HIV BASICS - PREVENTION

Yes. Abstinence means not having oral, vaginal, or anal sex. An abstinent person is someone who’s never had sex or someone who’s had sex but has decided not to continue having sex for some period of time. Abstinence is the only 100% effective way to prevent HIV, other sexually transmitted diseases (STDs), and pregnancy. The longer you wait to start having oral, vaginal, or anal sex, the fewer sexual partners you are likely to have in your lifetime. Having fewer partners lowers your chances of having sex with someone who has HIV or another STD.

In general, there is little to no risk of getting or transmitting HIV from oral sex. Theoretically, transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex.
Oral sex involves putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (anilingus). There’s little to no risk of getting or transmitting HIV through oral sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs), which may or may not be visible.
While there is little to no risk of getting HIV from oral sex, using a barrier (for example, a condom, dental dam, or cut-open nonlubricated condom) can further reduce your risk of getting or transmitting HIV and protect you and your partner from some other STDs, including gonorrhea of the throat and hepatitis.

The risk is also lower if the HIV-positive partner is taking medicine to treat HIV (called antiretroviral therapy or ART), or if the HIV-negative partner is taking medicine to prevent HIV (called pre-exposure prophylaxis or PrEP). Both PrEP and ART need to be taken as prescribed in order to work.

Because your mouth may come into contact with feces or other body fluids during oral sex, it is important that you talk to a health care provider about your chances of getting hepatitis A and B. If you’ve never had hepatitis A or B, there are vaccines to prevent them. Your provider can help you decide if vaccination is right for you.

Use condoms the right way every time you have sex, take medicines to prevent or treat HIV if appropriate, choose less risky sexual behaviors, get tested for other sexually transmitted diseases (STDs), and limit your number of sex partners. The more of these actions you take, the safer you can be.

Specifically, you can:

• Use condoms the right way every time you have sex (see How well do condoms prevent HIV?). Learn the right way to use a male condom.
• Reduce your number of sexual partners. This can lower your chances of having a sex partner who will transmit HIV to you. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
• Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicines daily to prevent HIV infection, if you are at very high risk for HIV. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you aren’t in a mutually monogamous relationship with a partner who recently tested HIV-negative, and you are a:
  • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months;
  • man who has sex with both men and women; or
  • heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at very high risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).
• Post-exposure prophylaxis (PEP) means taking HIV medicines after being potentially exposed to HIV to prevent becoming infected. If you’re HIV-negative or don’t know your HIV status and think you have recently been exposed to HIV during sex (for example, if the condom breaks), talk to your health care provider or an emergency room doctor about PEP right away (within 3 days). The sooner you start PEP, the better; every hour counts. If you’re prescribed PEP, you’ll need to take it once or twice daily for 28 days. Keep in mind that your chance of getting HIV is lower if your HIV-positive partner is taking medicine to treat HIV infection (called antiretroviral therapy, or ART) as prescribed and his or her viral load stays undetectable (see Does my HIV-positive partner’s viral load affect my risk of getting HIV?).
• If you’re HIV-negative and your partner is HIV-positive, encourage your partner to get and stay on treatment. If taken as prescribed, HIV medicine (ART) can make the amount of HIV in the blood (viral load) very low—so low that a test can’t detect it (called an undetectable viral load). People with HIV who get and keep an undetectable viral load can stay healthy for many years and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
• Choose less risky sexual behaviors. HIV is mainly spread by having anal or vaginal sex without a condom or without taking medicines to prevent or treat HIV.

Receptive anal sex is the riskiest type of sex for getting HIV. It’s possible for either partner—the partner inserting the penis in the anus (the top) or the partner receiving the penis (the bottom)—to get HIV, but it is much riskier for an HIV-negative partner to be the receptive partner. That’s because the lining of the rectum is thin and may allow HIV to enter the body during anal sex.

Vaginal sex also carries a risk for getting HIV, though it is less risky than receptive anal sex. Most women who get HIV get it from vaginal sex, but men can also get HIV from vaginal sex.

In general, there is little to no risk of getting or transmitting HIV from oral sex. Theoretically, transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other STDs, which may or may not be visible. See How can I prevent getting HIV from oral sex?

Sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission but may pose a risk for other STDs.

If you use them the right way every time you have sex, condoms are highly effective in preventing HIV infection. But it’s important to educate yourself about how to use them the right way.

Condoms can also help prevent other sexually transmitted diseases (STDs) you can get through body fluids, like gonorrhea and chlamydia. However, they provide less protection against STDs spread through skin-to-skin contact, like human papillomavirus or HPV (genital warts), genital herpes, and syphilis.

