What You Need To Know About Safer Sex
HOW DOES HIV SPREAD DURING SEX?
HIV isn't magical... we know exactly how it is spread. Unprotected anal sex (both top and bottom) and sharing needles continue to fuel the HIV epidemic in our community.
HIV is a fluid-based virus and is found in high enough concentrations to cause an infection in the following fluids:
- Blood (highest risk fluid)
- Semen (second highest, includes pre-cum)
- Vaginal Fluid (lowest risk fluid)
Someone else's blood, semen or vaginal fluid needs to get into your body. The exchange of fluids must be direct (like when sharing needles or during unprotected sex) as the virus is very fragile and dies quickly when exposed to light and air. Using condoms correctly and every time will protect you from HIV!
If your sexual partner tests negative for HIV and hasn't shared needles or had unprotected anal or oral sex in the past three months (also known as the "window period"), they are not infected with HIV. Your sex partner can't give you HIV if they don't have HIV (that is, have passed their window period for testing). The window period can be tricky... if someone tests HIV-negative today, that doesn't necessarily mean they don't have HIV, especially if they've had sex with someone within the last couple of months.
You can't tell if someone is HIV-positive or HIV-negative by looking, only through testing after the window period. Think you can tell someone's status? Play "Pos or Not"!
If you are HIV-positive you can infect or re-infect your sex partners during unprotected sex. Studies are showing that higher viral loads can make it much easier to infect your partner, so keeping your viral load low helps. If you are doing well with managing your HIV infection, the reality is that you can STILL spread HIV to your sex partners even if you have an undetectable viral load.
Figuring out the differences in risk between different activites (from safe to unsafe to safer) will help keep you and your partners HIV-negative.
SAFE ACTIVITIES
Safe activities have NO risk for spreading HIV. Abstinence (not having sex) is totally safe. If abstaining from sex is not an option for you, then it is important to learn about other options for protecting yourself from HIV and other STDs.
HIV is very specifically transmitted, so 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 from HIV. Saliva is not a risk fluid for HIV, so activities like kissing and receiving oral sex (having someone give you head) are safe from HIV.
That being said, it is good to recognize that there are some activies that are safe from HIV, but not from other STDs (especially skin-to-skin STDs like syphilis, herpes and genital warts). Take some time to learn how other STDs are spread... check out our STD facts!
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 to clear both you and your partner's window period fully before engaging in unprotected sex with each other. It is also important to find a partner you can trust not to have sex outside of your relationship (HIV is a life-long, incurable infection). If you have trouble trusting your sex partner enough to start a joint checking account, then you may want to reconsider trusting your sex partner with your life-long health!
UNSAFE ACTIVITIES
Unprotected anal sex (both topping and bottoming) has a high risk of spreading HIV and other STDs.
Receptive anal sex (bottoming) without a condom is the highest risk for HIV. Having someone ejaculate (cum) inside you is the absolute highest sexual risk. Not letting a guy cum inside of you helps reduce your risk (but not eliminate it!) as there's less fluid. Unfortunately, pre-cum can also transmit HIV.
Insertive anal and vaginal sex (topping) without a condom is the second highest sexual risk for HIV. Though the risk is "lower" while topping than bottoming, that DOES NOT translate to "low" risk. The belief that tops don't get HIV is not only untrue, it's contributing to the spread of HIV and other STDs (such as syphilis) right here in the Twin Cities.
Your risk for getting or giving HIV increases dramatically when you have another STD. For example, if you are infected with syphilis, you are 2 - 5 times more likely to get or give HIV. STDs like syphilis and herpes can turn unprotected oral sex (a low risk for HIV) into a high risk for HIV.
Drug use (especially meth use) paired with sex is strongly linked to barebacking, multiple sex partners and new HIV infections. If you are injecting, be sure to have clean needles - familiarize yourself with needle exchange programs like AccessWorks. If you are using meth and want some resources and support around how to use safer or to quit, check out CrystalClearMN.
SAFER ACTIVITIES
Many sexual activities have some sort of risk for spreading HIV - the rule of thumb is avoiding blood, semen and vaginal fluid. The less fluids the better!
Performing oral sex (putting a penis in your mouth, giving head) without a condom is a low risk for HIV. The risk is primarily when you get semen 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. The best way to dramatically reduce your risk is to not let guys cum in your mouth... telling your man you want to see him shoot on your chest makes things safer for you and hot for him.
Receiving oral sex (putting your penis in someone's mouth, getting head) without a condom is not a risk for HIV. It is, however, a risk for other STDs, such as gonorrhea, herpes and syphilis.
When considering what is safer sex, consider the following: skin is a natural barrier to HIV. If you don't have any cuts or sores on your skin, you are protected. HIV enters through mucous membranes located in specific areas.
Cover up the following sites with a barrier such as a latex or polyurethane condom:
Urethra (tip of the penis)- Butt
- Mouth and throat (be careful of bleeding gums)
- Eyes (watch out for big shooters!)
- Anywhere with a sore, cut or abrasion
Don't forget to use lubricants. Not only do they feel good, but they also reduce the chance of chaffing, cuts or abrasions inside the rectum or on the penis. It also reduces the chance of condom breakage. Be sure to use water-based lubricants with latex condoms - DO NOT use oil-based lubricants such as Crisco, Vaseline or vegetable oil.
If you are into fisting, don't use a latex condom for sex if you've used oil-based lube like Crisco. Be sure to use a polyurethane condom.
If a condom ever does break and your sex partner is known to be HIV-positive, ask a clinican about post-exposure prophylaxis (PEP) within 72 hours (ideally within the first 36 hours). For more information about PEP, contact the HIM Program at 612.348.9100 or go to the HCMC Emergency Room for immediate assistance.
Click here to find out more about latex and polyurethane condoms.
WHAT IF BOTH PEOPLE ARE ALREADY HIV-POSITIVE?
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.
Pregnancy is also a concern if you are having unprotected vaginal sex with women.
The other issue is re-infection - being infected with a different strain of HIV. There are many different strains of HIV, some more resistant to HIV medications than others. Even if someone knew who they got HIV from, each body is it's own incubator for HIV and can produce very different types of virus over time. 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.
SET YOUR LIMITS
Now that you know what the risks are, decide how much risk you are willing to take. Know what level of protection you want to use during different kinds of sexual activities. Before you have sex:
- Think about safer sex
- Set your limits
- Get a supply of lube and latex condoms (or other barriers, like the bottom condom)
- Make it easy to have safer sex - keep your supplies plentiful and handy
- Talk to your partners so they know your limits
- Stick to your limits. Don't let alcohol or drugs or an attractive partner make you forget to protect yourself
THE BOTTOM LINE
HIV infection and other STDs can occur during sexual activity. Sex is only safe if there is no HIV, no blood or sexual fluids, or no way for HIV to get into the body. Sex is safer if condoms and lube are used correctly and every time. Decide on your limits and stick to them. Both HIV and syphilis are on the rise right here in the Twin Cities, so don't forget to wrap it up!
Click here to find out more about condoms.
Click here for information about HIV/STD testing and counseling services.
