Safe sex (or safer sex) is important to protect women from human immunodeficiency virus (HIV) as well as a range of other sexually transmissible infections (STIs). In Australia, HIV is most commonly spread through unprotected anal or vaginal intercourse with a person who has HIV, and is more easily transmitted when either person has another STI. If untreated, HIV infection can progress to acquired immune deficiency syndrome, or AIDS, and death.
Relationships in which one partner has HIV and the other does not are called serodiscordant. Being in a serodiscordant sexual relationship can raise a number of issues, such as how to have sex without putting the HIV negative partner at risk. You may find it helpful to talk to others with experience or with a counsellor about your concerns.
When treated effectively, HIV is much less likely to be transmitted. If you have HIV, consider starting treatment if you’re not already on it. Stay in regular contact with your treating doctor, get your viral load (the amount of HIV in a body fluid) tested regularly, and take your treatment carefully. Being untreated, or stopping or changing treatment without medical supervision will result in an increasing viral load and increase the risk of infection to your partner.
If both you and your partner have HIV, you may wish to find out if it’s okay for you to have unprotected sex. It’s important that you aren’t at risk of other sexually transmitted infections, which might happen if either of you has a sexual partner outside the relationship. Honesty with one another is very important. You can talk to your doctor about this, and find out if there are any tests you should get done.
It is recommended that sexually active people with HIV infection have regular STI screening, as some sexually transmitted infections may not have symptoms. How often you should be tested depends on the number of sexual partners and whether you have had an STI in the last 12 months.
How HIV is spread
HIV is spread through body fluids, including blood, semen, vaginal fluids, rectal mucus and breastmilk. 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 breastmilk.
Transmission can occur from men to women, from women to men and between two female partners (although female to female transmission is extremely rare), or between two men.
Safe sex and HIV
Safe sex is sex where body fluids do not contact vulnerable body parts of the other partner. This includes the vagina, rectum, foreskin and urethra,,and mouth, as well as any skin or mucous membrane that may have breaks or cuts on it.
There is recent evidence that if the partner with HIV infection is on antiretroviral treatment and their HIV viral load is suppressed to very low levels (less than 200 copies/ml) then transmission of HIV to the negative partner is extremely unlikely.
There is guidance on what safe sex is. If you feel unsure, talk with your HIV doctor or sexual health service. Remember that:
- Kissing, cuddling, masturbation, mutual masturbation, massage and ejaculating 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 of an HIV-positive man may transmit the virus, so don’t rely on the withdrawal method. Withdrawal means having intercourse that is stopped before the man ejaculates or ‘cums’.
- 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. To minimise the risk from oral sex, people may choose to use a condom or a dental dam during oral sex.
- If you use sex toys during sex, make sure they are either covered with a new condom, or washed with soapy water before being used by your partner.
- Lesbian serodiscordant couples should also follow these safer sex suggestions. Transmission of HIV between women during sex is extremely rare. However, it is possible where blood or vaginal fluids come in contact with the other partner’s genital mucosa.
Other factors affecting risk of HIV
The presence of other sexually transmitted infections increases the risk of HIV transmission. If either partner has sex outside the relationship, safe sex with other partners must also occur, as well as regular testing and communication about risky events, in order to minimise the risk of HIV transmission.
Effective HIV treatment reduces the risk of it spreading to sexual partners. Regularly missing treatment, or stopping and starting treatment can result in increased in viral load, which increases the risk of transmission.
Negotiating safe sex
Negotiating safe sex is not always easy. A few tips that may help include:
- Have condoms and dental dams 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.
- Make it your business to find out about condoms and dental dams.
- Don’t assume that your partner will feel confident about using condoms or dental dams. Learn how they are used so you can be sure they are used properly
- Find out where you can get condoms and dental dams 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.
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.’
- ‘To make sure I don’t get pregnant, I like to use condoms.’
- ‘I just don’t have unsafe sex.’
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 have HIV you have a responsibility not to transmit the virus.