There are two main types of condoms: male and female.

Male Condoms

• A male condom is a thin layer of latex, polyurethane, polyisoprene, or natural membrane worn over the penis during sex. Male Condom Dos and Don’ts.
• Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies, but plastic ones break more often than latex ones. Natural membrane (such as lambskin) condoms have small holes in them, so they don’t block HIV and other STDs.
• Use water- or silicone-based lubricants to lower the chances that a condom will break or slip during sex. Don’t use oil-based lubricants (for example, Vaseline, shortening, mineral oil, massage oils, body lotions, and cooking oil) with latex condoms because they can weaken the condom and cause it to break. Don’t use lubricants containing nonoxynol-9. It irritates the lining of the vagina and anus and increases the risk of getting HIV.

Female Condoms

• A female condom is a thin pouch made of a synthetic latex product called nitrile. It’s designed to be worn by a woman in her vagina during sex. Female Condom Dos and Don’ts.
• When worn in the vagina, female condoms are comparable to male condoms at preventing HIV, other STDs, and pregnancy. Some people use female condoms for anal sex. We don’t currently know how well female condoms prevent HIV and other STDs when used by men or women for anal sex. But we do know that HIV can’t travel through the nitrile barrier.
• It is safe to use any kind of lubricant with nitrile female condoms.

Even if you use condoms the right way every time you have sex, there’s still a chance of getting HIV. For some individuals at high risk of getting or transmitting HIV, adding other prevention methods, like taking medicines to prevent and treat HIV, can further reduce their risk (see How can I prevent getting HIV from anal or vaginal sex?).

If you are at very high risk for HIV from sex or injecting drugs, taking HIV medicines daily, called pre-exposure prophylaxis (or PrEP), can greatly reduce your risk of HIV infection. You can combine additional strategies with PrEP to reduce your risk even further.

Federal guidelines recommend that PrEP be considered for people who are HIV-negative and at very high risk for HIV. This includes anyone who is in an ongoing sexual relationship with an HIV-positive partner. It also includes anyone who:

1. Is not in a mutually monogamous* relationship with a partner who recently tested HIV-negative, and
2. Is a
   • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months;
   • man who has sex with both men and women; or
   • heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).

PrEP is also recommended for people who’ve injected drugs in the past 6 months and have shared needles or works or been in drug treatment in the past 6 months.

If you have a partner who is HIV-positive and are considering getting pregnant, talk to your doctor about PrEP. It may be an option to help protect you and your baby.

PrEP involves daily medication and regular visits to a health care provider.

Yes. Taking medicine after being potentially exposed to HIV, called post-exposure prophylaxis (or PEP), can keep you from becoming infected. But PEP must be started within 72 hours after a possible exposure.

If you think you’ve recently been exposed to HIV during sex (for example, if the condom breaks) or through sharing needles and works to prepare drugs (for example, cotton, cookers, water), talk to your health care provider or an emergency room doctor about PEP right away. The sooner you start PEP, the better; every hour counts. If you’re prescribed PEP, you’ll need to take it once or twice daily for 28 days.

Someone who is on PEP should continue to use condoms with sex partners and safe injection practices while taking PEP.

There are many actions you can take to lower your risk of transmitting HIV to a partner. The more actions you take, the safer you can be.

• The most important thing you can do is to take medicine to treat HIV infection, called antiretroviral therapy (ART), as prescribed. Taking HIV medicine as prescribed can make the amount HIV in your blood (viral load) very low—so low that a test can’t detect it (called an undetectable viral load). Getting and keeping an undetectable viral load is the best thing you can do to stay healthy. If your viral load stays undetectable, you have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
• If you’re taking ART, follow your health care provider’s advice. Visit your health care provider regularly and always take your medicines as prescribed. Find Ryan White HIV/AIDS Program medical care providersexternal icon who help people living with HIV access the HIV primary medical care, medicationsexternal icon, and essential support services they need (from HRSA).
• Use condoms the right way every time you have sex. Learn the right way to use a male condom.
• Choose less risky sexual behaviors. Anal sex is the highest-risk sexual activity for HIV transmission. If your partner is HIV-negative, it’s less risky if they’re the insertive partner (top) and you’re the receptive partner (bottom) during anal sex. Oral sex is much less risky than anal or vaginal sex. Sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission.
• If you inject drugs, never share your needles or works with anyone.
• Talk to your partners about pre-exposure prophylaxis (PrEP), taking HIV medicines the right way, every day to prevent HIV infection. See Can I take medicines to prevent getting HIV?
• Talk to your partners about post-exposure prophylaxis (PEP) if you think they’ve recently had a possible exposure to HIV (for example, if they had anal or vaginal sex without a condom or if the condom broke during sex). Your partners should talk to a health care provider right away (within 72 hours) after a possible exposure. Starting PEP immediately and taking it daily for 28 days will reduce their chance of getting HIV.
• Get tested and treated for other STDs and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase the risk of getting or transmitting HIV. Find an STD testing site.

