When you are first diagnosed with HIV, you may not want to think about having sex. Some people may be afraid of infecting a partner and decide sex is too risky. These are common reactions, especially if you got HIV through sex. Chances are, however, that you will want to have sex again. The good news is that there is no reason why you can't. People living with HIV enjoy sex and fall in love, just like other people. And there are many ways to have satisfying and safe sexual relationships.

One of the most effective ways to prevent HIV from passing to an HIV-negative sex partner is to take your own HIV medications (antiretroviral therapy, or ART) every day — these not only protect your health but can prevent transmission of HIV.

If you are having a hard time dealing with negative feelings like anger or fear, you can get help. Talk to your healthcare health care provider about support groups or counseling. Sex is a difficult topic for many people living with HIV — you are not alone.

By reading this information, you are already taking a good first step toward a healthy sex life. Having good information will help you make good decisions.

Your provider or other members of your health care team may ask you about your sexual practices each time you go in for a checkup. It may feel embarrassing at first to be honest and open. But they are trying to help you stay healthy.

Your healthcare provider and staff will still give you care if you have had sex with someone of the same sex or someone other than your spouse. healthcare is not there to judge you. It's OK to tell your providers the truth. It will not affect your medical benefits. It will help your health care team take better care of you.

Make sure you set aside time to ask questions about safer sex, sexually transmitted diseases (STDs), or any other questions you might have. If you feel that you need help dealing with your feelings, ask about support groups or counseling.

Many people living with HIV ask their provider to talk with them and their partners about HIV and how it is transmitted. They can answer technical questions and address the specifics of your situation. If you live with someone, they may have questions about everyday contact as well as sexual contact.

This may be one of the hardest things you have to do. But you need to tell your sex partner(s) that you are living with HIV, whether you have a primary partner such as a spouse or girlfriend or boyfriend, have more than one partner, or are single or casually dating.

What follows are tips for talking to your main partner, other partners, and former partners.

Talking to your main partner

If you are in a relationship, one of the first things you will probably think about after learning that you have HIV is telling your partner or partners. For some couples, a positive HIV test may have been expected. For others, the news will be a surprise that can be difficult.

Your partner may not be prepared to offer you support during a time when you need it. Your partner may be worrying about their own HIV status. On the other hand, if you think you may have contracted HIV from your partner, you are probably dealing with your own feelings.

Unless your partner is known to have HIV infection, they should get an HIV test right away. Don't assume that the results will come back positive, even if you have been having unprotected sex or sharing needles. Your partner may assume the worst and may blame you for possibly spreading the disease. It is important that you discuss these feelings with each other in an open and honest way, perhaps with a licensed counselor.

Talking to new partners

Talking about HIV with someone you are dating casually or someone you met recently may be difficult. You might not know this person very well or know what kind of reaction to expect. When telling a casual partner or someone you are dating, each situation is different and you might use a different approach each time. Sometimes you may feel comfortable being direct and saying, "Before we have sex, I want you to know that I have HIV."

Other times, you may want to bring it up by saying something like, "Let's talk about safer sex." Whichever approach you choose, you should tell the person that you have HIV before you have sex the first time. Otherwise, there may be hurt feelings or mistrust later. Also be sure to take your HIV medications every day (this is very effective in protecting partners from infection) and practice safer sex (see the Protecting your partner section). Whatever way you decide to tell your partner, the tips at the bottom of this page may help.

Talking to former partners

With people you had sex with in the past or people you have shared needles with, it can be very difficult to explain that you have HIV. However, it is important that they know so that they can get tested.

If you need help telling people that you may have been exposed to HIV, most city or county health departments will tell them for you, without using your name. Ask your provider about this service.

Remember

Before telling your partner that you have HIV, take some time to think about how you want to bring it up.

• Decide when and where would be the best time and place to have a conversation. Choose a time when you expect that you will both be comfortable and as relaxed as possible.
• Think about how your partner may react to stressful situations. If there is a history of violence in your relationship, consider your safety first and make a plan with a social worker or counselor.
• Imagine several ways in which your partner might react to the news. Write down what they might say, and then think about what you might say in response.

We know a lot about how HIV is transmitted from person to person. Having safer sex means you take this into account and avoid risky practices.

There are two reasons to practice safer sex: to protect yourself and to protect others.

Protecting yourself

If you have HIV, you need to protect your health. When it comes to sex, this means practicing safer sex (like using condoms) to avoid sexually transmitted diseases like herpes and hepatitis. HIV makes it harder for your body to fight off diseases. What might be a small health problem for someone without HIV could be big health problem for you. Your healthcare provider can prescribe condoms for you if you need them.

Protecting your partner

Taking care of others means making sure that you do not pass HIV or any other sexually transmitted infections to them.