You may be guilty of a criminal offence if your actions put another person at risk of getting HIV. Practising safer sex as described above is the best way to reduce the risk of HIV transmission during sex. There have been very few criminal convictions for HIV transmission, but it’s important to act within the law, and also to reduce HIV transmission risk.
In Victoria, you are not obliged to tell
sexual partners that you have HIV if you are having safe sex (not exposing them to HIV). Sometimes, however, telling is important, for example, if a condom breaks during intercourse. Your partner can then access post-exposure prophylaxis (PEP) if needed, which reduces their risk of acquiring HIV.
Laws about disclosing your status vary from state to state, with some states requiring you to tell sexual partners that you have HIV before you have sex. To find out your local laws, contact your state’s HIV/AIDS organisation.
What to do if you are exposed to body fluids
If you are exposed to body fluids, you should wash the skin or area 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.
If there is blood or body fluid in the mouth, either swallow or spit it out immediately, rather than letting it stay in the mouth. If necessary, eyes can be rinsed with water or saline, after removing any contact lenses. Don’t use antiseptic on wounds if they are exposed. Once body fluids have dried, they are unable to transmit HIV.
Post-exposure prophylaxis (PEP) is a month-long course of medication for people who have recently been at risk of exposure to HIV. To be most effective, it’s important that the medication is started within 72 hours. It is best to start as early as possible after exposure. PEP is not an alternative to safe sex, because it is not a guarantee of HIV prevention and may have side effects. It is not recommended as a standard prevention strategy.
If you think you or your partner have been exposed to HIV or think you need help, call Get PEP, a free 24-hour telephone service on 1800 889 887.
Talk with your partner, doctor or counsellor about the factors that led to the unprotected sex and work out ways to avoid the same mistake in future.
Don’t share toothbrushes or razors
Everyday household contact does not 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, tweezers, razors or any other personal item that could have come in contact with blood.
Sharing injecting equipment is high risk for HIV transmission. Always use new equipment where available, and never share any equipment, including needles, syringes, spoons or water.
Long-term relationships when one partner has HIV
Practising safer sex in long-term relationships can be a challenge. The term ‘safer sex’ seems to conjure up thoughts of condoms and not much else, but other issues can arise.
Relationships where one person has HIV can be vulnerable to specific problems for a number of reasons, including:
- Fear – both partners could be fearful of the HIV-positive partner developing AIDS or other complications, 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 practise safer 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.
- Abuse – the HIV-negative partner may threaten to disclose their partners’ HIV status, or use their partners’ status to control or denigrate them.
- Guilt – the person living with HIV may feel guilty and ashamed about their status.
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 person living with HIV and their HIV-negative partner. Talking through these issues with a professional counsellor, individually or as a couple, can be very helpful for people in serodiscordant relationships.
It is helpful to remember these fears often occur because the partner cares. Remember that many serodiscordant couples have lived in healthy and respectful intimate relationships for many years without passing on the virus to their partner.
Talking honestly with your partner about your feelings will help both of you through these difficulties. In any relationship, communication is the key.
Having fun in relationships
Keeping the spontaneity in a relationship is probably the hardest part. Tips that might help include:
- Keep a condom and dental dams handy in your pocket.
- Make your sex life as intimate and loving as you possibly can. Remember that intimacy is not all about sex. – for example, massage can be a wonderful avenue for both of you to explore.
- Don’t forget to have fun together.
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
- 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, Box Hill (for information on contraception and safe sex)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
- Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795 (for country callers)
- Positive Women Victoria Tel. (03) 9863 8747
- 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
- Centre for Culture, Ethnicity and Health Tel. (03) 9418 9929
- Women’s Domestic and violence crisis service. 24 hour phone 1800 015 188
Things to remember
- HIV is spread through body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), vaginal fluids, rectal mucus and breast milk.
- It is important to prevent the transfer of HIV, no matter which partner has HIV.
- Safe sex is possible in relationships where one partner has HIV and the other does not.
- Women living with HIV who have HIV-negative partners can still enjoy physically intimate relationships.
- Talk with your doctor, health worker or HIV organisation about how you can practise safer sex.