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Safe sex is important to protect women from human immunodeficiency virus (HIV) and a range of other sexually transmissible infections. In Australia, HIV is most commonly spread through unprotected anal or vaginal intercourse with an infected person.
Relationships in which one partner is HIV positive and the other is not are called ‘serodiscordant’. Being in a serodiscordant couple can raise a number of issues, such as how to have sex safely. Finding out more about what is safe, talking to others with experience or talking with a counsellor may be helpful.
If you are HIV positive, you should talk with your doctor or local HIV/AIDS organisation for further information and advice.
How HIV is spread
HIV is spread (transmitted) through body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), female genital fluids (both vaginal and cervical fluid) and breast milk. The way the virus gains entry to another person may be directly across the mucosa (the lining of the vagina or bowel) or into the bloodstream. HIV can also pass from mother to baby during pregnancy or birth, or via breast milk.
Transmission can occur from men to women and from women to men and between same sex partners.
Safe sex
Safe sex is sex where semen, vaginal secretions or blood are not exchanged between sexual partners. It is important to prevent the transfer of these body fluids, whether you or your partner is HIV positive.
Be guided by your doctor or health worker, but safe sex suggestions include:
- Kissing, cuddling, masturbation, mutual masturbation, massage and ejaculating or urinating on unbroken skin are considered safe activities.
- Men should always wear a condom and use a water based lubricant when having vaginal or anal sex.
- Women may prefer to wear a female condom that is inserted into the vagina.
- Pre-ejaculate (pre-cum) of an HIV positive man may transmit the virus, so don’t rely on the withdrawal method.
- Oral sex with either a man or woman is considered a ‘low risk’ activity for transmission of HIV. However, the risk increases when people have cuts or sores in their mouth or on their lips, or have recently brushed their teeth and gums or flossed their teeth. For extra safety, you may choose to use a condom during oral sex performed on a man, or a dental dam or similar protection (such as clear plastic cling wrap – but not the ‘microwave safe’ variety which has tiny holes in it) during oral sex performed on a woman.
- Avoid penetration of the vagina or anus with finger or fist if there are abrasions on the hand or arm – to be sure, wear a latex glove and use lots of water based lubricant.
- Don’t share penetrative sex toys such as dildos – consider having a separate collection for each partner, covering them with a new condom each time they are used or washing them thoroughly in warm soapy water between partners.
- Lesbian serodiscordant couples should also follow these safer sex suggestions.
Negotiating safe sex
Practicing safe sex is important even if you don’t know whether your partner is HIV positive or not. It protects you from HIV as well as other sexually transmissible infections (STIs). HIV is more easily transmitted when a person has another STI.
Telling sexual partners you have HIV is a complex issue. Deciding when and how to tell will vary according to the relationship, the situation and the people involved.
If you are a person living with HIV, you do have a responsibility not to transmit the virus. In Victoria, it is an offence to knowingly or recklessly infect another person with an infectious disease. NSW has specific legislation that requires that people disclose their HIV status before having sex. Any person who recklessly endangers or inflicts harm on another person may be charged under criminal law in all states and territories.
Some tips to consider
- Negotiating safe sex is not always easy. Here are a few tips that may help.
- Have condoms handy if you think there is a possibility that you will be having sex.
- Don’t assume that safe sex is the man’s responsibility. Women can carry condoms too.
- Don’t assume that a man will feel confident about using condoms. Learn about how they are used correctly so you can help. This can be fun.
- Make it your business to find out about condoms. Investigate colours and flavours.
- Find out where you can get condoms without embarrassment.
- Try to negotiate safe sex before you get into the ‘heat of the moment’. This is usually not the best time for debate and discussion.
Some things you could say
Think up some statements that you feel comfortable using, for example:
- ‘Where’s the condom?’
- ‘Let’s have safe sex to protect both of us.’
- ‘I can roll the condom onto you with my mouth.’ Make sure you can.
- ‘To make sure I don’t get pregnant, I like to use condoms.’
What to do if you are exposed to body fluids
If you are exposed to body fluids, you should wash the skin or area thoroughly with soap and water. Don’t use a douche in the vagina or rectum as this can irritate the area and increase the risk of HIV transmission. See your doctor for further information and advice.
Post-exposure prophylaxis (PEP) is a month-long course of medication for people who have been exposed to the HIV virus. To be most effective, it should be started within 72 hours of exposure. It is best to start as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex.
If you think you have been exposed to HIV or think you need help, call 1800 889 887. This is a 24-hour telephone service.
Clothes, bedding or other material can be washed in water and detergent or dry-cleaned.
Don’t share toothbrushes or razors
Everyday household contact doesn’t transmit the HIV virus, but the intimacy of a sexual relationship means that lovers tend to share personal items, which can be a risk. A serodiscordant couple should avoid sharing toothbrushes, razors or any other personal item (including injecting equipment) that could have come in contact with blood.
Long-term relationships
Practicing safe sex in long-term relationships is a challenge. The term ‘safe sex’ seems to conjure up thoughts of condoms and not much else. However, in all relationships, reducing the risk of HIV transmission is vital.
Open discussion and being honest with your partner about your feelings and fears will help communication in your relationship. Different fears and concerns may arise for the positive person in the relationship and the negative partner. Often these fears may need to be addressed by a professional counsellor.
It is helpful to remember these fears are occurring because the partner cares. Remember that many serodiscordant couples have lived in intimate relationships for many years without passing on the virus to their partner.
Try to have fun
Keeping the spontaneity in your relationship alive is probably the hardest part to work at. To help, you could:
- Keep a condom handy in your pocket.
- Make your sex life as intimate and loving as you possibly can. Remember that intimacy is not all about sex.
- Don’t forget to have fun – for example, massage can be a wonderful avenue for both of you to explore.
Talking to other people living with HIV about these issues may be helpful. Straight Arrows and Positive Women are community support organisations that have peer support workers.
Where to get help
- HIV, Hepatitis and STI Education and Resource Centre, Alfred Health Tel. (03) 9076 6993
- PEP Information Line, Victorian NPEP Service Tel. 1800 889 887 (24 hours)
- Your specialist HIV doctor
- Victorian HIV/AIDS Service, Alfred Health Tel. (03) 9076 6076
- Positive Women Tel. (03) 9076 6918
- Straight Arrows (heterosexual men, women and children) Tel. (03) 9076 3792
- People Living with HIV/AIDS Vic Tel. (03) 9865 6772
- Melbourne Sexual Health Centre (03) 9341 6200, 1800 032 017 or TTY (for the hearing impaired) (03) 9346 8619
- Family Planning Victoria Tel. (03) 9257 0100
- Well Women’s Clinic, Royal Women’s Hospital Tel. (03) 9344 2288 or (03) 9344 2183
- Blood Borne Viruses/Sexually Transmissible Infections Program, Department of Human Services Victoria Tel. (03) 9096 0000
Things to remember
- The HIV virus is spread through body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), vaginal and cervical fluids, and breast milk.
- It is important to prevent the transfer of the HIV virus, whether the woman or her partner is HIV positive.
- Safe sex is still possible in relationships where one partner is HIV positive and the other is not.
- Talk with your doctor, health worker or AIDS organisation about how you can practice safer sex.
You might also be interested in:
HIV and AIDS.
HIV and men - safe sex.
HIV and women - having children.
HIV testing.
HIV treatment.
Safe sex.
Sexually transmissible infections - avoid the risk.
Sexually transmissible infections - overview.
Sexually transmissible infections - signs and symptoms.
Want to know more?
Go to More information for support groups, related links and references.
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