"Being safe" usually means protecting yourself and others by using condoms for the highest-risk sex activities, specifically for anal and vaginal sex. When done correctly, condom use is very effective at preventing HIV transmission. In recent years, "being safe" has come to include two other important strategies for reducing HIV infections:

1. HIV treatment (ART medications) for people with HIV and,
2. PrEP for HIV negative people (see below). Both are very effective at reducing the risk of HIV infection. One or more of them is likely to be appropriate for your situation — be sure to ask your health care provider for more information.

What about antiretroviral therapy (ART) for HIV prevention?

One of the most effective ways you can prevent HIV from passing to an HIV-negative sex partner is to take your ART (HIV medications) every day. If they are working well to suppress the HIV in your body they also will prevent transmission of HIV to others. Learn more about ART as a prevention strategy.

What about pre-exposure prophylaxis (PrEP)?

HIV-negative individuals may, under the supervision of their health care provider, take a pill every day to prevent HIV infection. We call this pre-exposure prophylaxis, or PrEP. Usually these are persons who are at relatively high risk of becoming infected with HIV (for example, because they have a partner with HIV, they have risky sexual exposures, or they share injection drug equipment). The medications used for PrEP are Truvada and Descovy. PrEP appears to be extremely effective if it is taken every day, and is not effective if it is taken irregularly. Your healthcare health care provider can tell you more about PrEP.

Q: If I am on HIV medications and my viral load is undetectable (meaning that the virus isn't showing up on blood tests), can I still pass the virus to another person through sex?

The current HIV medication regimens (antiretroviral therapy, or ART) are extremely effective at preventing HIV transmission to a sex partner if the HIV viral load is undetectable. The following three research studies have focused on this question.

A large international study looked at couples (largely heterosexual) in which one partner was HIV positive and the other was HIV negative (we call these serodifferent couples). The study found that if the person with HIV took ART to suppress their viral loads, their risk of infecting their partners was enormously reduced, by 93% overall, over about 5 years. And, if the person with HIV was consistently on HIV medications, with an undetectable HIV viral load, there were no partner infections. It is important to note that the couples in this study were encouraged to use condoms.

A smaller study looked at both male-female and male-male serodifferent couples who did not use condoms (and did not plan to use them). All of the people with HIV in the study were on ART and had undetectable HIV viral loads. After more than a year, none of the HIV-negative partners had been infected by their partner. As a reminder, if someone does have a detectable HIV viral load it is very important to use condoms.

The third study examined male-male serodifferent couples. Again, all of the people with HIV were on ART and had undetectable HIV viral loads. During the study, there were more than 12,000 episodes of anal receptive sex (which confer the highest risk of HIV transmission) in which there was no use of condoms or PrEP. There were no HIV transmissions between the positive men on ART and their HIV-negative partners.

The results of these studies show that if a person with HIV is on ART with a completely suppressed HIV viral load, the risk of infecting an HIV-negative sex partner is exceedingly low. The CDC reviewed these data and stated that, "People who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner."

This is extremely reassuring for everyone who takes ART every day and whose viral load stays undetectable. As you think about yourself and your partner(s), here are some things to consider:

• The risk of HIV transmission will increase substantially if someone's HIV viral load goes up, for example if they miss medication doses or stop taking their ART.
• An HIV-negative person will not be protected from being infected by any other HIV-positive partners who are not taking ART.
• We have very few data on how effective ART is in preventing HIV transmission via sharing injection drug equipment.
• ART does not prevent pregnancy — use other strategies (such as condoms) as needed.
• ART does not prevent sexually transmitted diseases (STDs) — it is very important to use condoms to prevent other STDs such as gonorrhea, chlamydia, syphilis, hepatitis B and hepatitis C.

It is important to ask your health care provider for advice that is targeted to you as an individual, and to your partner, about the risks of passing HIV. And of course, it is really important to have frank and open conversations about HIV transmission with your HIV-negative partner(s), so you and they can make informed decisions about sexual health.

Q: Why is it important to wear condoms when HIV is treatable?

Latex condoms are highly effective in preventing the sexual transmission of HIV when used consistently and correctly. In addition, the consistent and correct use of latex condoms reduce the risk of other STDs such as gonorrhea and chlamydia, and to a lesser degree, genital ulcer disease such as Herpes. Condom use may also reduce the risk of genial human papillomavirus (HPV) and HPV-associated diseases, e.g. genital warts and cervical cancer.

HIV is treatable but it is a chronic infection and treatment requires taking pills every day so they will continue to work against the virus. If you get HIV, there are also other things to consider like managing medication side effects and risk of infecting other partners. So, consistent and correct use of latex condoms is recommended to prevent HIV transmission.

Risky sex is sex that may lead to infection of an HIV-negative individual. There are many ways to decrease the risk of HIV infection, like (for the partner living with HIV) taking HIV medications (ART) every day, or (for the HIV-negative partner) using PrEP, or (for partners of any HIV status) using condoms or other latex barriers during sex.

