How can a person reduce the risk of getting HIV?

Anyone can get HIV, but you can take steps to protect yourself from HIV.

• Get tested for HIV. Talk to your partner about HIV testing and get tested before you have sex.
• 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.
• Use condoms every time you have sex. Read this fact sheet from CDC on how to use condoms correctly.
• Limit your number of sexual partners. The more partners you have, the more likely you are to have a partner with poorly controlled HIV or to have a partner with a sexually transmitted disease (STD). Both of these factors can increase the risk of HIV.
• Get tested and treated for STDs. Insist that your partners get tested and treated, too. Having an STD can increase your risk of getting HIV or spreading it to others.
• Talk to your health care provider about pre-exposure prophylaxis (PrEP). PrEP is an HIV prevention option for people who do not have HIV but who are at risk of getting HIV. PrEP involves taking a specific HIV medicine every day to reduce the risk of getting HIV through sex or injection drug use.
• Do not inject drugs. But if you do, use only sterile drug injection equipment and water, and never share your equipment with others.

How can a person who is HIV positive prevent passing HIV to others?

Take HIV medicines daily. Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live longer, healthier lives. ART cannot cure HIV, but it can reduce the amount of HIV in the body (called the viral load). One of the main goals of ART is to reduce a person's viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

Here are some other steps you can take to prevent HIV transmission:

• Use condoms correctly every time you have sex.
• Talk to your partner about taking PrEP.
• If you inject drugs, do not share your needles, syringes, or other drug equipment with your partner.

Are HIV medicines used at other times to prevent HIV transmission?

Yes, HIV medicines are also used for post-exposure prophylaxis (PEP) and to prevent perinatal transmission of HIV.

• Post-exposure prophylaxis (PEP)
  PEP means taking HIV medicines within 72 hours after a possible exposure to HIV to prevent HIV infection. PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently.
• Prevention of perinatal transmission of HIV
  Pregnant women with HIV take HIV medicines for their own health and to prevent perinatal transmission of HIV. After birth, babies born to women with HIV receive HIV medicine to protect them from infection with any HIV that may have passed from mother to child during childbirth.

What is abstinence? Abstinence means not having oral, vaginal, or anal sex. An abstinent person is someone who’s never had sex or someone who’s had sex but has decided not to continue having sex for some period of time.

What we know about abstinence

Abstinence is a 100% effective way to prevent HIV, other sexually transmitted diseases (STDs), and pregnancy. The longer you wait to start having oral, vaginal, or anal sex, the fewer sex partners you are likely to have in your lifetime. Having fewer partners lowers your chances of having sex with someone who has HIV or another STD.

Some STDs are transmitted through skin-to-skin contact (like human papillomavirus or HPV, genital herpes, and syphilis), so even if you don’t have anal or vaginal sex (or if you use a condom when you have sex), you can get those STDs.

What you can do

Choose to be abstinent and talk to your partner about that decision. Not having sex is a 100% effective way to prevent getting or transmitting HIV.

What is choosing less risky sexual activities? Some sexual activities are riskier for HIV transmission than others. By choosing less risky sexual activities, you can reduce your risk of getting or transmitting HIV.

What we know about choosing less risky sexual activities

HIV is mainly spread by having anal or vaginal sex without using a condom or without taking medicine to prevent or treat HIV. Anal sex is the riskiest type of sex for transmitting HIV. It’s possible for either partner—the partner inserting the penis in the anus or the partner receiving the penis—to get HIV, but it is much riskier for an HIV-negative partner to be the receptive partner. The receptive partner’s risk of getting HIV is very high because the lining of the rectum is thin and may allow HIV to enter the body during anal sex. Even though the risk is lower for the insertive partner, there’s a chance of getting HIV because it can enter the body through the opening at the tip of the penis (or urethra); through small cuts, scratches, or open sores on the penis; and through the foreskin if he’s uncircumcised.

Vaginal sex is less risky than anal sex, and oral sex and touching are much less risky than anal or vaginal sex for getting or transmitting HIV. There is extremely low to no risk of getting or transmitting HIV through oral sex or touching.

What you can do

Choosing activities with little to no risk like oral sex instead of higher-risk activities like anal or vaginal sex can lower your chances of getting or transmitting HIV. If you have anal sex, it is riskier for the HIV-negative partner to be the receptive partner. You can do other things to reduce your risk, including taking medicine to prevent or treat HIV and using condoms the right way every time you have sex. If the partner with HIV takes HIV medicine (called antiretroviral therapy or ART) as prescribed and keeps an undetectable viral load, they will not transmit HIV through sex.

Using condoms during anal or vaginal sex can help protect you and your partners from HIV and other sexually transmitted diseases (STDs). If used the right way every time you have sex, condoms are highly effective in preventing HIV infection. There are two main types of condoms: male condoms and female condoms. Sometimes condoms break or slip during sex. To help prevent this, use a water-based or silicone lubricant.

Male condoms

What is a male condom? A male condom is worn over the penis during sex. It is a thin layer of latex, polyurethane, polyisoprene, or natural membrane.

What we know about male condoms

Condoms are very effective at reducing risk for getting or transmitting HIV if you use them the right way every time you have sex. Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies, but plastic ones break more often than latex ones. Natural membrane (such as lambskin) condoms have small holes in them, so they don't block HIV and other sexually transmitted diseases (STDs).

Theoretically, condoms can be highly effective for preventing HIV if you use them the right way every time you have sex. But in the real world, condoms sometimes break or slip, and are less effective for preventing HIV. Studies show that for people who report using male condoms the right way every time, male condoms are about 63% effective for preventing HIV through insertive anal sex (the HIV-negative partner is the insertive partner), 72% effective for preventing HIV through receptive anal sex (the HIV-negative partner is the receptive partner) and 80% effective for preventing HIV through vaginal sex.

Condoms can also help prevent other STDs you can get through body fluids, like gonorrhea and chlamydia. However, they provide less protection against STDs spread through skin-to-skin contact, like human papillomavirus or HPV (genital warts), genital herpes, and syphilis.

