Strategies To Reduce Risk
As with any other mode of HIV transmission, prevention requires a combination of strategies to more effectively:
- Reduce the infectivity of the HIV-positive partner
- Reduce the susceptibility of the HIV-negative partner
Current evidence has shown that the consistent use of antiretroviral therapy in the HIV-infected partner completely eliminates the risk of HIV transmission when viral activity is suppressed to undetectable levels.
The effectiveness of the strategy known as Treatment as Prevention , is evidenced by the PARTNER1 and PARTNER2 studies in which not a single HIV infection occurred among 1,770 gay and heterosexual mixed-status couples despite engaging condomless anal or vaginal sex.
The studies, which ran from 2010 to 2018, showed unequivocally that undetectable equals untransmittable in a real-world setting.
The use of pre-exposure prophylaxis , whereby the uninfected partner is prescribed a daily dose of the HIV drug Truvada, can also reduce risk. Studies have shown that when taken daily, PrEP reduces the risk of getting HIV from sex by about 99%.
Although these figures may suggest that condoms are no longer needed, neither TasP nor PrEP can prevent other sexually transmitted diseases.
Moreover, according to the Centers for Disease Control and Prevention , only 59.8% of Americans with HIV are able to achieve an undetectable viral load. Without complete viral suppression, TasP is rendered useless, placing the uninfected partner at risk.
The Myth: Only Sluts Have Anal Sex
The truth: Youve always heard that bad girls are the only ones willing to have anal sex. In actuality, anal sex was once voted the number one taboo sexual behavior that heterosexual couples want to try. So obviously, we all cant be sluts. Theres a natural curiosity about our bodies and if there is pleasure to be had, you should feel you can explore that in a safe and healthy way.
Whats The Risk For Types Of Oral Sex
Oral sex ranks very low on the list of ways HIV can be transmitted. Its more likely to transmit HIV through anal or vaginal sex. Its also possible to transmit the virus by sharing needles or syringes used for injecting drugs or tattooing.
However, the risk of contracting HIV through oral sex is not zero. The truth is, you can in theory still contract HIV this way. Theres just been from years of research to show that it has happened.
Why is it hard to get data?
Its difficult to know the absolute risk of transmitting HIV during oral sex acts. Thats because many sex partners who engage in oral sex of any type also engage in vaginal or anal sex. It may be difficult to know where the transmission occurred.
Fellatio carries some risk, but its low.
- If youre giving a blowjob. Receptive oral sex with a male partner who has HIV is considered exceptionally low-risk. In fact, a 2002 study found that the risk for HIV transmission through receptive oral sex was statistically zero.
- If youre receiving a blowjob. Insertive oral sex is an unlikely method of transmission, too. Enzymes in the saliva neutralize many viral particles. This may be true even if the saliva contains blood.
There are no documented cases of HIV being transmitted between partners through cunnilingus .
Anilingus , or rimming, has some risk, but it is negligible. Its especially low for receptive partners. In fact, the lifetime risk of transmitting HIV during rimming is
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Like The Vagina The Anus Has A Muscle That Must Relax To Allow Comfortable Penetration
The anal sphincter acts as a bit of a gatekeeper for the rectum. For anal sex, however, its important that this muscle relaxes. Not only does it make the experience more pleasurable, it reduces the risk of tearing or discomfort. Relaxation involves patience, both at the time youre attempting penetration, and as you become more accustomed to anal sex.
What Is Risky Sex
Risky sex is sex that may lead to infection of an HIV-negative individual. There are many ways to decrease the risk of HIV infection, like taking HIV medications every day, or using PrEP, or using condoms or other latex barriers during sex.
HIV is passed through body fluids such as semen, vaginal, or anal fluid, or blood. The less contact you have with these, the lower the risk. The most sensitive areas where these fluids are risky are in the vagina or anus and rectum . The protective tissue there is thin, and is easily torn, which makes it easier for the virus to enter your body. Saliva and tears aren’t as risky.
In general, vaginal or anal sex without a condom is the most risky.
Here is a list of sexual activities organized by level of risk to help you and your partner make decisions:
High risk
- Anal sex without a condom
- Vaginal sex without a condom
Low risk
- Sex with a condom when you use it correctly
- Oral sex, but don’t swallow semen
- Deep kissing
- Sharing sex toys that have been cleaned or covered with a new condom between uses
No risk
- Cyber sex
- Using sex toys that you don’t share
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Hiv And Maternal Transmission
HIV can be passed from mother to child during pregnancy, delivery, or through breastfeeding. If left untreated throughout these stages, there is a 15-45% chance of an HIV positive mother transmitting the virus to their child . However there are treatment options to prevent this from happening.
If pregnancy occurs and there has been potential HIV exposure, ask a healthcare provider about getting tested for HIV as early as possible. Taking medications called antiretroviral therapy as prescribed can reduce the viral load so that the baby has a very low chance of contracting HIV .
A person with HIV should not breastfeed their child, as breast milk can transmit HIV. Even if a person is taking ART and their viral loads are undetectable, they should still not breastfeed.
