How do you get HIV from sex?
HIV is transmitted through semen (cum and pre-cum), vaginal fluid, blood, and anal mucus. During sex without a condom the bodily fluids from one person can pass into the body of their sexual partner. This can happen through the mucous membranes of the penis, vagina and rectum, or sores in the mouth and throat.
You can only get HIV from someone who is living with HIV and has a detectable viral load.
Do some types of sex have more HIV risk?
Anal sex and HIV
Anal sex has the biggest HIV risk because the lining of the anus is more delicate than the lining of the vagina. This means it is more easily damaged, providing an easier route for HIV to enter the body. Receptive anal sex (‘bottoming’) carries more risk than insertive anal sex (‘topping’).
Vaginal sex and HIV
Both male and female partners can get HIV from vaginal sex. The risk of getting and passing on HIV through vaginal sex increases during menstruation.
Oral sex and HIV
The risk of getting HIV from unprotected oral sex is extremely low. It only poses a risk if the person giving oral sex has mouth ulcers, sores or bleeding gums, or the person receiving oral sex has sores on their genitals.
Sex toys, fingering, fisting and HIV
Sex toys, such as dildos, come into direct contact with rectal/vaginal fluids and mucous membranes. This means sharing an uncleaned dildo or other toy can pass on HIV. Using sex toys on your own has no risk.
There is no direct risk of HIV from fingering or fisting (unless you have open cuts or sores on your hands), but be aware of being rough. Damage to anal/vaginal tissues, especially if there is any bleeding, will increase risk of HIV transmission if you then have anal, vaginal or oral sex later.
Kissing and HIV
There is such a small amount of HIV in the saliva of a person living with HIV that the infection can’t be passed on from kissing.
Having multiple sexual partners and/or STIs also increases the risk of HIV infection through sex if you are not using other protection.
How can I avoid getting HIV from unprotected sex?
Condoms are the most effective way of preventing transmission of HIV and other STIs.
They can be used during vaginal and anal sex as well as on a penis during oral sex. They should be put on before any sexual contact as HIV can be passed on through pre-cum, vaginal fluid, and from anal mucus.
Both internal (female) and external (male) condoms are available so you can experiment and use whichever works best for you.
Pre-exposure prophylaxis (PrEP)
PrEP is a pill taken by HIV-negative people to prevent HIV. It contains antiretroviral drugs that stop the virus from taking hold in your body.
PrEP is taken by people who have a higher risk of getting HIV, this can include people in a relationship with someone living with HIV, or people who belong to groups who are more at-risk of HIV infection – such as men who have sex with men, and young women in many countries in Southern Africa.
Ask a healthcare professional if you want to know if PrEP would be right for you. PrEP is not currently available everywhere, but access is expanding.
When taken properly PrEP virtually eliminates the risk of getting HIV. PrEP won’t protect you against other sexually transmitted infections (STIs) such as hepatitis C. Condoms are still the best protection from these STIs.
Antiretroviral treatment (ART) lowers the amount of HIV in your body, making it less likely that you will pass HIV on.
If you are living with HIV, are on effective treatment, and have an ‘undetectable’ viral load, it means you have such a low amount of HIV in your body, that you cannot pass HIV on through sex.
If you are HIV-negative, you cannot get HIV from sex with someone who is HIV-positive and undetectable.
Not everyone on HIV treatment has an undetectable viral load, so to be sure that you are ‘undetectable’ (and stay undetectable) you must attend regular viral load monitoring.
Lubricants, or lube, make sex safer by reducing the risk of tears or damage to the vagina or anus caused by dryness or friction. It can also reduce the risk of a condom breaking.
Lube is particularly important for anal sex, as the anus is delicate and does not self-lubricate.
Use water-based lubricants instead of oil-based lubricants, as oil-based lubricants (such as Vaseline) weaken the latex in condoms and can cause them to break.
A dental dam is a small plastic sheet that can be used to cover the mouth, vagina or anus during oral sex to reduce the risk of STIs.
Post-exposure prophylaxis (PEP)
PEP is a course of antiretroviral medicines that can prevent HIV after an event that might have put you at risk of infection, for example if you have had sex without a condom with someone of unknown HIV status.
PEP can stop HIV infection, but it must be started within 72 hours of possible exposure.
Unlike condoms or PrEP, PEP should not be relied upon as a regular form of protection.
Your doctor or healthcare professional will advise you on whether you could take PEP. PEP may not be available where you are.
Testing for HIV
Knowing your HIV status is an important part of looking after your sexual health and can help you to have safer-sex. If you know you’re positive you can take ART to stay healthy and reduce the risk of transmitting HIV, or if you’re negative, knowing your status can give you more motivation to protect your sexual health.
It’s important to have regular check-ups for other sexually transmitted infections (STIs) as well, as having an STI increases your chance of getting HIV.