What you can do: Use a condom the right way every time you have sex:

Use a condom the right way every time you have sex:

• Use a new condom every time you have vaginal or anal sex, and keep it on the entire time you’re having sex. There’s little to no risk of getting HIV through oral sex. But you can make that risk even lower by using a condom during oral sex.
• Before you start having sex, put the condom on the tip of the hard penis with the rolled side out.
• Pinch the tip of the condom enough to leave a half-inch space for semen to collect. While holding the tip, unroll the condom all the way to the base of the hard penis.
• After ejaculation and before the penis gets soft, hold the bottom of the condom so it stays on and carefully pull out the penis. Then gently pull the condom off the penis, making sure that semen doesn't spill out.
• Wrap the condom in a tissue and throw it in the trash where others won't handle it.
• If you feel the condom break at any time during sex, stop immediately, pull out the penis, take off the broken condom, and put on a new condom.
• Use plenty of lubricant (lube) during vaginal and anal sex to help keep the condom from tearing. Don’t use oil-based lubricants (for example, Vaseline, shortening, mineral oil, massage oils, body lotions, and cooking oil) because they can weaken the condom and cause it to break.

Don’t use natural membrane condoms for HIV or STD prevention. If you or your partner has a latex allergy, you can use male condoms made out of polyurethane or polyisoprene. Use water- or silicon-based lubricants to lower the chances that the condom will break or slip during sex.

Water-based and silicone-based lubricants are safe to use with all condoms. Oil-based lubricants and products containing oil such as hand lotion, Vaseline, or Crisco shouldn’t be used with latex condoms because they can weaken the condom and cause it to break. With condoms made of polyurethane or polyisoprene, it’s safe to use lubricants that contain oil.

Lubricants containing nonoxynol-9 should not be used. Nonoxynol-9 is added to some lubricants and is effective for preventing pregnancy, but it irritates the lining of the vagina and anus and increases the risk of getting HIV.

Even if you use condoms the right way every time you have sex, there’s still a chance of getting HIV, so adding other prevention methods, like medicine to prevent or treat HIV, can make your risk even lower. If a person with HIV is taking HIV medicine as prescribed and keeps an undetectable viral load (or stays virally suppressed), they will not transmit HIV through sex.

Female condoms

What is a female condom?

A female condom is worn by a woman in her vagina during sex. It’s a thin pouch made of a synthetic latex product called nitrile. The female condom lines the vagina and helps prevent pregnancy and sexually transmitted diseases (STDs), including HIV. Some people also use the female condom for anal sex.

What we know about the female condom

When worn in the vagina, female condoms prevent HIV, other STDs, and pregnancy as well as male condoms.

A handful of female condom brands are available in many countries around the world. However, the FC2 is the only one available in the United States. It’s pre-lubricated with a silicone-based lubricant and has an inner and outer ring. The inner ring is used to help you insert the condom and keeps the condom in place in the vagina. The outer ring stays outside the vagina, covering the external genitalia.

We don’t currently know how effective female condoms are at preventing HIV and other STDs when used by men or women for anal sex. But we do know that HIV can’t travel through the nitrile barrier. It’s safe to use any kind of lubricant with female condoms.

Always using a female condom the right way every time you have sex can lower your risk for getting or transmitting HIV. Here are some tips on how to use a female condom.

What you can do

You and your sex partners might consider using a female condom instead of a male condom. Female condoms can help people use condoms in relationships where it’s difficult to talk about or use male condoms because of an imbalance in power between partners. Female condoms also allow couples to alternate who wears the condom, giving them more options when they have sex. If you or your partner has an allergy to latex, you can use female condoms since they are made from nitrile.

Even though it may be difficult, you can learn how to talk with your partner about condoms and safer sex. And there are many tips for learning to use a condom or a dental dam the right way. Even if you use condoms the right way every time you have sex, there’s still a chance of getting HIV, so adding other prevention methods, like taking medicine to prevent and treat HIV, can make your risk even lower. If a person with HIV is taking HIV medicine as prescribed and keeps an undetectable viral load (or stays virally suppressed), they will not transmit HIV through sex.

Some of the same medicines people take to treat HIV can also be taken to prevent HIV. If you have HIV, your doctor should prescribe medicine to treat HIV, called antiretroviral therapy, or ART. People with HIV who take HIV medicine as prescribed and keep an undetectable viral load can stay healthy and prevent HIV transmission.

If you don’t have HIV but are at high risk for getting it, your doctor may prescribe medicines to reduce your chances of getting it. This is called pre-exposure prophylaxis, or PrEP. If taken as prescribed, PrEP is highly effective for preventing HIV. If you have a recent possible exposure to HIV, your doctor can prescribe the same medicines used for PrEP to reduce your chances of getting HIV. This is called post-exposure prophylaxis, or PEP.

Antiretroviral Therapy (ART) for Treating HIV

What is ART? The medicines used to treat HIV infection are called antiretrovirals. Antiretroviral therapy, or ART, refers to taking these medicines to treat HIV infection.

What we know about ART

ART can reduce the amount of HIV (called "viral load") in your blood to very low levels. This is called viral suppression. ART can reduce a person’s viral load to such a low level that current lab tests can’t detect it. This is called an undetectable viral load. ART can be prescribed only by a health care provider.

ART slows the progression of HIV and helps protect your immune system . ART can keep you healthy for a long time.

ART also prevents HIV transmission through sex. People who take ART as prescribed and keep an undetectable viral load (or stay virally suppressed) will not transmit HIV through sex. Getting and keeping an undetectable viral load is a 100% effective way to prevent getting or transmitting HIV from sex.

ART can also prevent HIV transmission from mother to baby during pregnancy, labor, and delivery. If a woman takes HIV medicine as prescribed throughout pregnancy, labor, and delivery and received HIV medicine for her baby for 4-6 weeks after delivery, the risk of transmitting HIV to her baby can be 1% or less. Having an undetectable viral load substantially reduces, but does not eliminate, the risk of transmitting HIV to an infant from breastfeeding. Current recommendation in the United States is that mothers with HIV should not breastfeed their infants.