HIV is passed through body fluids such as semen, vaginal, or anal fluid, or blood. The less contact you have with these, the lower the risk. The most sensitive areas where these fluids are risky are in the vagina or anus and rectum (ass). The protective tissue there is thin, and is easily torn, which makes it easier for the virus to enter your body. Saliva (spit) and tears aren't as risky.

In general, vaginal or anal sex without a condom is the most risky.

Here is a list of sexual activities organized by level of risk to help you and your partner make decisions:

High risk

• Anal sex without a condom (penis in the anus)
• Vaginal sex without a condom (penis in the vagina)

Low risk

• Sex with a condom when you use it correctly
• Oral sex, but don't swallow semen (cum)
• Deep kissing (French kissing or tongue kissing)
• Sharing sex toys that have been cleaned or covered with a new condom between uses

No risk

• Hugging, massage
• Masturbation
• Fantasizing
• Dry kissing
• Phone sex
• Cyber sex
• Using sex toys that you don't share

Some sexual activities are riskier than others for getting or transmitting HIV. Anal sex is the riskiest type of sex for HIV transmission. If you don’t have HIV, being a receptive partner (or bottom ) for anal sex is the riskiest sexual activity for getting HIV. If you do have HIV, being the insertive partner (or top ) for anal sex is the riskiest sexual activity for transmitting HIV. There is extremely low to no risk of getting or transmitting HIV through activities like oral sex, touching, and kissing.

If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not transmit HIV through sex.

Anal Sex

What is anal sex? Anal sex is when a penis is inserted into an anus. The partner inserting the penis is called the insertive partner. The partner receiving the penis is called the receptive partner.

What we know about anal sex

Anal sex is the riskiest type of sex for getting or transmitting HIV. Although receptive anal sex is much riskier for getting HIV than insertive anal sex, it’s possible for either partner—the insertive or receptive—to get HIV.

An HIV-negative receptive partner’s risk of getting HIV is very high because the lining of the rectum is thin. HIV can enter the body through this lining during anal sex from body fluids that carry HIV, including semen (cum) or pre-seminal fluid (pre-cum).

• On average, an HIV-negative receptive partner has about a 1 in 70 chance of getting HIV every time they have receptive anal sex with a partner who has HIV.
• Being the receptive partner for anal sex is about 13 times more risky for getting HIV from a partner with HIV than being the insertive partner.
• For women, anal sex is about 17 times more risky for getting HIV from a man with HIV than vaginal sex.
• If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , you will not get HIV through sex with that partner.

An HIV-negative insertive partner is also at risk because HIV can enter the body through the opening at the tip of the penis (or urethra); the foreskin if the penis isn’t circumcised; or small cuts, scratches, or open sores anywhere on the penis. There is some evidence that circumcision decreases a man’s risk of getting HIV during sex.

• On average, an HIV-negative insertive partner has about a 1 in 900 chance of getting HIV every time they have insertive anal sex with a partner who has HIV.
• Being the receptive partner for anal sex is about 13 times more risky for getting HIV from a partner with HIV than being the insertive partner.
• For men, anal sex with a women with HIV is about 3 times more risky for getting HIV than vaginal sex.
• If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , you will not get HIV through sex with that partner.

An uncircumcised penis still has foreskin. The inner lining of the foreskin is different than other types of skin and has more of the cells that HIV infects. The foreskin may also be easier to tear during sex, providing another way for HIV to infect the body. Also, HIV may be able to survive for a longer time in the space between the foreskin and the penis. There is some evidence that circumcision may decrease the insertive partner’s risk of getting HIV during anal sex. And, being circumcised greatly reduces the risk of a man from getting HIV when having sex with a women who has HIV. Finally, a person with an uncircumcised penis may also have a higher risk of getting other sexually transmitted diseases (STDs), such as syphilis or herpes, which can increase the risk of getting HIV.

Keep in mind that HIV can be found in pre-seminal fluid (pre-cum), which means there’s a risk for either partner to get HIV even if the insertive partner withdraws before ejaculating. Withdrawal before ejaculating may, in theory, reduce the receptive partner’s risk of getting HIV. But it does not change the insertive partner’s risk of getting HIV.

Many things can increase someone’s risk of getting HIV from anal sex besides sexual position (insertive vs. receptive). For example, the HIV-negative partner is more likely to get HIV if either partner has another sexually transmitted disease (STD). Also, if you are HIV-negative and have anal sex with a partner who has HIV, your chance of getting HIV is very high if that partner is not on HIV treatment and does not have an undetectable or suppressed viral load. If your partner with HIV takes HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex.