Are You At High Risk
PrEP is a medication that is recommended for people who are at a high risk of HIV transmission. Some of the leading causes of HIV transmission include:
- Engaging in unprotected sex with a partner who is HIV positive or whose HIV status is unknown.
- Engaging in unprotected sex with partners who have additional sexual partners.
- Having unprotected sex if you have been diagnosed with an STI.
- Sharing needles or syringes.
The only way HIV can be transmitted to another person is through contact with blood, semen, or vaginal fluids. It is also important to note that uncircumcised males are at a slightly higher risk of contracting HIV since they are more prone to bacteria and infections. There is evidence that male circumcision can also reduce the risk of HIV transmission.
Homosexual and bisexual males are typically at a higher risk of contracting HIV. The transmission rate through anal sex is more than ten times greater than through vaginal intercourse. Receptive anal sex also has a higher transmission rate, meaning that the risk of HIV transmission is higher for bottoms than for tops.
However, this does not mean that tops are not at risk as the insertive partner may also contract HIV through anal intercourse. So, whether you are a top, a bottom, or versatile, you could be at a high risk of HIV transmission, and you should consider taking PrEP.
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All Exposures Are Not Equal
The results of several meta-analyses suggest that some types of sex carry on average a higher risk of HIV transmission than others. Below are estimates from meta-analyses that have combined the results of studies conducted in high-income countries. For types of sex where meta-analysis estimates do not exist, numbers from individual studies are provided.
Anal sex
A meta-analysis exploring the risk of HIV transmission through unprotected anal sex was published in 2010.1 The analysis, based on the results of four studies, estimated the risk through receptive anal sex to be 1.4%. This risk was similar regardless of whether the receptive partner was a man or woman.
No meta-analysis estimates currently exist for insertive anal sex but two individual studies were conducted to calculate this risk. The first, published in 1999, calculated the risk to be 0.06% .2 However, due to the design of the study, this number likely underestimated the risk of HIV transmission. The second study, published in 2010, was better designed and estimated the risk to be 0.11% for circumcised men and 0.62% for uncircumcised men.3
Vaginal sex
A meta-analysis of 10 studies exploring the risk of transmission through vaginal sex was published in 2009.4 It is estimated the risk of HIV transmission through receptive vaginal sex to be 0.08% .
A meta-analysis of three studies exploring the risk from insertive vaginal sex was estimated to be 0.04% .4
Oral sex
What Medication Is Available
There are currently two medications approved by the FDA for PrEP: Truvada and Descovy.
Both of these medications can be up to 99% effective at HIV prevention when taken correctly. However, the notable difference between these medications is that Descovy is currently only approved for use in cisgender males and transgender females, while Truvada is approved for all genders.
PrEP does not have any significant health effects even with long-term use, but you may experience some side effects, such as:
- Rash
- Abdominal pain
- Changes in weight
Some more severe side effects that may occur can be kidney issues, liver problems, or bone density loss. But these often occur in people who had health issues prior to taking PrEP. Ultimately, it is between you and your doctor to determine whether or not PrEP is the best choice for you.
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Says That Young People In Particular Find It Hard To Get What They Want From Sex
Basic tips for safe sex with HIV
- If you are HIV positive and you are not sure of your sexual partners HIV status, assume they are HIV negative
- If you are HIV negative and you are not sure of your sexual partners HIV status, assume they are HIV positive
- If you are negative, assume everyone you have sex with is positive
- Sex is not meant to be logical, anticipate that you might be tempted to have unsafe sex. When are you more likely to feel this way, and what can you do about it?
- Try making a decision to be safe before you have sex, particularly if you are feeling down or using drugs or alcohol.
- Make sure there are lots of condoms nearby so you aren’t ‘scrabbling around’ for them.
- Carry condoms in your handbag or wallet
- If you are HIV positive and are looking for other positive partners for sex without condoms , you can get advice about the risk of picking up new infections from your HIV doctor.
- HIV charities often offer counselling or courses on how to enjoy sex more and be safe.
Last reviewed May 2017.
How Does Hiv Spread
HIV spreads when infected blood, semen or vaginal fluids enter the body. Because symptoms can be mild at first, people with HIV might not know they’re infected. They can spread HIV to others without knowing it.
HIV can spread:
- during sex
- through sharing needles for injecting drugs or tattooing
HIV also can pass from mother to child during pregnancy, childbirth, or breastfeeding.
HIV does not spread through:
- pee, poop, spit, throw-up, or sweat
- coughing or sneezing
- sharing eating utensils or drinking glasses
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Increased Risk Of Fistula A Rare Complication
In very rare instances, it is possible that a tear in the lining of the anus or rectum can grow larger. Doctors call this a fissure or large tear.
Sometimes, this tear is so big that it extends beyond the bowel to other parts of the body. Doctors call this a fistula.
A fistula can be an emergency medical situation because it allows stool from the bowel to go to other places in the body.
Because stool naturally contains significant amounts of bacteria, having a fistula can introduce bacteria to other parts of the body, leading to infections and damage. Doctors usually suggest surgery to repair a fistula.
Again, this is a rare but potential complication of anal sex. For this reason, it is important to use proper lubrication and stop anal sex if pain occurs.
