People who are at high risk of acquiring the human immunodeficiency virus (HIV) should know how to protect themselves from the virus. According to HIV.gov, those especially at risk include:
- Men who have sex with men
- Couples who are in mixed status relationships in which one person is HIV positive and one HIV negative
- People who do not use protection during sex
- People who inject drugs
What’s important to note, though, is that you can have a healthy relationship (and sex life) with someone who has HIV without exposing yourself to the virus.
A growing body of evidence is finding that when people with HIV take certain steps, the risk that they will transmit the virus to someone else can be extremely low. But because you can get HIV from even a single encounter, prevention requires an ongoing commitment by everyone involved. Here’s what you should know to protect yourself from HIV.
Get a Prescription for PrEP (or PEP)
Short for “pre-exposure prophylaxis,” PrEP is medication that can reduce a person’s risk of contracting HIV by about 99 percent when taken as prescribed, according to the Centers for Disease Control and Prevention (CDC). PrEP can be taken as a once-daily pill; as an “on-demand” regimen of three pills (2 to 24 hours before sex, 24 hours after the first dose, and then 24 hours after the second dose); and as an injection.
If you (or your partner) regularly have sex with someone who is HIV positive, have sex without using condoms, or share needles with others, PrEP can be a powerful tool for preventing the spread of HIV.
Organizations like PleasePrEPMe and Emory University offer free web tools that can help you find PrEP treatment nationwide and also get financial resources for the treatment if needed.
Additionally, if you believe you were exposed to HIV during sex — for example, if a sexual partner was recently diagnosed with HIV — you can take emergency pills called PEP, or “postexposure prophylaxis.” A 28-day course of medication, PEP treatment needs to be taken within three days after a potential infection to help block the virus from taking root in your body, according to HIVinfo.
If Your Partner Is HIV-Positive, Talk About Antiretroviral Therapy
Antiretroviral therapy, or ART, can reduce the amount of HIV in a person’s blood to undetectable levels — an amount that can’t be detected by modern technology, which is less than 200 copies of the virus per milliliter of blood. If your partner is taking ART and maintaining undetectable levels, the risk of them passing the virus to you during sex may be virtually nonexistent, according to the CDC.
This conclusion has been demonstrated by the results of the PARTNER and PARTNER 2 studies, published in 2016 and 2019, respectively: When researchers from Europe recruited more than 1,000 HIV-positive people (both gay and straight) with undetectable viral loads for the PARTNER study, they found that during an average two-year period, none of the participants passed the virus to their HIV-negative partners. The PARTNER 2 study, which followed gay couples only for one year, also found that the risk of HIV transmission through condomless sex is effectively zero when HIV viral load is suppressed through ART.
If you know that your partner is HIV positive, try to talk with them about ART if they aren’t already using the treatment.
Understand Viral Load
For ART to be effective, people must take the medication every day, at the same time each day. Skipping doses can cause the virus to replicate unchecked and possibly mutate into a form that’s resistant to the medication. If that occurs, a person’s viral load count may increase, which means there is a greater likelihood that the virus can be transmitted to someone else during sex.
If you or your partner are HIV positive and taking ART, doctors recommend that you get viral load tested at least twice a year, if not more often. If the results demonstrate undetectable levels of HIV, “It’s pretty safe [to have sex],” says Monica Gandhi, MD, MPH, associate chief of the division of HIV, infectious diseases, and global medicine at University of California, San Francisco-San Francisco General Hospital.
Use Condoms
Condoms continue to be an important and highly effective method to prevent HIV infection, advises the CDC. Even if an HIV-positive partner’s viral load count is undetectable, there are plenty of additional reasons to use condoms. Not only do they help prevent an unwanted pregnancy, but they also protect against other STIs — such as syphilis, gonorrhea, and chlamydia infections — some of which can increase inflammation and raise your risk of getting HIV. “If you [or your partner] have a genital sore and you’re going to have sex that day,” says Dr. Gandhi, “use a condom.”
If You Inject Drugs, Avoid Sharing Equipment
Anytime you share a needle with someone, whether you’re injecting steroids, hormones, or drugs, you’re at risk of HIV and other blood infections. And it’s not just the needle and syringe that can transmit the virus; you can also get HIV by sharing the water that’s used to clean the equipment or reusing filters and other containers. That’s because the equipment or water could contain blood and, therefore, the virus itself.
The best thing you can do if you use drugs is to seek treatment. For example, if you use heroin, joining a methadone program could help you manage your addiction without the use of needles, lowering your risk of HIV.
The CDC also offers information about Syringe Services Programs (SSPs), which are community-based organizations that provide disposable syringes and safe injection sites (among other services) for people who do continue to use drugs. And research has found that SSPs are associated with a 50 percent reduction in HIV and hepatitis C in areas where they are located, notes the CDC.
Get Tested for HIV Regularly
If you’re currently HIV negative, it’s important to be tested for any change in your status. If a test shows you’ve contracted the virus, your risk of spreading it to someone else is greatest in the acute phase, or the first two to four weeks after being infected, per the CDC. During that period, the viral load (a measurement of how much HIV is in your blood) spikes, increasing the likelihood you’ll transmit the virus. Although some people experience flu-like symptoms in the acute phase, many are not aware that they are infected because they don’t feel sick at all or might not feel sick until later, according to the CDC.
If You’re Taking Steps to Be Safe, Try to Relax and Enjoy Yourself
The virus is only transmitted in specific ways: mainly through anal or vaginal sex or by sharing needles. There are plenty of ways HIV isn’t spread, including kissing, hugging, or sharing eating utensils, all of which you can do with a loved one who has HIV without worrying about contracting the virus.
And if you know that your HIV-positive partner is on ART and their viral load is undetectable, try to forget about HIV during sex, too, Gandhi says: “It should be a pleasurable thing.”
Jane Yoon Scott, MD
Medical Reviewer
Jane Yoon Scott, MD, is an infectious disease physician and an assistant professor of medicine at Emory University in Atlanta. Dr. Scott enjoys connecting with her patients, empowering them to understand and take ownership of their health, and encouraging them to ask questions so that they can make informed and thoughtful decisions.
She graduated with the highest honors from the Georgia Institute of Technology, then received her MD from the Medical College of Georgia. She completed her internal medicine residency training and chief residency at Temple University Hospital, as well as a fellowship in infectious diseases at Emory University. She is board-certified in both internal medicine and infectious diseases.
When she is not seeing patients, Dr. Scott works with neighboring health departments to promote public health, especially to communities that have been historically underserved. She also teaches medical trainees and lectures medical students at the Emory University School of Medicine.
In her free time, Dr. Scott appreciates a good coffee shop, weekend hikes, playing guitar, strolling through cities, sampling restaurants, and traveling to new places.
Natalie Gingerich Mackenzie
Author
Natalie Gingerich Mackenzie is a freelance writer and editor specializing in health and fitness. A former editor at SELF and Prevention magazines, she has also written for Shape, MindBodyGreen.com, ESPNW.com, and Men's Fitness, among others. Her book Tone Every Inch, based on a research collaboration with Ithaca College, was published in 2012 by Rodale. Natalie lives with her husband and two children in Ann Arbor, Michigan.