ART may also prevent transmission from injection drug use. We don’t have data about whether having an undetectable viral load prevents HIV transmission through sharing needles, syringes, or other injection equipment (for example, cookers). It is reasonable to assume it reduces the risk by some amount, but we don’t know how much.

What you can do

If you have HIV, it is important that you start medical care and begin HIV treatment right away. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART slows the progression of HIV and helps protect your immune system . ART can keep you healthy for a long time and prevent sexual transmission of HIV as long as you keep an undetectable viral load.

If you’re taking ART, visit your health care provider regularly and always take your medicine as prescribed to keep your viral load as low as possible. If your viral load doesn’t go down with ART, talk to your health care provider about your treatment options or get a second opinion from a doctor who specializes in HIV.

If you’re HIV-negative and have a partner with HIV, encourage your partner to get in care and always take ART as prescribed to live a longer, healthier life and reduce the chances of transmitting HIV to you.

Health insurance will generally cover part or all of the cost for medicine used to treat HIV.

Even if the partner with HIV has an undetectable viral load, you or your sex partner(s) may want to use additional prevention options. Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or having the HIV-negative partner take medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if the partner with HIV

• Is unsure, for any reason, that they have an undetectable viral load
• Has a higher viral load (200 copies/ml of blood or greater)
• Has trouble taking HIV medicine regularly
• Missed some doses since their last viral load test
• Has stopped taking HIV medicine or may do so in the future

You and your partner(s) should learn about all the available prevention options and make the decisions that are right for both of you.

If the partner with HIV does not have an undetectable viral load—or it does not stay undetectable—you can take other steps to prevent HIV transmission. The following actions are highly effective for preventing HIV:

• Use condoms the right way every time you have sex you have anal or vaginal sex.
• Choose sexual activities with little to no risk, like oral sex.
• The HIV-negative partner can take medicine to prevent HIV, called pre-exposure prophylaxis or PrEP.
• If the HIV-negative partner might have been recently exposed to HIV—for example, if the condom breaks during sex and the partner with HIV doesn’t have an undetectable viral load—they should talk to a health care provider right away (within 3 days) about taking medicine (called post-exposure prophylaxis (PEP)) to prevent getting HIV.
• Never share needles, syringes, or other equipment to inject drugs.

If either partner has other sexually transmitted diseases (STDs), getting treatment for those STDs can also help lower the risk of getting or transmitting HIV.

Pre-exposure Prophylaxis (PrEP) for Preventing HIV

What is pre-exposure prophylaxis? Pre-exposure prophylaxis (or PrEP) is medicine that can reduce your chance of getting HIV from sex or injection drug use. PrEP can be pills or shots.

What we know about PrEP

PrEP can be pills or shots that reduce your chances of getting HIV from sex or injection drug use. Studies have shown that PrEP is highly effective for preventing HIV if it’s taken as prescribed. PrEP is much less effective when it isn't taken consistently. When taken as prescribed, PrEP reduces the risk of getting HIV from sex by about 99%.

Among people who inject drugs, PrEP pills reduce the risk of getting HIV by at least 74% when taken as prescribed. Currently, PrEP shots are not recommended for people who inject drugs.

PrEP is for people without HIV who:

Have had anal or vaginal sex in the past 6 months and:

• 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 a sexually transmitted disease (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 .

Because PrEP involves taking medicine as prescribed and regular visits to a health care provider, it may not be right for everyone. And PrEP can cause side effects like nausea in some people, but these generally get better over time. These side effects aren’t life threatening.

What you can do

PrEP can significantly reduce your risk of HIV infection if taken consistently. You must take an HIV test before beginning PrEP (to be sure you don’t already have HIV) and routinely as recommended while you're taking it. You will have to visit your health care provider regularly for follow-up visits, HIV tests, and prescription refills or shots.
With telehealth (phone or video consultation with a health care provider) and mail-in self-testing, it is possible to order a specimen collection kit which contains the supplies to do the testing required to start or continue taking PrEP pills, even if an in-person appointment is not possible.

If you think you were recently exposed to HIV, there are other antiretroviral medications (called post-exposure prophylaxis or PEP) you can take to prevent getting HIV. If you have been prescribed PEP and have continued risk behavior, or have used multiple courses or PEP, talk to your doctor about taking PrEP. For PEP to work, you need to start taking it as soon as possible but always within 72 hours after the exposure. You will need to take PEP for 28 days as directed by your health care provider.

The cost of PrEP is covered by most insurance plans and state Medicaid programs. Under the Affordable Care Act, PrEP must be free under almost all health insurance plans. That means you can’t be charged for your PrEP medication or the clinic visits and lab tests you need to maintain your prescription. Help is also available through commercial assistance or co-pay assistance programs. You can also get free PrEP if you don't have insurance for prescription coverage, or co-pay assistance if you do have coverage. Some states also have their own PrEP assistance programs.

If you’re in a relationship where one partner is HIV-positive and the other is HIV-negative and you are considering getting pregnant, you should talk to your doctor about PrEP. PrEP is especially important if the partner with HIV has trouble getting or keeping an undetectable viral load.

Post-exposure Prophylaxis (PEP) for Preventing HIV after Exposure

What is post-exposure prophylaxis? Post-exposure prophylaxis (or PEP) means taking antiretroviral medicine (ART) after being possibly exposed to HIV to prevent becoming infected.

What we know about PEP

PEP should be used only in emergency situations and must be started within 72 hours after a possible exposure to HIV. PEP is safe but may cause side effects like nausea in some people. These side effects can be treated and aren’t life threatening.

Your health care provider will test you for HIV before prescribing PEP to make sure you don’t already have it and may test you for up to 6 months after you begin taking PEP to be sure you stay HIV-negative.

