What You Need To Know About Safer Sex

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HOW IS HIV TRANSMITTED DURING SEX?

Today we know a great deal more about HIV than we did 15, even 10 years ago. From HIV prevention, transmission and infection to living a healthy life being HIV+, HIV is something we can understand and control now.

Let's talk about the basics first:

WHAT IS HIV?

Human Immunodeficiency Virus is a lot like other viruses but there is an important difference.  HIV stays with you for life.  HIV takes over and T-cells otherwise known as the CD4 cells.  The body needs these cells to help fight infections and disease.  HIV becomes a part of these cells using them to make copies of itself and then destroys the CD4 cell. 

Over time, HIV can destroy so many of these CD4 cells that the body can’t fight infections and disease.  At the point, HIV infection can lead to an AIDS diagnosis.

WHAT IS AIDS?

Acquired Immunodeficiency Syndrome is the advanced stage of HIV infection.  People at this stage of HIV infection have compromised immune systems that can lead to Opportunist Infections (OI).   Someone can be have an AIDS diagnosis when one or more OIs are present and the number of CD4 cells drops to a very low number.

It is important to anyone who is HIV+ to see a doctor for the most appropriate HIV health care to remain as health as possible.

HOW IS HIV TRANSMITTED?

HIV is a fluid-based virus and is found in high concentrations in the following fluids:

• Blood (highest risk fluid) – sharing needles and/or “works” while using injectable drugs
• Semen/Cum (second highest, includes pre-cum) – exchanging semen during oral and/or anal sex
• Vaginal Fluid (lowest risk fluid)
• Breast milk

Someone else's blood, semen or vaginal fluid needs to get into the body. The exchange of fluids must be direct (like when sharing needles or during sex with an infected partner).  HIV is very fragile and dies quickly when exposed to light and air. The use of latex condoms and non-latex condoms such as polyurethane and polyisoprene have proven to be the best prevention against HIV infection if someone does not know the status of his partners!   

Most people develop detectable HIV antibodies within 3 months of infection.  This is known as the “window period”, the time it takes HIV antibodies to show on an HIV test.  If someone is infected today, it could take up to 3 months for antibodies to show on a test. 

WHAT ARE THE SYMPTOMS?

Many newly infected individuals can experience an acute illness much like the flu a few weeks to a few months after infection.   It is during this time that HIV is found in high numbers in the blood and someone is most infectious.  Generally, most don’t notice any symptoms for acute HIV infection.  Also, having these symptoms DOES NOT mean there has been an HIV infection. 
*The best way to know your status is to get tested!

REINFECTION

There are many different strains of HIV, some more resistant to HIV medications than others. Even if someone knows how he or she became HIV-infected, each body is it's own incubator for HIV and can produce different strains of HIV over time. It can depend on how well you and/or your partner are taking your meds, and what types of meds you're using. And different types of virus have different types of resistance to medications. We don't know everything about re-infection. But it is important to recognize that medication available to you now may not work in the future if you get a different strain.

Protecting yourself and your partner from HIV is still important, even if both parties are HIV-positive. Some HIV-positive individuals "serosort", meaning they only have sex with other HIV-positive people. This helps reduce the risk of spreading HIV to non-infected members of the community, but does not protect an HIV-positive individual from other STDs such as syphilis, gonorrhea, chlamydia, genital warts and herpes. If you have HIV, it can be easier to be infected by other STDs, and the infections themselves are often much more serious than when an individual is HIV-negative. This is especially true of syphilis.

SAFE OR SAFER SEX 

One thing we know about “safe sex” is that the only true “safe sex” is abstinence. For some, abstinence may be the best choice until they meet the right person with whom they are able to have a monogamous relationship.  This is where we get into the “safer sex” dynamic and where safer sex can get a little confusing.

HIV is transmitted in very specific ways like we mentioned earlier.  There are many different sexual activities you can do that are safe from HIV. Things like rimming (oral-anal sex), mutual masturbation (jerking off together), frottage (rubbing your genitals against each other), erotic massage, and web camming (stripping or jerking off together over the Internet with the use of a web cam) are all safe. Kissing and “making out” are also safe. 