You can get other STDs from anal sex even if you use a condom because some STDs are transmitted through skin-to-skin contact. And you can get hepatitis A and B, parasites like Giardia, and other bacteria like Shigella, Salmonella, Campylobacter, and E. coli from anal sex because they’re transmitted through feces.

If you’ve never had hepatitis A or B, there are vaccines to prevent these infections. Talk to a health care provider about your chances of getting hepatitis A or B and whether vaccination is right for you.

What you can do

Not having sex is a 100% effective way to make sure you don’t get or transmit HIV through sex. If you’re sexually active, you can lower your risk by choosing sexual activities that carry a lower risk for HIV than anal sex. You can also do other things to reduce your risk, including taking medicine to prevent or treat HIV and using condoms the right way, every time. Condoms and medicine to prevent or treat HIV are highly effective at preventing HIV if used correctly. But the medicines are much less effective if you don’t take them as prescribed, and condoms can sometimes break or come off during anal sex. Using a water-based or silicone lubricant can help prevent condoms from breaking or slipping.

Talking openly and frequently with your partner about sex can help you make decisions that decrease your risk of getting or transmitting HIV.

If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not transmit HIV through sex.

Vaginal Sex

What is vaginal sex? Vaginal sex is when a penis is inserted into a vagina.

What we know about vaginal sex

When a woman has vaginal sex with a partner who has HIV, HIV can enter her body through the mucous membranes that line the vagina and cervix. Most women who get HIV get it from vaginal sex. Even if a woman’s male partner withdraws or pulls out before ejaculating, she can still get infected because pre-seminal fluid (pre-cum) can carry HIV.

• On average, an HIV-negative woman has about a 1 in 1,250 chance of getting HIV every time she has vaginal sex with a man who has HIV.
• On average, a woman with HIV has about a 1 in 2,500 chance of transmitting HIV every time she has vaginal sex with an HIV-negative man.
• For an HIV-negative woman, anal sex is about 17 times more risky than vaginal sex for getting HIV from a partner with HIV.
• For a woman with HIV, anal sex is about 3 times more risky than vaginal sex for transmitting HIV to an HIV-negative partner.
• If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , their partner will not get HIV through sex.

Men can also get HIV from having vaginal sex with a woman who has HIV. This is because vaginal fluid and blood can carry HIV. Men get HIV through the opening at the tip of the penis (or urethra); the foreskin if they’re not circumcised; or small cuts, scratches, or open sores anywhere on the penis. There is strong evidence that circumcision greatly reduces the man’s risk of getting HIV during vaginal sex. There is no evidence that circumcision benefits the woman, though more studies are underway.

• On average, an HIV-negative man has about a 1 in 2,500 chance of getting HIV every time he has vaginal sex with a woman who has HIV.
• On average, a man with HIV has about a 1 in 1,250 chance of transmitting HIV every time he has vaginal sex with an HIV-negative woman.
• For an HIV-negative man, anal sex with a woman with HIV is about 3 times more risky for getting HIV than vaginal sex.
• For a man with HIV, anal sex with a woman with HIV is about 17 times more risky for transmitting HIV than vaginal sex.
• If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , they will not transmit HIV through sex.

Men who aren’t circumcised are more likely to get HIV through vaginal sex than men who are circumcised. When a man isn’t circumcised, he still has the foreskin on his penis. The inner lining of the foreskin is different than other types of skin on the body and has more of the cells that HIV infects. The foreskin may also be easier to tear during intercourse, providing another way for HIV to infect the body. In addition, HIV may be able to survive for a longer time in the space between the foreskin and the penis. Finally, uncircumcised men also have a higher risk of getting sexually transmitted diseases, such as syphilis or herpes, which can increase the risk of getting HIV.

Keep in mind that HIV can be found in pre-seminal fluid (pre-cum), which means there’s a risk for either the man or the woman to get HIV even if the man withdraws before ejaculating. Withdrawal before ejaculating may, in theory, reduce the woman’s risk of getting HIV. But it does not change the man’s risk of getting HIV.

Many things can increase someone’s risk of getting HIV from vaginal sex. For example, the HIV-negative partner is more likely to get HIV if either partner has another sexually transmitted disease (STD). Also, if you are HIV-negative and have vaginal sex with a partner who has HIV, your chance of getting HIV is very high if that partner is not on HIV treatment and does not have an undetectable or suppressed viral load. If your partner with HIV takes HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex.

Taking medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP) can reduce your risk of getting HIV, and using condoms the right way every time you have sex can reduce your risk of getting both HIV and other STDs like gonorrhea and chlamydia that are transmitted through body fluids.

Condoms provide less protection against STDs that spread through skin-to-skin contact like human papillomavirus or HPV (genital warts), genital herpes, and syphilis.