What you can do

If you’re HIV-negative or don’t know your HIV status and think you have recently been exposed to HIV during sex (e.g., if the condom breaks) or through sharing needles, syringes and other injection equipment (for example, cookers), talk to your health care provider or an emergency room doctor about PEP right away if you are not already taking pre-exposure prophylaxis (PrEP) as prescribed. The sooner you start PEP, the better; every hour counts. If you’re prescribed PEP, you’ll need to take it for 28 days.

Since PEP is not 100% effective, you should continue to use condoms with sex partners and safe injection practices while taking PEP. These strategies can protect you from being exposed to HIV again and reduce the chances of transmitting it if you do become infected while on PEP.

If you have HIV and have an HIV-negative partner, PEP might be an option if they’re not already taking pre-exposure prophylaxis (PrEP) and they’re exposed to HIV during sex (e.g., if you have trouble getting or keeping an undetectable viral load) or through sharing needles, syringes, and other injection equipment (for example, cookers). Encourage your partner to talk to a health care provider about PEP right away to find out if it’s right for them. The sooner someone starts PEP, the better; every hour counts.

Since PEP is not 100% effective, your partner should continue to use condoms and safe injection practices while taking PEP. These strategies can protect your partner from being exposed to HIV again.

Another way you can reduce the risk of transmitting HIV to your sex partners is if you take ART. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART reduces the amount of HIV (viral load) in the blood. If you take ART as prescribed and keep an undetectable viral load, you can stay healthy and will not transmit HIV through sex.

What is reducing the number of partners? Reducing the number of partners refers to choosing to limit how many sex partners you have in your lifetime.

What we know about reducing the number of partners

The more sex partners you have in your lifetime, the more likely you are to have a sex partner who does not know their status, is not taking medicine to treat HIV, and/or does not have an undetectable viral load. Having more sex partners also increases your chances of having a partner with another STD.

What you can do

Not having sex is a 100% effective way to prevent getting or transmitting HIV. If you are sexually active, you can choose to have fewer partners. You can also choose sexual activities that are lower risk for HIV than anal or vaginal sex.

Limiting the number of partners you have can lower your risk for getting or transmitting HIV. You can decrease your risk even more by taking other actions, including using a condom the right way every time you have sex and taking medicine to prevent or treat HIV.

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

Sharing your HIV status with your sex partners, and have them tell you their status. This can help you make good decisions about sex and the strategies you use to lower the chance of getting or transmitting HIV.

Certain choices you make about your sexual partnerships can lower your chances of getting or transmitting HIV. This includes being in a monogamous relationship, choosing partners with the same HIV status (serosorting), and having sex agreements to protect yourselves and your partners from HIV.

Any of these actions can decrease the chance of getting or transmitting HIV. But for these actions to help, you and your partner must have accurate information and share it. For example, if you aren’t certain of your HIV status, or if you don’t want to tell your partner you’ve had sex outside the relationship, these strategies won’t reduce your HIV risk. When partners don’t share accurate information, your chance of getting or transmitting HIV can actually increase.

Monogamy

What is monogamy? Monogamy means that you’re in a sexual relationship with only one person and that both of you are having sex only with each other.

What we know about monogamy

If you and your partner are both HIV-negative and don’t have any sexually transmitted diseases (STDs), agreeing to be in a monogamous relationship can decrease your chances of getting HIV and other STDs. But monogamy works only if both partners are certain they’re HIV-negative and stay monogamous. If you’re just beginning a monogamous relationship, it’s important for both of you to be tested for HIV.

If both you and your partner have HIV, agreeing to be in a monogamous relationship can decrease your chances of getting other STDs or transmitting HIV to an HIV-negative sex partner. You may not always know if your partner is having sex outside of the relationship or doing other things to increase the risk for getting HIV or other STDs. Having open and honest communication with your partner is important.

If you’re in a monogamous relationship with someone who has a different HIV status than you, it is important that the partner with HIV take medicine to treat HIV (antiretroviral therapy or ART) as prescribed. If the partner with HIV takes their HIV medicine as prescribed and gets and keeps an undetectable viral load, they will not get or transmit HIV through sex. If the partner with HIV has a detectable viral load, it’s important to know that the overall chance of getting or transmitting HIV increases the more times you have sex. Your risk for getting or transmitting HIV is also affected by whether you or your partner has another STD.

What you can do

Being in a monogamous relationship can help reduce your risk of getting HIV if you and your partner are HIV-negative. Talk to your partner about monogamy and what you would do if one of you had sex with another person. Be sure that you and your partner understand any agreements you have about sex and talk about any changes in your HIV status or sexual activity. And, if you’re just beginning a monogamous relationship and neither of you have HIV, it’s a good idea for both of you to get tested for HIV before you have sex.

If you’re in a monogamous relationship with someone whose HIV status is different from yours, it’s important to remember that the overall chance of getting or transmitting HIV increases the more times you have sex if the partner with HIV has a detectable viral load. Taking one or more of these actions can decrease your risk of getting or transmitting HIV.

• The most important thing a person with HIV can do is to take ART as prescribed. ART reduces the amount of virus (viral load) in their blood. If they take ART as prescribed and keep an undetectable viral load, they can stay healthy and will not transmit HIV through sex.
• Choose less risky sexual behaviors than anal or vaginal sex, such as oral sex.
• Use condoms the right way every time you have sex.
• The HIV-negative partner should talk to their health care provider to see if taking pre-exposure prophylaxis (PrEP) is right for you.
• The HIV-negative partner can talk to their health care provider right away (within 3 days) about taking medicine (called post-exposure prophylaxis, or PEP) to prevent getting HIV if you might have been recently exposed to HIV—for example, if the condom breaks during sex.
• Get tested and treated for STDs and encourage your partner to do the same.

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

Choosing Partners with the Same HIV Status (Serosorting)

What is choosing partners with the same HIV status?