That being said, it is good to recognize that there are other Sexually Transmitted Diseases.   STDs like syphilis, chlamydia, gonorrhea and herpes can increase someone’s risk for acquiring HIV.  If someone is already HIV+, knowing about other STDs is equally important to stay healthy.  Take some time to learn how other STDs can affect you.  Learning how you can prevent, test for and treat these infections will help you stay healthy ... check out our STD facts!

If you are HIV negative, get regularly tested for HIV and STDs. If you are HIV positive, knowing your CD4 count, viral load and STD status are equally or even more important.  STDs can negatively affect your health causing an increase in viral load and decrease in CD4 cells.  Red Door Clinic is one of many great options available to help you figure out what tests you may need and how often you should be tested.
Those who are sexually active may have varied perceptions of safer sex and their HIV risks.  These perceptions can vary from person to person or even within groups or networks of friends and can change often over time.  Safer sex is not always easy for one person to think about on his own.  Discussing safer sex and one’s sex life with partners, or a total stranger when you get tested, can be even more difficult BUT being honest with where you are sexually is important for your health and the health of your partners.  It will also help us at Red Door Clinic provide you with the best information to meet you specific needs.  SO…let’s talk a bit about that!

CONDOMS OR NO CONDOMS

This topic has always been one with drastically different opinions within the MSM community AND within the professional HIV prevention and medical communities.  It is not a comfortable topic of conversation but necessary.  We definitely know that consistent condom use is the best HIV prevention while sexually active.  Condom use significantly reduces the risk of HIV transmission as well as the transmission of other sexually transmitted infections.  For many, there is no other option than always using condoms.  For others, though, condoms are not the desired choice and not used for different reasons. 

With the wide range of social networking and hook-up sites, sex is very accessible and easy to find at a moment’s notice.  With that comes the quick decision of discussing HIV/STD testing history and status with prospective partners and whether or not to use condoms.  These topics can sometimes “ruin the mood” or even be “deal breakers” for some so bringing them up is often bypassed for sex.   Your partner shouldn’t be drunk, high or in an altered state that may prevent him for making a decision he normally wouldn’t make.  If you know your partners true status and recent sexual history, your decision may be to not use condoms.  HOWEVER AND VERY IMPORTANT:  Someone saying they are disease free does not always mean they are disease free.  Not everyone knows their status or knows what their test result truly means.  They may base their response on their most recent test result which may not take into account an existing window period.  Choosing to not use condoms is a big decision and one that should be made with care to avoid becoming infected or being re-infected with HIV. 

ALL ABOUT CONDOMS

Using condoms consistently (and correctly!) protects us from getting or giving HIV and other STDs.  There are a wide variety of condoms available today but they are NOT all the same.  Click on the condom to the left and we will help you explore and understand each type.  Not everyone uses or wants to use condoms but we have put together a section with everything you want to know about them! 

Types of condom:

• Latex
• Polyisoprene
• Polyurethane
• Female Condom (Bottom Condom)
• Lambskin

For additional condom facts from the CDC, click on this link (PDF).

MONOGAMY OR OPEN RELATIONSHIP

Having a monogamous relationship with just one sex partner is safe as long as neither of you are infected with HIV and neither of you are having sex (or sharing needles) outside of your relationship. It is important for both partners to get tested for HIV 3 months after each is no longer in the 3-month HIV window before starting a condom-free relationship with each other to remain HIV-.  In an exclusively monogamous relationship with both partner being HIV- and neither is in the window period, it is unlikely that either partner will transmit HIV to the other. 
If both partners in a relationship are HIV- and have decided to no longer using condoms, beginning an open relationship can easily change your health.  Communication and understanding the dynamics of open relationship can be factors that define your future health status.   Beyond feelings, couples should also agree on the rules of sex outside of the relationship.  They need to talk about what kind of sex is acceptable and what is not.  

