In Australia, the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. HIV weakens the immune system and causes acquired immune deficiency syndrome (AIDS). If you are HIV-positive (are infected with HIV), you should talk with your doctor or local HIV/AIDS organisation for further information and advice.
It is important to remember that body fluids entering the bloodstream transmit the virus. Remember that the risk goes both ways. For example, it is commonly believed that only the partner who is penetrated is at risk, but HIV can be transmitted to the partner who penetrates via small cuts and abrasions on his penis or via the urethra (the tube that carries urine out from the bladder through the penis).
How HIV is spread
Transmission can occur from men to women and from women to men as well as between men who have sex with men. The best way to stop HIV transmission is to always use a condom when having sex.
HIV is transmitted by body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), female genital fluids (both vaginal and cervical fluid), breastmilk and anal mucous.
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. Broken skin is more prone to allowing entry of HIV, including if other sexually transmissible infections are present, such as herpes and chlamydia. HIV can also pass from mother to baby during pregnancy, birth or via breastmilk.
Unsafe sexual activities
Unsafe sexual activities include:
- Unprotected anal sex – the virus can enter the bloodstream through mucus membranes or small cuts or abrasions
- Withdrawing before ejaculation – pre-ejaculate fluid can contain the virus
- Using pre-ejaculate as a lubricant prior to anal intercourse
- Sucking ejaculate from the anus (felching)
- Activities involving razors or shaving – blood can be drawn from small nicks and cuts
- Any sexual activity that draws blood.
Safe sex and HIV
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 the man or his partner is HIV-positive. Be guided by your doctor or health worker, but safe sex suggestions include:
- Kissing, cuddling, masturbation, mutual masturbation and massage are safe, as are ejaculating or urinating on unbroken skin.
- Always wear a condom and use a water-based lubricant when having vaginal or anal sex.
- The woman may prefer to wear a female condom that is inserted into the vagina.
- The withdrawal method is not a safe sex alternative, as the pre-ejaculate (pre-cum) of an HIV-positive man may transmit the virus.
- Oral sex with either a man or woman is considered a ‘low-risk’ activity for transmission of HIV. The risk increases when people have cuts or sores in their mouth or on their lips, or have recently brushed or flossed their teeth. To ensure oral sex is a no-risk activity, people may choose to use a condom or a dental dam during oral sex.
- HIV cannot be transmitted via licking and kissing the anus (oral–anal contact or ‘rimming’), but other diseases such as hepatitis A and intestinal parasites and bacteria (for example, shigella) can. Use a barrier such as a dental dam or clear plastic wrap (but not the ‘microwave-safe’ variety – it has tiny holes in it).
- Avoid urinating on skin if there are cuts or abrasions on the skin. Don’t allow urine to come in contact with the eyes or mouth, in case there is blood in the urine.
- Don’t allow faeces to come in contact with the eyes, mouth or cuts on the skin. HIV can be transmitted in faeces if it contains blood. Hepatitis and intestinal parasites can also be transmitted by faeces.
- Avoid penetration of the vagina or anus with finger or fist if there are abrasions on the hand or arm. To be sure that this is a safe sex activity, wear a latex glove and use lots of water-based lubricant.
- Don’t share penetrative sex toys such as dildos. It’s best to have a separate collection for each partner. You should also cover them with a new condom each time they are used, or wash them thoroughly in warm soapy water between partners.
Negotiating safer sex
Negotiating safe sex is not always easy. Tips that may help include:
- Negotiate safe sex before you get into the ‘heat of the moment’. This is usually not the best time for debate and discussion.
- Have condoms and water-based lubricant handy if you think there is a possibility that you will be having sex.
- Don’t assume that your partner will take responsibility for having condoms. Make sure you have condoms with you.
- Don’t assume that your partner will feel confident about using condoms. Everyone should learn how to use them correctly.
- Make it your business to find out about condoms. Condoms come in a range of different sizes, shapes, styles, colours and flavours to suit personal preferences and enhance pleasure. It is important to investigate what is best for you and your partner.