What you can do

Not having sex is a 100% effective way to make sure you don’t get or transmit HIV through sex. If you’re sexually active, you can lower your risk for HIV by choosing sexual activities that carry a lower risk for HIV than vaginal sex. You can also do other things to reduce your risk, including taking medicine to prevent or treat HIV and using condoms the right way, every time. Condoms and medicine to prevent or treat HIV are highly effective at preventing HIV if used correctly. But the medicines are much less effective if you don’t take them as prescribed, and condoms can sometimes break or come off during vaginal sex. Using a water-based lubricant can help prevent condoms from breaking or slipping.

Talking openly and frequently with your partner about sex can help you make decisions that may decrease your risk of getting or transmitting HIV.

Some sexual activities are riskier than others for getting or transmitting HIV. Anal sex is the riskiest type of sex for HIV transmission. There is extremely low to no risk of getting or transmitting HIV through activities like oral sex, touching, and kissing.

If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not transmit HIV through sex.

Oral Sex

What is oral sex? Oral sex involves putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (anilingus).

What we know about oral sex

The chance an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low. However, it’s hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. The risk is even lower if the HIV-negative partner is taking medicine as prescribed to prevent HIV (pre-exposure prophylaxis or PrEP). If the partner with HIV is taking HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex, including oral sex.

But you can get other sexually transmitted diseases (STDs) from oral sex. And, if you get feces in your mouth during anilingus, you can get hepatitis A and B, parasites like Giardia, and other bacteria like Shigella, Salmonella, Campylobacter, and E. coli.

What you can do

Choosing activities with extremely low to no risk like oral sex instead of higher-risk activities like anal or vaginal sex can lower your chances getting or transmitting HIV. If you have oral sex. If you have oral sex, using a barrier (e.g., a condom, dental dam, or cut-open nonlubricated condom) can make your risk of getting or transmitting HIV even lower and protect you and your partner from some other STDs, including gonorrhea of the throat, and hepatitis.

A dental dam is a thin, square piece of rubber that is placed over the vagina or anus during oral sex. Dental dams are usually made from latex or silicone, and they work by preventing the mouth from coming into direct contact with the vagina and anus.

Because your mouth may come into contact with feces or other body fluids during oral sex, it is important that you talk to a health care provider about your chances of getting hepatitis A and B. If you’ve never had hepatitis A or B, there are vaccines to prevent it. Your provider can help you decide if vaccination is right for you.

Some sexual activities are riskier than others for getting or transmitting HIV. Anal sex is the riskiest type of sex for HIV transmission. There is extremely low to no risk of getting or transmitting HIV through activities like oral sex, touching, and kissing.

If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not transmit HIV through sex.

Touching

What is Touching? Touching involves one partner putting their hands or other body parts on their sex partner's vagina, penis, or anus (with or without clothes on). Touching can also include the use of sex toys.

What do we know about touching

There’s extremely low to no risk for getting or transmitting HIV from touching. The only possible risk would be if body fluids from a partner with HIV touch the mucous membranes or damaged tissue of someone who’s HIV-negative. Mucous membranes can be found inside the rectum , the vagina, the opening of the penis, and the mouth. Damaged tissue could include a cut, sore, or open wound.

There’s a chance of getting or transmitting other sexually transmitted diseases (STDs) through touching because some STDs (like human papillomavirus or HPV, genital herpes, and syphilis) can be transmitted through skin-to-skin contact.

You could also get or transmit other kinds of infections, like hepatitis A and hepatitis B virus; parasites like Giardia; and bacteria such as Shigella, Salmonella, Campylobacter, or E. coli if you touch someone’s anus because you may get feces on your hands or fingers.

What you can do

Choosing activities with little to no risk like touching instead of higher-risk activities like anal or vaginal sex can lower your chances of getting or transmitting HIV. To make this risk even lower, make sure you and your partner don’t have open cuts, wounds, or sores on the hands or fingers. To prevent transmission of STDs that can be transmitted through skin-to-skin contact, you can wear medical gloves for touching.

If your genitalia is touching your partner’s genitalia, keeping your clothes on will reduce the chances of exposure to body fluids and open sores that can spread HIV or other STDs.

If you use sex toys, do not share them with your partner. If you do share them, cover sex toys with a new condom if possible, and wash them carefully after each use.

If a person with HIV takes HIV medicine as prescribed and keeps an undetectable viral load they will not transmit HIV through sex, including touching.

Some sexual activities are riskier than others for getting or transmitting HIV. Anal sex is the riskiest type of sex for HIV transmission. There is extremely low to no risk of getting or transmitting HIV through activities like oral sex, touching, and kissing.

If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not transmit HIV through sex.

Kissing

What is kissing? Kissing involves partners touching their lips and/or tongues together.

What we know about kissing

There’s no chance of getting HIV from closed-mouth or “social” kissing, and you can’t get HIV through saliva. In some very rare cases, people have gotten HIV from deep, open-mouth “French” kissing because they and their partners had blood in their mouths from bleeding gums or sores (like canker sores). But the chance of getting HIV from deep, open-mouth kissing is much lower than from most other sexual activities.