PEP (Post Exposure Prophylaxis)

PEP (PDF) involves taking anti-HIV drugs as soon as possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV positive.  PEP is most effective when treatment begins within 72 hours of exposure. PEP consists of 2-3 antiretroviral medications and should be taken for 28 days. A medical evaluation is important to determine PEP effectiveness for each individual.  PEP does not guarantee that someone exposed to HIV will not become infected with HIV.  Contact the HIM Program @ 612-349-9100 or go to the HCMC Emergency Room for immediate assistance.

PrEP (Pre Exposure Prophylaxis)

PrEP is an HIV prevention method for someone who is HIV negative to reduce their risk for becoming HIV infected.  When used consistently, PrEP has been shown to be effective in men who have sex with men (MSM) and heterosexually-active men and women.  A CDC study is also underway to evaluate whether PrEP is safe and effective in reducing the risk of HIV infection through injection drug use, but those results are not yet available.   Contact us at Red Door Services for more information on both PEP and PrEP!

RISK LEVELS

I’M A BOTTOM  (receptive anal sex):

• The odds of getting HIV from "bottoming" without a condom are higher than any other sexual behavior.
• HIV has been found in pre-cum (pre-ejaculatory fluid), so having your partner pull out before he cums (ejaculates) may not decrease your risk.
• Do not douche before sex. Douching irritates the lining of your rectum and this can increase your risk for getting HIV. If you are concerned about cleanliness, clean the rectum gently, with a soapy finger and water.
• If you are bottoming, always use plenty of water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize damage to the rectum during sex and to prevent the transmission of STIs (including HIV).

I’M A TOP (insertive anal sex)

• "Topping" without a condom is considered a high-risk behavior for transmission of HIV and other STIs.
• Your partner may have sores or other signs of infection in his/her rectum that you can't see. If you have tears or cuts on your penis, HIV can enter your body this way.
• It is possible for blood and other fluids containing HIV to infect the cells in the urethra of your penis.
• Though the risk is "lower" while topping than bottoming, that DOES NOT translate to "no" risk.

I GIVE HEAD 

• You can get HIV by performing oral sex on your male partner, although the risk is not as great as it is with unprotected anal or vaginal sex.
• You are also at risk for getting other sexually transmitted infections (STIs), like chlamydia and gonorrhea.
• Your risk of contracting HIV is reduced if your male partner does not ejaculate (cum) in your mouth. There is no conclusive evidence in the spitting versus swallowing debate (choosing to swallow semen or spit it out after ejaculation). What we do know is that once semen is in your mouth, the risk occurs.
• Your risk of HIV is reduced if you do not have open sores or cuts in your mouth.
• Using condoms for oral sex reduces your risk of getting HIV or other STIs.

I GET HEAD

• There is less associated risk for HIV infection with this sexual activity.
• Your risk of HIV is reduced substantially if you do not have open sores or cuts on your penis.
• There is a risk of contracting other STIs such as gonorrhea, syphilis and herpes

RIMMING (oral-anal contact)

• The risk of getting HIV by rimming is very low—but this kind of sexual contact comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
• If you want to lower the risk for other infections, using a barrier method such as a dental dam or non-

I PNP (Party and Play)

Drug use paired with sex, especially meth use (commonly known as T or Tina), is strongly linked to high risk sex.  Crystal meth lowers inhibition and boosts libido, a coupling that fosters high-risk sexual behavior and increasing the risk of HIV infection.  Men who use meth may say they would normally have safe sex are smoking, snorting or injecting meth which is leading to greater concerns within the MSM population.

CDC HIV Transmission Risk Chart here

If you are injecting, be sure to have clean needles - familiarize yourself with a local needle-exchange program, Minnesota AIDS Project Syringe Exchange Program.  Minneapolis has a great resource for those who want help with their meth use of want to help a friend who is using.  This program is offered through PrideAlive at the Minnesota AIDS Project (MAP).  Tweaker.org is a resource that will help better understand Meth and how it is changing the gay community.

Click here for information about HIV/STD testing and counseling services.