Safe Sex When You’re HIV-Positive

If you are HIV-positive, you can still have sex. In some cases, you can even have unprotected sex without putting your partner or partners at risk for HIV.

The steps you need to take to protect yourself and your partner depend on several things. These include whether you’re treating your HIV with medication. It also matters if you or your partner have recently had unprotected sex with someone who may have HIV.

Learn how you can have safe sex. That means protecting yourself and your partners.

Get ART

Antiretroviral therapy, or ART, is medication that stops HIV from damaging your immune system. The medications lower the amount of HIV in your body. It can take up to 6 months for ART to start working.

Sometimes, ART works so well that the tests can’t find HIV in your blood. Doctors call this an undetectable viral load. That means you can’t infect anyone with HIV through sex. It may take 6 months for ART to lower your viral load enough to make unprotected sex safe.

Even if you’re HIV-positive, you can still get infected with a different strain of the virus. So protect yourself if you’re not sure of your partner’s status.

If you’re on ART, you will need a blood test every 3-4 months to monitor your viral load. Some people may never reach undetectable viral levels.

Use Condoms

Condoms worn by both women and men greatly lower the chances that you’ll pass on or catch HIV.

The amount of protection depends on how you and your partner are having sex. Anal sex has the highest risk of passing on HIV. For example, you have a 1 in 72 chance of an HIV infection each time you are the person receiving anal sex. Wearing a male condom cuts that risk by 72%, or 1 in 259.

Next riskiest is if you’re the person on top during anal sex. You have a 1 in 909 chance of getting HIV from your partner without a condom.

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If you’re female, you have slightly lower chance, or 1 in 1,234, of getting an infection during unprotected vaginal sex with an HIV-positive partner. Using a condom lowers that risk by an average of 80%.

Oral sex poses little or no risk of HIV transmission. Placing a condom on the penis or inside the vagina lowers that risk even more.

Remember that without condoms, you and your partner can still catch other sexually transmitted diseases such as gonorrhea and chlamydia.

Get PrEP and PEP

Pre-exposure prophylaxis (PrEP) is a preventive drug that stops HIV from taking hold or spreading in your body. You take this treatment when you don’t have HIV but may be at a high risk of getting infected by your partner.

If you take PrEP as instructed every day, your risk for getting HIV will fall by 99%. But it takes at least 7 days for PrEP to start working.

Post-exposure prophylaxis, or PEP, is an emergency form of ART. You take it if you’ve recently had sex that might have exposed you to HIV. You must take PEP as soon as possible, and no later than within 72 hours of having sex. Otherwise, the drugs won’t help.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on June 09, 2020

Sources

SOURCES:

CDC: “HIV Treatment as Prevention,” “Male Condom Use,” “Vaginal Sex and HIV Risk,” “Anal Sex and HIV Risk,” “Oral Sex and HIV Risk,” “PrEP,” “PEP,” “HIV Risk Behaviors.’

U.S. Department of Health and Human Services: “HIV Treatment: The Basics,” “Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.”

Southern Arizona AIDS Foundation: “We are both HIV positive…we don’t have to use condoms.”

Terrence Higgins Trust: “Unprotected Sex,” “How to Use a Condom.”

HIV.gov: “Preventing Sexual Transmission of HIV.”

NAM Aidsmap (UK): “Estimated HIV risk per exposure.”

GMHC.org: “HIV Risk for Lesbians, Bisexuals & Other Women Who Have Sex With Women.”

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