Of course, you want to protect your HIV-negative partners from becoming infected. The simple way to do this is to either refrain from high-risk sex (such as anal or vaginal sex without condoms) or always use a condom. There are also some considerations and things that you might think about and may not know about to reduce the risk of HIV transmission to your partner or partners.
PrEP (Pre-Exposure Prophylaxis)
PrEP is a daily HIV pill, namely Truvada, that an HIV-negative person can take to prevent infection (along with using condoms). Taking it as prescribed can reduce transmission by 90% or more. This is true in both women and men and for both vaginal and anal sex. PrEP was approved by the FDA in July of 2012 and should only be done with the help of a doctor. If you have an HIV-negative sex partner, PrEP may be something to explore.
The CDC recommends that PrEP is for people without HIV who are at very high risk for getting it from sex or injection drug use. The federal guidelines recommend that PrEP be considered for people who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner.
This recommendation also includes anyone who
- isn’t in a mutually monogamous relationship with a partner who recently tested HIV-negative, and - is a . . .
-- gay or bisexual man who has had anal sex without using a condom or been diagnosed with an STD in the past 6 months, 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 have 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 if you’re not already taking it. PrEP may be an option to help protect you and your baby from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.
Because PrEP involves daily medication and regular visits to a health care provider, it may not be right for everyone. And PrEP may cause side effects like nausea in some people, but these generally subside over time. These side effects aren’t life threatening.
PrEP reaches maximum protection from HIV for receptive anal sex at about 7 days of daily use. For all other activities, including insertive anal sex, vaginal sex, and injection drug use, PrEP reaches maximum protection at about 20 days of daily use. For more information, watch Project Inform’s videos at www.projectinform.org/prep/. Also, some people's insurance will cover PrEP, for those whose insurance won’t cover PrEP, Gilead may be able to help those with lower incomes. To learn more about this program, go online at www.start.truvada.com/.
PEP (Post-Exposure Prophylaxis)
PEP stands for post-exposure prophylaxis. It means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP must be started within 72 hours after a recent possible exposure to HIV, but 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. PEP is effective in preventing HIV when administered correctly, but not 100%. PEP should only be used in emergency situations and should not be used by someone after every time they have unprotected sex or use a dirty needle.
There’s more of a chance of passing HIV if you have sex when a sexually transmitted disease like chlamydia or syphilis is present in either partner. Even if symptoms aren’t present, active genital infections can still raise the risk. Make sure your provider regularly screen for and treat STDs.
Undetectable Viral Load
The chance for passing HIV is much less likely when the positive partner takes HIV meds and stays undetectable over time. Undetectable viral load in the blood is linked to lower and perhaps undetectable viral load in vaginal and anal fluids and semen. However, several things can briefly raise viral load in genital fluids and blood: sexually transmitted infections, other infections that challenge the immune system like hepatitis B or C, or even a recent vaccination.
Foreskin vs. No Foreskin
Having a foreskin increases the risk because HIV likes to find the immune cells found within the foreskin. For straight men during vaginal sex, there’s about a 60% lower risk of transmission when he is circumcised. As for anal sex (straight or gay), it’s not as clear how much more protection there is for the man who’s cut.
Sometimes HIV-positive people change their unprotected sex to lower the risk of passing HIV to others: by sero-sorting, or having sex with someone they think is also HIV-positive; and by sero-positioning, or “bottoming” for an HIV-negative partner.
Sero-sorting with another HIV-positive person increases the risk for super-infection, or getting another strain of HIV which may make it harder to control. This most often occurs during the first months after infection. However, there are probably fewer serious concerns if both partners are on HIV meds and stay undetectable.
Sero-positioning may somewhat reduce the risk for passing HIV, but the HIV-negative top (insertive) can still get HIV through unprotected vaginal and anal sex. This is especially true if breaks in the skin or infections are present, if viral load is detectable, or if the top is uncut. Since these sero-adaptive behaviors imply unprotected sex, you can still get other sexual infections such as chlamydia, herpes and syphilis, as well as diseases that people don’t often think of in terms of sex, like hepatitis C. Recent mini-epidemics of both syphilis and hepatitis C have been seen in HIV-positive gay and bisexual men. Both have a faster progression and are harder to treat in people with HIV.
Some states make it a crime to have sex with an HIV-negative person if you don’t disclose you have HIV—even if you use a condom, take HIV meds, and have an undetectable viral load. In some states, notably in the Midwest and the South, more prosecutions are occurring against those people who don’t disclose. To learn more about this and how to protect yourself, visit www.seroproject.com.Contributed in part by Project Inform: www.projectinform.org/HIVhealth/
Copyright 2018, Positive Health Publications, Inc.
This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!