- Find out where you can get condoms without embarrassment.
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. Any person who recklessly endangers or inflicts harm on another person may be charged under criminal law in all states and territories.
Exposure to HIV
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 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 HIV. To be most effective, you should start taking the medication within 72 hours of exposure. It is best to take them as early as possible after exposure. These medications can have a toxic effect 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 advice, call Get PEP, a free 24-hour telephone service available in nine languages and with an optional interpreter service.
Clothes, bedding or other material can be washed in water and detergent or dry-cleaned.
Talk with your doctor or partner about the factors that led to the unprotected sex and work out ways to avoid the same mistake in future.
Personal care items and HIV
Everyday household contact doesn’t transmit HIV, but the intimacy of a sexual relationship means that lovers tend to share personal items, which can be a risk. Avoid sharing toothbrushes, razors or any other personal items (including injecting equipment) that could have come in contact with blood.
Relationships when one partner has HIV
When one partner is HIV-positive and the other is not (also known as serodiscordant), safe sex becomes more of an issue. A serodiscordant relationship can trigger various relationship problems including:
- Fear – both partners could be fearful of the HIV-positive partner developing AIDS or of the HIV-negative partner contracting the virus.
- Sexual problems – some people may feel bored and frustrated by the constraints of always having to practice safe sex, which can cause tension within the relationship. Sometimes, treatments can also affect the HIV-positive partner’s libido.
- Insecurity – the person with HIV may feel insecure and worry that their partner may leave them because of their HIV status.
For the HIV-positive person in the relationship, issues can be totally different to those of the HIV-negative person. Fears around transmitting HIV to your sexual partner are real, and sometimes these fears may need to be addressed by a professional counsellor. It is helpful to remember these fears are occurring because the partner cares.
The HIV-negative person may also have fears associated with contracting HIV or of family or friends finding out about their partner and what their reaction might be. Talking to a professional counsellor may also help these fears.
Being honest with your partner about your feelings and talking will help both of you through these difficulties. In any relationship, communication is the key.
Talking to other people living with HIV about these issues may be helpful. People Living with HIV/AIDS Victoria, Straight Arrows and Victorian Aids Council Victoria are community support organisations that have peer support workers.
Where to get help
- Your doctor
- Your community health clinic
- Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 (toll free from outside of Melbourne only) or TTY (for the hearing impaired) (03) 9347 8619
- Victorian AIDS Council/Gay Men’s Health Centre Tel. (03) 9865 6700 or 1800 134 840
- Victorian HIV/AIDS Service, Alfred Health Tel. (03) 9076 6076
- HIV and Sexual Health Connect Line Tel. 1800 038 125 or TTY. 1800 555 677
- The Centre Clinic, St Kilda Tel. (03) 9525 5866
- Family Planning Victoria Tel. (03) 9257 0100
- CBD Action Centre (for people under 25) Tel. (03) 9660 4700 or 1800 013 952
- Sexual Health Clinic Ballarat Tel. (03) 5338 4500
- HIV and Sexual Health Connect Line Tel. 1800 038 125
- People Living Centre Tel. (03) 9863 0444 or 1800 622 795 (for country callers)
- Straight Arrows Tel. (03) 9863 9414
- Get PEP Tel. 1800 889 887 – a 24-hour service in nine community languages with the option of a translation service
- Multicultural Health and Support Service Tel. (03) 342 9700
Things to remember
- HIV is transmitted by body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), vaginal and cervical fluids, and breastmilk.
- It is important to prevent the transfer of HIV in these body fluids no matter who is HIV-positive.
- For the HIV-positive person in the relationship, issues can be totally different to those of the HIV-negative person.
- HIV-positive men with HIV-negative partners can still enjoy physically intimate relationships.
This page has been produced in consultation with and approved by:
Department of Health and Human Services - MHW&A - Prevention and Population Health - Prevention System and Policy
Page content currently being reviewed.
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.