV transmission whether they had anal or vaginal sex. It’s important to remember that these are preliminary findings so as the study goes on the advice may change, but this is what has been reported so far.

If you have HIV, having untreated STIs could make it more likely that you’ll pass on HIV during condomless sex. But if HIV drugs have made your viral load undetectable then STIs don’t appear to make you more likely to pass on HIV.

Condoms are still the best way to prevent the spread of STIs and an unwanted pregnancy.

Before you make any decisions about not using condoms, get advice from your HIV doctor or nurse.


Keep protected sex in mind:

  1. Even when you know the facts it might not be easy to practice protected sex.
  2. It’s harder to play safe when you’re under the influence of alcohol or drugs.
  3. It’s harder to talk about condoms and safer sex once sex has started, so bring the subject up before then.
  4. Just because someone you have sex with doesn’t mention condoms or HIV doesn’t mean it’s safe to not use protection. It’s possible to have HIV without knowing. Some HIV positive people find it difficult to talk openly about their status.
  5. It would be wrong to think you can tell if someone has HIV by how they look. People with HIV usually don’t look any different. Assume that every person you have sex with might have HIV and always have safe sex – it’s the best way to protect yourself against HIV.
  6. If you know your partner has HIV, ask them whether their viral load is undetectable – if it is, and they meet the criteria above, this can reduce the chances of them passing on HIV. Condoms will protect you from STIs, HIV and an unwanted pregnancy.

If you’ve got questions or are worried about risks during sex, you can contact THT Direct on 0808 802 1221.

 

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The Information Standard: Certified member

This article was last reviewed on 25/8/2016 by Anna Peters

Date due for the next review: 24/9/2019

Content Author: Kerri Virani

Current Owner: Health Promotion

More information:

Body fluids, NAM aidsmap

Other body fluids, NAM aidsmap

Saliva, NAM aidsmap

HIV and AIDS – causes, September 2014, NHS Choices

Withdrawal and the risk from pre-cum, NAM aidsmap

No one with an undetectable viral load, gay or heterosexual, transmits HIV in the first two years of PARTNER study, Gus Cairns, March 2014, NAM aidsmap

Viral load and transmission, a factsheet for people with HIV, Gus Cairns, September 2015, NAM aidsmap

Viral load and transmission, a factsheet for HIV negative people, Gus Cairns, September 2015, NAM aidsmap

Routes and susceptibility – mucous membranes and target cells, NAM aidsmap

Oral sex, Michael Carter and Greta Hughson, September 2012, NAM aidsmap

Oral sex (from HIV and Sex booklet), Selina Corkery, 2016, NAM aidsmap

Sexual activities and risk, January 2016, NHS Choices

Condoms, Roger Pebody, Septmeber 2015, NAM aidsmap

Unprotected sex, Michael Carter and Greta Hughson, September 2012, NAM aidsmap

Sexual activities and risk, January 2016, NHS Choices

Preventing HIV and other STDs with safe sex, Web MD

Healthy Respect - Types of sex, 2016

Alcohol, sex and drugs, Avert, May 2015

HIV and AIDS, September 2014, NHS Choices

HIV: the facts, November 2014, NHS Choices

M Carter, Unprotected sex, NAM (2011)

R Pebody, How transmission occurs, NAM

R Pebody, Rectal secretions, NAM

R Pebody, Sex toys, NAM

EAGA/BHIVA Extremely low risk with undetectable viral load

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