Some people choose to have sex with partners with the same HIV status because they think it lowers their risk of getting or transmitting HIV and they can safely have sex without using a condom. For example, if you know you don’t have HIV, you would only have sex with HIV-negative partners. If you have HIV, you would only have sex with partners who also have HIV. This is sometimes called serosorting.

What we know about choosing partners with the same HIV status (serosorting)

Serosorting can reduce your HIV risk if you know for sure you don’t have HIV and your partner is actually HIV-negative. For serosorting to be effective, though, you need to know your own HIV status and your sex partner’s status, without any doubt. This strategy could be risky because your sex partners may not know for sure whether they have HIV if they were not tested recently. Even if they were recently tested, they might be in the window period. Or they may not tell you they have HIV even if they know they have it. Because of these uncertainties, serosorting is less effective than consistent condom use. And even if your partner is HIV-negative, you can still get or transmit other sexually transmitted diseases (STDs).

What you can do

If you and your partner both have HIV or are both HIV-negative, having sex only with each other will eliminate the risk of getting or transmitting HIV. But if you don’t know your HIV status or your partner’s HIV status for sure, use condoms the right way every time you have sex. This is because some people have not been tested recently. Even if they were tested recently, they may be in the window period. Or they may not tell you they have HIV even if they know they have it. And you can still get or transmit other sexually transmitted diseases (STDs) if you serosort.

For serosorting to be effective, you need to:

• Know your HIV status by getting tested.
• Know your partner's HIV status..
• Know when you should get another HIV test. If you or your partner have had a possible exposure to HIV since the last test, you may not really be HIV-negative, and you and your partner need to get tested again. You should use condoms or other prevention strategies until you can be retested.

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

Negotiated Safety

What is negotiated safety?

Negotiated safety is a type of sex agreement for HIV-negative persons. People in relationships may have agreements about sex outside the relationship—whether, when, and with whom it’s okay. Sometimes these agreements focus on what kind of sex is allowed inside and outside the relationship. Or the agreement may focus on what prevention methods are used to decrease the chances of getting HIV. Negotiated safety can help HIV-negative couples reduce the risk of getting HIV and other sexually transmitted diseases (STDs) if they follow the conditions of the strategy (all the parts of the agreement).

What we know about negotiated safety

Negotiated safety can help HIV-negative couples reduce the risk of getting HIV and other STDs if they follow the conditions of the strategy and help to support the relationship and build intimacy. Negotiated safety only works if partners talk openly with each other, plan carefully and follow through on the agreement, and use condoms during sex until they have met all the conditions for safety.

Negotiated safety involves these conditions:

• Both partners begin the relationship being exclusive with each other and stay monogamous.
• Both partners test for HIV, share their results, and know they’re HIV-negative.
• Both partners use condoms until both partners test again for HIV after the window period and know they’re still HIV-negative.
• Both partners develop a clear spoken or written agreement about their sex practices within and outside of their relationship. This agreement may include
  • not having other sexual partners,
  • not having anal sex outside their relationship,
  • only having oral sex outside their relationship, or
  • always using condoms for sex outside their relationship.
  • one of both partners using PrEP
• The agreement is kept by both partners.
• If the agreement is broken, both partners talk about it openly and honestly right away.
• If the agreement is broken, both partners use condoms until both partners test again after the window period and know they’re HIV-negative.

If partners meet all the conditions of a negotiated safety agreement, it can help keep them from getting HIV. If partners break any of the conditions, they can be at high risk for getting HIV. If partners can’t follow the sex agreement or other aspects of negotiated safety, they should use other prevention methods such as PrEP or condoms.

What you can do

If you and your partner agree to a negotiated safety strategy and follow all required conditions, you can lower your risk of getting HIV. But you and your partner have to talk openly, plan carefully and follow through on the agreement, and use condoms during sex until you’ve met all the conditions for safety.

If you don’t think you and your partner can meet all the conditions of negotiated safety, you can do other things to reduce the risk of getting HIV including:

• Use condoms the right way every time you have sex.
  • Use a condom every time you have vaginal or anal sex.
  • Put the condom on after the penis is hard and before the penis touches the vagina or anus.
  • Take out the penis out of the vagina or anus right after ejaculating.
  • Throw the condom away
• Take medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP).
• Choose sexual activities that are lower risk for HIV than anal or vaginal sex.

Disclosure of HIV Status

What does it mean to disclose your HIV status? This means telling your sexual partners the result and date of your last HIV test and having your partners tell you the result and date of their last HIV test.

What we know about disclosing your HIV status

Knowing your HIV status, telling it to your sex partners, and having them tell you their status before you start having sex may help reduce risky behaviors and lower your chances of getting or transmitting HIV. But sometimes people don’t know their HIV status, or they’re wrong or not honest about it.

If you learned you were HIV-negative the last time you were tested, you can only be sure you’re still negative if you haven’t had a possible HIV exposure since your last test. The same is true for your partner.

Even if you or your partner learned you were HIV-negative the last time you were tested, keep in mind that there’s a window period. This is the time between when a person gets HIV and when most HIV tests will show that a person has HIV. That’s why it’s important to be tested regularly if you have a possible HIV exposure.

If you have HIV, be aware that many states have laws that require you to tell your sex partners you have HIV before you have sex (anal, vaginal, or oral) or tell injection partners before you share drugs or share needles or syringes to inject drugs. In some states, you can be charged with a crime if you don’t tell your partner your HIV status, even if your partner doesn’t get HIV.

What you can do

It’s important that you and your partner get tested for HIV and talk to each other about your results so that you can take steps to stay healthy. You might consider getting tested together. Make sure you know what your test result means so you can share that information with your sex partner.

If your HIV test result shows that you don’t have HIV, remember that it only means you’re HIV-negative until the next time you have a possible HIV exposure. Every time you have a possible HIV exposure, you could get HIV. Also, there’s a window period, which is the time between when a person gets HIV and when most HIV tests will show that a person has HIV. That’s why it’s important to be tested regularly if you have a possible HIV exposure.