Getting and keeping an undetectable viral load is the best thing you can do to stay healthy. If you keep an undetectable viral load, you have effectively no risk of transmitting HIV to an HIV-negative sex partner.

Most people can get the virus under control within six months. But some people face challenges that make it hard to stick to a treatment plan, and a few people cannot get an undetectable viral load even though they take HIV medicine as prescribed.

If your viral load is not undetectable—or does not stay undetectable—you can still protect your partner by using other prevention methods. The following actions are highly effective for preventing HIV:

• Use condoms the right way every time you have anal or vaginal sex.
• Choose sexual activities with little to no risk, like oral sex. You could also use condoms or dental dams with oral sex to lower the risk even more.
• Your partner can take medicine to prevent HIV, called pre-exposure prophylaxis (PrEP). Your partner will need to take PrEP every day for around 7 days before it becomes as effective as it can be for receptive anal sex and around 20 days for receptive vaginal sex,^* and they’ll need to keep taking PrEP every day.
• Never share syringes or works to inject drugs.

If your partner or you have other sexually transmitted diseases (STDs), getting treatment for those STDs can also help lower your risk of transmitting HIV. People who are HIV-positive and have another STD may have an increased concentration of HIV in their semen and genital fluids, which might make them more likely to transmit HIV. People who are HIV-negative and have another STD may have irritation that makes it easier for HIV to enter their body during sex, or inflammation in their body may increase the number of cells that HIV can target.

Keep in mind that your greatest chance of transmitting HIV is when you are the insertive partner (top) during anal sex. But it’s also possible to transmit HIV when you are the receptive partner during anal sex or either partner during vaginal sex.

Stopping injection and other drug use can lower your chances of getting or transmitting HIV a lot. If you keep injecting drugs, use only sterile needles and works. Never share needles or works.

You are at very high risk for getting HIV if you use a needle or works after someone with HIV has used them. Also, when people are high, they’re more likely to have risky sex, which increases the chance of getting or transmitting HIV.

The best way to reduce your risk of HIV is to stop using drugs. You may need help to stop or cut down using drugs, but many resources are available. Talk with a counselor, doctor, or other health care provider about substance abuse treatment. To find a treatment center near you, check out the locator tools on SAMHSA.govexternal icon or HIV.govexternal icon, or call 1-800-662-HELP (4357).

If you keep injecting drugs, here are some things you can do to lower your risk for getting HIV and other infections:

• Use only new, sterile needles and works each time you inject. Many communities have needle exchange programs where you can get new needles and works, and some pharmacies may sell needles without a prescription.
• Never share needles or works.
• Clean used needles with bleach only when you can’t get new ones. Bleaching a needle may reduce the risk of HIV but doesn’t eliminate it.
• Use sterile water to fix drugs.
• Clean your skin with a new alcohol swab before you inject.
• Be careful not to get someone else’s blood on your hands or your needle or works.
• Dispose of needles safely after one use. Use a sharps container, or keep used needles away from other people.
• Get tested for HIV at least once a year.
• Ask your doctor about taking daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP).
• Don’t have sex if you’re high. If you do have sex, use a condom the right way every time. Learn the right way to use a male condom.

If you have HIV, the most important thing you can do is to take medicine to treat HIV infection (called antiretroviral therapy or ART) as prescribed.

If you’re pregnant, talk to your health care provider about getting tested for HIV and other ways to keep you and your child from getting HIV. Women in their third trimester should be tested again if they engage in behaviors that put them at risk for HIV.

If you are HIV-negative but you have an HIV-positive partner and are considering getting pregnant, talk to your doctor about taking pre-exposure prophylaxis (PrEP) to help keep you from getting HIV. Encourage your partner to take medicine to treat HIV (ART). People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

If you have HIV, take ART as prescribed. If you are treated for HIV early in your pregnancy, your risk of transmitting HIV to your baby can be 1% or less. After delivery, you can prevent transmitting HIV to your baby by avoiding breastfeeding, since breast milk contains HIV. A woman living with HIV should avoid breastfeeding even if she has an undetectable viral load.