What you can do

Choosing activities with little to no risk like kissing instead of higher-risk activities like anal or vaginal sex can lower your chances of getting or transmitting HIV. To make this risk even lower, make sure you and your partner don’t have bleeding gums or mouth sores when kissing.

If a person with HIV takes HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex, including kissing.

You and your partners will have to decide what you are comfortable doing sexually.

Here are some tips:

• Find a time and place outside the bedroom to talk.
• Decide your own boundaries, concerns and desires before you start to talk.
• Make sure you clearly state what you want. Use only "I" statements, for example: "I want to use a condom when we have sex."
• Make sure you don't do, or agree to do, anything that you're not 100% comfortable with.
• Listen to what your partner is saying. Acknowledge your partner's feelings and opinions. You will need to come up with solutions that work for both of you.
• Be positive. Use reasons for safer sex that are about you, not your partner.

Of course, only you and your partner can decide what level of risk you are willing to take.

The only forms of birth control that will protect against HIV are abstinence and using condoms while having sex. Other methods of birth control offer protection against unplanned pregnancy, but do not protect against HIV or other sexually transmitted diseases.

Birth control options that DO protect against HIV:

• Abstinence (not having sex)
• Male condom
• Internal or female condom

Birth control options that DO NOT protect against HIV:

• Oral contraceptive ("the pill")
• Injectable contraceptive (shot)
• Contraceptive implant
• IUD (intrauterine device)
• Emergency contraception ("morning-after pill")
• Diaphragm, cap, and shield
• Vasectomy (getting your tubes tied if you are a man)
• Tubal ligation (getting your tubes tied if you are a woman)

Considerations for women with HIV

If you are in a monogamous relationship and your partner also has HIV, you may decide to use a birth control method other than condoms. (These methods won't protect against other STDs or re-infection.)

Safe methods of birth control for a woman with HIV with a partner who also has HIV include:

• Using a diaphragm
• Tubal ligation (getting your tubes tied)
• IUD (intrauterine device)

Use only after checking with your provider (these may interact with your HIV medications):

• Birth control pills
• Contraceptive injection (eg, Depo-Provera)
• Contraceptive implant (eg, Norplant)

If you need condoms, you can ask your healthcare provider for a prescription for condoms at your next visit. If you are not used to using condoms: practice, practice, practice.

Male condom dos and don'ts:

• Shop around: Use lubricated latex condoms. Always use latex, because lambskin condoms don't block HIV and STDs, and polyurethane condoms break more often than latex (if you are allergic to latex, polyurethane condoms are an option). There is a lot of variety--one will work for you!
• Keep it fresh: Store condoms loosely in a cool, dry place (not your wallet). Check the expiration date. Throw away condoms that have expired, were exposed to very hot temperatures, or were washed in the washer. If you think the condom might not be good, get a new one.
• Take it easy: Open the package carefully, so that you don't rip the condom and make sure that the condom package has not been punctured (there should be a pocket of air). Check the condom for damaged packaging and signs of aging such as brittleness, stickiness, and discoloration.
• Keep it hard: Put on the condom after the penis is erect and before it touches any part of a partner's body. If a penis is uncircumcised (uncut), the foreskin must be pulled back before putting on the condom.
• Heads up: Make sure the condom is right-side out. Before you put it on the penis, unroll the condom about half an inch to see which direction it is unrolling. Then put it on the head of the penis and hold the tip of the condom between your fingers as you roll it all the way down the shaft of the penis from head to base. This keeps out air bubbles that can cause the condom to break. It also leaves a space for semen to collect after ejaculation.
• Slippery when wet: If you use a lubricant (lube), it should be a water-soluble lubricant (for example, ID Glide, K-Y Jelly, Slippery Stuff, Foreplay, Wet, Astroglide) in order to prevent breakdown of the condom. Put lubricant on after you put on the condom, not before — it could slip off. Add more lube often. Dry condoms break more easily. Products such as petroleum jelly, massage oils, butter, Crisco, Vaseline, and hand creams are not considered water-soluble lubricants and should not be used.
• Come and go: Withdraw the penis immediately after ejaculation, while the penis is still erect; grasp the rim of the condom between your fingers and slowly withdraw the penis (with the condom still on) so that no semen is spilled.
• Clean up: Throw out the used condom right away. Tie it off to prevent spillage or wrap it in bathroom tissue and put it in the garbage. Condoms can clog toilets. Use a condom only once. Never use the same condom for vaginal and anal intercourse. Never use a condom that has been used by someone else.

Do you have to use a condom for oral sex?