If your HIV test says you have HIV, you may need to get a follow-up test to be sure you really have it. If you learn that you have HIV, the most important thing you can do is to take antiretroviral therapy (ART) as prescribed. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART can reduce the amount of HIV (viral load) in your blood. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and will not transmit HIV through sex.

If you have HIV and your sex or injection partner also has HIV, encourage your partner to take ART too.

When was the last time you had an HIV test and what was the result of that test?

The only way to know for sure if you have HIV is to get tested. Before having sex for the first time, you and your partner may want to get tested for HIV and learn the results. Be aware that there’s a window period, which is the time between when a person gets HIV and when most HIV tests will show that a person has it. If you have sex before you learn your test results, using a condom the right way every time you have sex can lower your risk for getting or transmitting HIV.

If you learn that you have HIV, the most important thing you can do is to take antiretroviral therapy (ART) as prescribed. ART can reduce the amount of HIV (viral load) in your blood. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and will not transmit HIV through sex.

Are you living with HIV and on treatment?

If you have HIV, the most important thing you can do is be on treatment (ART). If you take ART as prescribed and keep an undetectable viral load, you can stay healthy and will not transmit HIV through sex. If you’re taking ART, follow your health care provider’s advice. Visit your health care provider regularly and take your medicine as prescribed. This will give you the greatest chance of having an undetectable viral load. Even if you have undetectable viral load, you or your sex partner may want to use additional prevention options. Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or having your partner take medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if you

• Are unsure, for any reason, that you have an undetectable viral load
• Have a higher viral load (200 copies/ml of blood or greater)
• Have trouble taking HIV medicine regularly
• Missed some doses since your last viral load test
• Have stopped taking HIV medicine or may do so in the future

Ifyour partner has HIV, encourage your partner to take ART too.

If you’re HIV-negative and have a partner with HIV who is taking ART, your partner will not transmit HIV through sex as long as they keep an undetectable viral load. Even if your partner has an undetectable viral load, you or your sex partner may want to use additional prevention options. Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or taking medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if you are unsure, for any reason, that your partner has an undetectable viral load.

You and your partner should learn about all the available prevention options and make the decisions that are right for both of you.

If you’re not taking PrEP, you can take post-exposure prophylaxis (PEP) if you have a recent possible exposure to HIV. For PEP to work, you must start it as soon as possible, and always within 72 hours of a recent possible exposure.

How many other sex partners do you currently have?

Having multiple sexual partners increases your risk for HIV. The more sexual partners you have in your lifetime, the more likely you are to have a sex partner with HIV who does not know their status, is not taking medicine to treat HIV, and/or does not have an undetectable viral load. It also increases the chances that you have a partner who has another STD.

Do you have any other STDs?

Having other STDs increases your risk for getting or transmitting HIV. CDC recommends that sexually active gay and bisexual men get tested at least annually for

• — HIV,
• — Syphilis,
• — Hepatitis B and C,
• — Chlamydia and gonorrhea of the rectum if you've had receptive anal sex or been a "bottom" in the past year,
• — Chlamydia and gonorrhea of the penis (urethra) if you've had insertive anal or oral sex in the past year, and
• — Gonorrhea of the throat if you've performed oral sex in the past year.

Do you inject drugs?

Sharing needles, syringes or other injection equipment (for example, cookers) increases your risk for getting or transmitting HIV.

How can I prevent getting HIV after a recent possible exposure, like if a condom breaks or I’m sexually assaulted?

There is medicine you can take to prevent getting HIV after a recent exposure. Talk to your health care provider, an emergency room doctor, or an urgent care provider right away about PEP (post-exposure prophylaxis).

• PEP must be started within 72 hours after a possible exposure.
• 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.

Can male circumcision prevent HIV?

Talk to your health care provider about the risks and benefits of male circumcision.

• Male circumcision does decrease the risk of getting HIV in some situations, but it doesn’t decrease the risk of HIV as much as other HIV prevention options.
• Circumcised men are less likely than uncircumcised men to get HIV from vaginal sex with a partner with HIV.
• Male circumcision does not decrease a woman’s risk of getting HIV.
• The benefits of circumcision for gay and bisexual men are unknown.
• Circumcised men should take other actions to prevent getting HIV or to protect their partners.

Can I get vaccinated to prevent HIV?

• No vaccine is currently available to prevent HIV.

What is male circumcision?Removing some or all the foreskin (the fold of skin that covers the head, or glans, of the penis) from the penis is called male circumcision. This procedure is done for hygiene and health reasons or as part of religious or cultural traditions.

What we know about male circumcision

When men are circumcised, they’re less likely than uncircumcised men to get HIV from a female partner who has HIV. . There are biological reasons why, for some men, male circumcision may decrease the risk of getting HIV during vaginal sex with a female partner who has HIV. Male circumcision also reduces the risk of a man getting herpes and human papillomavirus (HPV) from a woman who has those infections. However, there is no evidence that circumcision decreases the risk of HIV-negative receptive partners getting HIV from a circumcised partner with HIV.

Male circumcision reduces the risk that an HIV-negative man will get HIV from a woman who has HIV by about 50%.

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 and has more of the cells that HIV infects. The foreskin may also tear during intercourse, providing another way for HIV to infect the body. Also, HIV may be able to survive in the space between the foreskin and the penis. Finally, uncircumcised men have a higher risk of getting other sexually transmitted diseases (STDs), such as syphilis or herpes. Having other STDs can increase the risk of getting HIV.

The evidence about the benefits of circumcision among gay and bisexual men is inconclusive. More studies are underway.

What you can do

Male circumcision decreases the risk that an HIV-negative heterosexual man will get HIV from a woman with HIV. But there’s no evidence that circumcision decreases any other person’s risk of getting HIV. Also, circumcised men and their partners can still get other sexually transmitted diseases. Take other actions to prevent getting or transmitting HIV, like using condoms the right way every time you have sex or taking medicine to prevent or treat HIV to further reduce your chance of getting HIV.

If you’re a parent, talk to your health care provider about the risks and benefits of male circumcision to your newborn.