Some people believe that a possible risk of anal sex is that the rectum will stretch long-term, and that this damage can lead to fecal incontinence. For the most part, medical experts disagree with this.
However, a 2016 study in the American Journal of Gastroenterology looked at the sexual behavior of 4,170 adults. Researchers asked the adults whether they had ever had anal intercourse, and whether they had fecal incontinence.
The study led the researchers to conclude there was a potential link between fecal incontinence and anal sex. However, many experts criticized the study because it did not evaluate other contributing factors to fecal incontinence.
The Myth: You Need An Enema First
The truth: Mmm, pretty sure theres no such thing as needing an enema before a sex act. But understandably, a major concern about anal sex is that itll make you poop. First off, its highly unlikely that youll actually poop because of anal stimulation. But if youre extremely worried about it, there are a few things you can do to avoid An Accident. The most obvious thing is to act like youre preparing for a road trip by going to the bathroom before you embark on this venture. And avoid things like, you know, black bean tacos or that takeout you know always gives you crazy poops. You may feel like you have to go, because anal penetration stimulates the muscles around your rectum in a similar way to having a bowel movement, but that doesnt necessarily mean you will.
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The Myth: Your Anus Will Get All Stretched Out
The truth: Just like the myth that the vagina gets irreparably stretched out from childbirth, this is also a misconception. There were rumors in the late 70s of groups of men who engaged in so much anal activity that they actually lost control of their bowel movements. Regular, healthy use of anal sex will not lead to this outcome. Through regular anal sex, your anus does learn to become more relaxed, but much of that has to do with your ability to relax yourself mentally for the act. And we all know that the vagina accommodates a wide range of penises, so the anus can toowith the right introduction.
The Myth: Your Partner Wont Respect You Later
The truth: So he got what he wanted from you and now wants nothing to do with you? Im sure this happens occasionallybut with any sort of sexual activity. Most men, though, are modern enough to see anal sex as just one component of a healthy sex life. And because of the taboo of anal sex, it might actually help you feel closer and more emotionally bonded to your partner.
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Treatment For Anal Sex
Treatment for problems from anal sex will depend on your symptoms and diagnosis. For pain, fissures, and hemorrhoids, your doctor may suggest:
- Warm water baths
News release, International Microbicides Conference.
University of Illinois at Urbana-Champaign McKinley Health Center: “Anal Sex: Questions and Answers.”
News release, New York City Department of Health and Mental Hygiene.
University of California, Santa Barbara, SexInfo Online: “What Are the Dangers of Anal Sex?”
Columbia University’s Health Q & A Internet Service, Go Ask Alice: “Pain from anal sex, and how to prevent it.”
Cedars-Sinai: ââ¬ÅAnal Fissure,ââ¬ï¿½ ââ¬ÅAnal Fistula.ââ¬ï¿½
Mayo Clinic: ââ¬ÅIs colon cleansing a good way to eliminate toxins from your body?ââ¬ï¿½ ââ¬ÅSexually transmitted diseases .ââ¬ï¿½
CDC: ââ¬ÅNail Hygiene,ââ¬ï¿½ ââ¬ÅDental Dam Use,ââ¬ï¿½ ââ¬ÅAnal Sex and HIV Risk,ââ¬ï¿½ ââ¬ÅGenital HPV Infection — Fact Sheet.ââ¬ï¿½
Center for Community Health: ââ¬ÅTips for Anal Health — Ways to Take Care of Your Bottom.ââ¬ï¿½
American Journal of Gastroenterology: ââ¬ÅAnal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey.ââ¬ï¿½
Healthdirect: ââ¬ÅAnal Injury.ââ¬ï¿½
How Is Hiv Transmitted
HIV is transmitted between humans through the exchange of certain types of bodily fluids. Bodily fluids that can transmit HIV include blood, semen, breast milk, and vaginal fluids .
Not all body fluids can transmit HIV. The following cannot transmit HIV:
- Exchanging saliva, like through closed-mouth kissing or sharing drinks/utensils
- Coming in contact with an HIV positive personâs tears, sneezes, or sweat
- Ordinary physical contact, such as hugging, hand shaking, or touching shared objects like cutlery, cups, or toilet seats .
- Air or water
- Pets and insects cannot carry the virus and infect you, because transmission of HIV is only between humans .
While care needs to be taken in some situationsâlike when having sex or when open injuries are presentâthis certainly does not mean that it is unsafe to be around people with HIV. Think of how you interact with the vast majority of peopleâbodily fluids are not exchanged. Harboring discriminatory thoughts only perpetuates a fearful stigma against someone with HIV, which only hurts the person who has it.
HIV is often transmitted through sexual activity and drug use in adults in the United States . Maternal transmissionâfrom mother to childâis how the infection is spread to infants .
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Is There A 100% Effective Way To Prevent Sexual Transmission Of Hiv And Stds
The only 100% effective way to prevent sexual transmission of HIV and STDs is through abstinence – avoiding all vaginal, anal and oral sex. Using a latex male condom or a female condom can greatly reduce, but not entirely eliminate, the risk of HIV and STD transmission. Abstinence is the only method to completely eliminate the possibility of sexual transmission of HIV or STDs.