It is possible for oral sex to transmit HIV, whether the infected partner is performing or receiving oral sex. But the risk is very low compared with unprotected vaginal or anal sex, however other sexually transmitted infections can be transmitted through oral sex.

If you choose to perform oral sex, you may:

• use a latex condom on the penis; or
• use a latex barrier (such as a natural rubber latex sheet, a dental dam, or a cut-open condom that makes a square) between your mouth and the vagina. A latex barrier such as a dental dam reduces the risk of blood or vaginal fluids entering your mouth. Plastic food wrap also can be used as a barrier.
• if either you or your partner are allergic to latex, plastic (polyurethane) condoms can be used.

If you perform oral sex and this sex includes oral contact with your partner's anus (anilingus or rimming),

• use a latex barrier (such as a natural rubber latex sheet, a dental dam, or a cut-open condom that makes a square) between your mouth and the anus. Plastic food wrap also can be used as a barrier.

If you share sex toys, such as dildos or vibrators, with your partner,

• each partner should use a new condom on the sex toy; and be sure to clean sex toys between each use.

Internal condom (also called female condom)

This type of condom was originally designed to be inserted into the vagina before sex. It also can be used in the anus, by either men or women, though its effectiveness in preventing HIV transmission via anal sex has not been studied.

The internal condom is a large condom fitted with larger and smaller flexible rings at each end. The rings help keep it inside the vagina during sex; for anal sex, the inner ring usually is removed before it is inserted. It is made of nitrile, so any lubricant can be used without damaging it. It may seem a little awkward at first, but can be a useful alternative to the traditional "male" condom. Female condoms generally cost more than male condoms. Remember to:

• Store the condom in a cool dry place, not in direct heat or sunlight.
• Throw away any condoms that have expired--the date is printed on the wrappers.
• Check the package for damage and check the condom for signs of aging such as brittleness, stickiness, and discoloration. The internal condom is lubricated, so it will be somewhat wet.
• Before inserting the condom, you can squeeze lubricant into the condom pouch and rub the sides together to spread it around.
• Put the condom in before sex play because pre-ejaculatory fluid, which comes from the penis, may contain HIV. The condom can be inserted up to 8 hours before sex.
• The internal condom has a firm but flexible ring at each end of it. To insert the condom in the vagina, squeeze the ring at the closed end between the fingers (like a diaphragm), and push it up into the back of the vagina. The open ring must stay outside the vagina at all times, and it will partly cover the lip area. For use in the anus, most people remove the internal ring before insertion.
• Do not use a male condom with the internal condom.
• Do not use an internal condom with a diaphragm.
• If the penis is inserted outside the condom pouch or if the outer ring (open ring) slips into the vagina, stop and take the condom out. Use a new condom before you start sex again.
• Don't tear the condom with fingernails or jewelry.
• Use a condom only once and properly dispose of it in the trash (not the toilet).

There are several ways to prevent getting or transmitting HIV through anal or vaginal sex.

If you are HIV-negative, you can use HIV prevention medicine known as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) to protect yourself. You can also use other HIV prevention methods, below.

If you have HIV, the most important thing you can do to prevent transmission and stay healthy is to take HIV medicine (known as antiretroviral therapy or ART) exactly as prescribed. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex. This is sometimes called HIV treatment as prevention or “undetectable = untransmittable” (U = U). There also are other options to prevent transmitting HIV, below.

Preventing Getting HIV

If you are HIV-negative, you have several options for protecting yourself from getting HIV through vaginal or anal sex. The more of these actions you take, the safer you can be.

To prevent getting HIV through sex, you can:

• Choose less risky sexual behaviors. HIV is mainly spread by having anal or vaginal sex without a condom or without taking medicines to prevent or treat HIV. Here is some information about the HIV risk associated with specific sexual behaviors. See CDC’s HIV Risk Reduction Tool for more information.
  • Receptive anal sex is the riskiest type of sex for getting or transmitting HIV. It’s possible for either partner—the partner inserting the penis in the anus (the top) or the partner receiving the penis (the bottom)—to get HIV, but it is much riskier for an HIV-negative partner to be the receptive partner. That’s because the lining of the rectum is thin and may allow HIV to enter the body during anal sex.
  • Vaginal sex also carries a risk for getting HIV, though it is less risky than receptive anal sex. Most women who get HIV get it from vaginal sex, but men can also get HIV from vaginal sex.
  • Oral sex carries little to no risk for getting or transmitting HIV. Theoretically, transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs), which may or may not be visible.
  • Sexual activities thatdon’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission but may pose a risk for other STDs.
• Use condoms. Condoms are highly effective at preventing HIV and other STDs like gonorrhea and chlamydia. Learn the right way to use condoms.
• Talk to your doctor about taking PrEP. Pre-exposure prophylaxis (PrEP) is HIV medicine people at risk for HIV take to prevent getting HIV. If taken as prescribed, PrEP is highly effective for preventing HIV from sex. PrEP is much less effective when it is not taken as prescribed. Currently, there are two FDA-approved daily oral medications for PrEP. A long-acting injectable form of PrEP has also been approved by the FDA. PrEP may be right for you if you do not have HIV, you have had anal or vaginal sex in the past 6 months, and you:
  • Have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load); or
  • Have not consistently used a condom; or
  • Have been diagnosed with an STD in the past 6 months.
  PrEP is also recommended for people who inject drugs and have an injection partner with HIV, or have shared needles, syringes, or other injection equipment.
• Take PEP within 72 hours after a possible HIV exposure. Post-exposure prophylaxis (PEP) means taking medicine to prevent HIV after a possible exposure. If you’re HIV-negative or don’t know your HIV status and think you have recently been exposed to HIV during sex (for example, if you had a condom break or you were sexually assaulted), talk to your health care provider or an emergency room doctor about PEP right away (within 72 hours). The sooner you start PEP, the better; every hour counts. If you’re prescribed PEP, you’ll need to take it daily for 28 days. Keep in mind that you will not get HIV if your HIV-positive partner is taking HIV medicine as prescribed and their viral load is undetectable.
• Encourage your HIV-positive partner to get and stay on HIV treatment. This is the most important thing your partner can do to stay healthy. If taken as prescribed, HIV medicine reduces the amount of HIV in the blood (the viral load) to a very low level. This is called viral suppression. HIV medicine can also make the viral load so low that a standard lab test can’t detect it. This is called having an undetectable viral load. As noted above, people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex. Learn more about HIV treatment as prevention.
• Get tested and treated for other STDsand encourage your partners to do the same. If you are sexually active, get tested at least once a year. Having other STDs increases your risk for getting HIV. STDs can also have long-term health consequences.
• Reduce your number of sexual partners. This can lower your chances of having a partner who could transmit HIV to you. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with an STD. Both these factors can increase the risk of HIV transmission.
• Decide not to have sex. Not having sex (also known as abstinence) is a 100% effective way to prevent HIV, other STDs, and pregnancy. You can be abstinent at different times in your life for different reasons that may change over time.
• Know your HIV status. The only way to know your HIV status is to get tested. Knowing your status can give you important information and help you make good decisions to prevent getting or transmitting HIV.

Preventing Passing HIV to Others

If you have HIV, there are many actions you can take to prevent transmitting HIV to an HIV-negative partner through sex. The more of these actions you take, the safer you can be.

• Get into care and take HIV medicine. The most important thing you can do is to get into HIV medical care and take HIV medicine (called antiretroviral therapy, or ART) exactly as prescribed. If taken as prescribed, HIV medicine reduces the amount of HIV in your blood (your viral load) to a very low level, which keeps your immune system working and prevents illness. This is called viral suppression. HIV medicine can also make your viral load so low that a standard lab test can’t detect it. This is called having an undetectable viral load. People with HIV who get and keep an undetectable viral load can live a long and healthy life and will not transmit HIV to an HIV-negative partner through sex. That’s why people say “Undetectable=Untransmittable.” Learn more about HIV treatment as prevention.
• If you’re taking HIV medicine, follow your health care provider’s advice. Visit your health care provider regularly and always take your HIV medicine as prescribed.
• Talk to your HIV-negative partners about PrEP. Pre-exposure prophylaxis (PrEP) is daily medicine that can reduce an HIV-negative person’s chance of getting HIV (see more about PrEP, above). Taken as prescribed, PrEP can stop HIV from taking hold and spreading throughout the person’s body.
• Talk to your HIV-negative partners aboutpost-exposure prophylaxis (PEP) if they think they’ve recently had a possible exposure to HIV (for example, if they had anal or vaginal sex without a condom or if the condom broke during sex with a partner whose viral load was not suppressed or whose viral load was unknown). Your partner should talk to a health care provider right away (within 72 hours) after a possible exposure. Starting PEP immediately and taking it daily for 28 days will reduce their chance of getting HIV. Keep in mind that you will not transmit HIV to your HIV-negative partner if you are taking HIV medicine as prescribed and your viral load is undetectable.
• Use condoms. Condoms are highly effective in preventing HIV and other STDs, like gonorrhea and chlamydia. Learn the right way to use condoms.
• Choose less risky sexual behaviors. Anal sex is the highest-risk sexual activity for HIV transmission. If your partner is HIV-negative, it’s less risky if they’re the insertive partner (top) and you’re the receptive partner (bottom) during anal sex. There is little to no risk of getting or transmitting HIV from oral sex. Sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission.
• Get tested and treated for other STDs and encourage your partners to do the same. If you are sexually active, get tested for STDs at least once a year. STDs can have long-term health consequences and can also increase your risk of transmitting HIV.