An estimated 1.2 million people in the United States have HIV, including about 158,500 people who are unaware of their status. Nearly 40% of new HIV infections are transmitted by people who don’t know they have the virus. For people with undiagnosed HIV, testing is the first step in maintaining a healthy life and preventing HIV transmission.

CDC’s Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings advises routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. The recommendations also call for reducing barriers to HIV testing.

CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. For people with certain risk factors, CDC recommends getting tested at least once a year.

Data from a clinical trial sponsored by the National Institutes of Health show clear benefits to being diagnosed with HIV early and starting treatment right away. This information also highlights the importance of routine HIV testing and its potential impact on better health outcomes.

Importance of HIV Testing for Prevention of HIV Infection

People with HIV who know their status can get HIV treatment (called antiretroviral therapy or ART) and remain healthy for many years. Studies show that the sooner people start HIV treatment after diagnosis, the more they benefit. HIV treatment reduces the amount of HIV in the blood (called viral load), reduces HIV-related illness, and prevents transmission to others. People with HIV who take HIV treatment as prescribed and get and keep an undetectable viral load (or stay virally suppressed) will not transmit HIV to their sex partners.

People who get tested and learn they don’t have HIV can make decisions about sex, drug use, and health care that can help prevent prevent HIV. Taking HIV medicine called pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV.

HIV Tests for Screening and Diagnosis

HIV tests are very accurate, but no test can detect the virus immediately after infection. How soon a test can detect HIV depends on the type of test being used. There are three types of HIV tests: antibody tests, antigen/antibody tests, and nucleic acid tests (NAT).

• Antibody tests look for antibodies to HIV in a person’s blood or oral fluid. Antibody testscan take 23 to 90 days to detect HIV after exposure. Most rapid tests and the only FDA-approved HIV self-test are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger stick or with oral fluid.
• Antigen/antibody tests look for both HIV antibodies and antigens. Antibodies are produced by a person’s immune system when they’re exposed to viruses like HIV. Antigens are foreign substances that cause a person’s immune system to activate. If a person has HIV, an antigen called p24 is produced before antibodies develop. Antigen/antibody tests are recommended for testing done in labs and are common in the United States. An antigen/antibody test performed by a lab on blood from a vein can usually detect HIV 18 to 45 days after exposure. There is also a rapid antigen/antibody test available that is done with a finger stick. Antigen/antibody tests done with blood from a finger stick can take 18 to 90 days after exposure.
• NATs look for the actual virus in the blood. This test should be considered for people who have had a recent exposure or a possible exposure with early symptoms of HIV and have tested negative with an antibody or antigen/antibody test. A NAT can usually detect HIV 10 to 33 days after exposure.

An initial HIV test usually will either be an antigen/antibody test or an antibody test. If the initial HIV test is a rapid or self-test and it is positive, the person should go to a health care provider to get follow-up testing. If the initial HIV test is a lab test and it is positive, the lab will usually conduct follow-up testing on the same blood sample as the initial test. Although HIV tests are generally accurate, follow-up tests allow the health care provider to confirm the result.

Preventing new HIV transmissions is a key step toward ending the HIV pandemic as we know it. NIAID-supported researchers have worked since the early days of AIDS in the 1980s to identify prevention tools to keep people healthy. Today, numerous prevention methods are available for use in combination or on their own, and scientists continue to work to develop and improve cutting-edge tools and techniques that can work to prevent HIV in diverse populations around the world.

Pre-exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis, or PrEP, is a biomedical HIV prevention tool recommended for use worldwide to help protect people vulnerable to HIV. NIAID played an instrumental role in establishing the efficacy of PrEP and currently supports research to develop longer-acting forms of this prevention strategy.

HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention

Research has proven that treatment for HIV not only preserves the health of the individual, but also prevents sexual transmission of the virus to others.

Microbicides

NIAID supports research to develop a microbicide, a product that could be inserted into the vagina or rectum to safely block sexual transmission of HIV. Since women and girls are at particularly high risk for HIV/AIDS in many parts of the world, it is especially important to have an effective, desirable vaginal microbicide as an HIV prevention tool that women can control.

Prevention of Perinatal Transmission

Perinatal HIV transmission—HIV transmission from mother to child during pregnancy, labor and delivery, or breastfeeding—accounts for most childhood HIV cases worldwide. NIAID research paved the way for development of approaches used to prevent perinatal transmission around the globe, and current work focuses on optimizing prevention strategies.

Passive Antibody Transfer

Passive antibody transfer is an experimental prevention technique that involves giving anti-HIV antibodies directly to an HIV-negative person by injections or intravenous infusions to protect them from HIV acquisition. NIAID supports research to test this strategy and to evaluate and improve antibodies that could be used for this purpose.

Voluntary Medical Male Circumcision

Voluntary medical male circumcision protects against HIV by safely removing the foreskin, which is susceptible to infection, from the penis. Male circumcision significantly reduces the risk of sexually transmitting HIV from a woman living with HIV to a man and is recommended by the World Health Organization. NIAID-funded research played a major role in the discovery that male circumcision is an effective HIV prevention strategy.

Harm Reduction

Drug use and related behaviors, such as the exchange of sex for drugs or money, are linked to an increased risk of HIV acquisition. NIAID and other NIH institutes work to develop and optimize harm reduction interventions that decrease the risk of drug use-associated and sexual transmission of HIV among injecting and non-injecting drug users.

Condom Use

Consistent and correct condom use was one of the earliest recommendations for preventing HIV at the start of the pandemic outbreak in the early 1980s. It remains an essential tool in preventing the transmission of not only HIV, but also other sexually transmitted infections like gonorrhea and chlamydia. Latex condoms offer an impermeable barrier, preventing the bodily fluids that contain active HIV from entering a partner during sex.

Developing an HIV Vaccine

Development of an even partially effective HIV vaccine would accelerate progress toward an end to the global HIV pandemic. NIAID oversees a robust research program to develop and evaluate HIV vaccine candidates. HIV poses unique challenges to vaccine researchers because of the complicated interactions between the virus and the human immune system, but one large clinical trial has demonstrated a moderate degree of success. In 2009, a candidate vaccine regimen studied in more than 16,000 people in Thailand was the first to show protection, albeit modest, against HIV. NIAID-supported researchers are working to build on this modest success and continuing to explore multiple avenues toward an HIV vaccine.

Your life matters and staying healthy is important. Staying healthy starts with getting tested for HIV and knowing your HIV status. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested more often. Some people are more likely to be at higher risk and should get tested at least once a year, including people with more than one sex partner, sexually active gay and bisexual men, people with other sexually transmitted diseases (STDs), and people who inject drugs.

Some gay and bisexual men may benefit from even more frequent testing (for example, every 3 to 6 months), depending on their risk. If you haven’t been tested for HIV in the past year, get tested for HIV, and encourage your partners to get tested too.

If you learn that you have HIV, the most important thing you can do is to take HIV medicine, called antiretroviral therapy (ART), as prescribed. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART can reduce the amount of HIV (viral load) in your body. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load . If you keep an undetectable viral load, you can stay healthy for many years and will not transmit HIV through sex.

If you have HIV, talk about your HIV status with all of your sex partners and take steps to protect your health and your partners’ health.

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, there are more tools available today to prevent HIV than ever before. Here’s what you can do:

1. Use condoms the right way every time you have sex. Using condoms when you have anal or vaginal sex can help protect you and your partners from HIV and other sexually transmitted diseases (STDs). If used the right way every time you have sex, condoms are highly effective in preventing HIV infection. But condoms can sometimes break or come off during sex. Using a water-based or silicone lubricant can help prevent condoms from breaking or slipping. Learn how to use condoms correctly and talk with your partner about condoms and safer sex.

2. Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. There is extremely low to no risk of getting HIV through oral sex. Sexual activities that don’t involve contact with body fluids (i.e., semen, vaginal fluid, or blood) carry no risk of HIV transmission.

3. Reduce the number of people you have sex with. Having multiple sex partners increases your risk for HIV and for other STDs.

4. If you’re HIV-negative, consider pre-exposure prophylaxis (PrEP), taking HIV medicines as prescribed to prevent HIV infection. If taken as prescribed, PrEP is highly effective for preventing HIV from sex or injection drug use. But it’s much less effective if you don’t take it consistently.

   PrEP is recommended for people who are HIV-negative and at risk for getting the virus from sex or injection drug use.

   For sexual transmission, this includes people without HIV who:

   Have had anal or vaginal sex in the past 6 months and:

   • 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 a sexually transmitted disease (STD) in the past 6 months

   For people who inject drugs, this includes those who have an injection partner with HIV, or have shared needles, syringes, or
   other injection equipment.

5. If you’re HIV-negative, talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a recent possible exposure to HIV.

   An example of a possible exposure is if you have anal or vaginal sex without using a condom, or the condom breaks or slips while having sex, with someone who has or may have HIV, and you’re HIV-negative and not taking PrEP. Starting PEP immediately and taking it daily for 28 days reduces your chance of getting HIV.

   If your partner with HIV is taking HIV medicine as prescribed and keeps an undetectable viral load, they will not transmit HIV to you through sex.

6. Get tested and treated for other STDs and encourage your partners to do the same. STDs can have long-term health consequences, and they can increase your chance of transmitting HIV or getting HIV.

7. If you have HIV, take HIV medicine, called antiretroviral therapy (ART) to get and keep an undetectable viral load.

   You can protect your partner from HIV if you take ART as prescribed AND get and keep an undetectable viral load.

   ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART can reduce the amount of HIV (viral load) in the body. Taking ART as prescribed can make the viral load so low that a test can’t detect it. This is called an undetectable viral load. If a person with HIV keeps an undetectable viral load, they can stay healthy for many years and will not transmit HIV through sex.

8. If you’re taking ART, follow your health care provider's advice. Visit your health care provider regularly and always take your medicines as prescribed.

9. If your partner has HIV, encourage your partner to get and stay on treatment. This is the most important thing your partner can do to protect their own health. If you are HIV-negative and your partner with HIV takes their HIV medicine as prescribed AND is able to get and keep an undetectable viral load, they will not transmit HIV to you through sex.

10. If you are HIV-negative and your partner with HIV has an undetectable viral load, you or your partner may want to use additional prevention.

    Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or having the HIV-negative partner take medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if the partner with HIV

    • Is unsure, for any reas on, that they have an undetectable viral load
    • Has a higher viral load (200 copies/ml of blood or greater)
    • You and your partner(s) should learn about all the available prevention options and make the decisions that are right for both of you.
    • Has trouble taking HIV medicine regularly
    • Missed some doses since their last viral load test
    • Has stopped taking HIV medicine or may do so in the future

You can also reduce your risk for getting or transmitting HIV by not sharing needles, syringes or other injection equipment (for example, cookers). The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment after someone with HIV has used them. People use needles, syringes, or other injection equipment for many reasons—to inject drugs for medical purposes (like insulin to treat diabetes), get high, change their appearance, or for tattoos and piercings. No matter the reason, never share your needles, syringes, or other injection equipment with anyone to lower your chances of getting or transmitting HIV.

If you keep using needles, syringes, or other injection equipment, here are some things you can do to protect yourself and others.

• Use only your own new, sterile syringes and injection equipment each time you inject.
• Use bleach to clean needles, syringes, cookers, and surfaces where drugs are prepared when you can’t get new ones. This may reduce the risk of HIV and hepatitis C but doesn’t eliminate it. Bleaching a used syringe may reduce the risk of HIV and hepatitis C but doesn’t eliminate it.
• Use sterile water to fix drugs. You can buy sterile water from a store. If you can’t get sterile water, use water that has been boiled for 10 minutes or clean tap or bottled water.
• If you inject around other people, be careful not to get someone else’s blood on your hands, needles, syringes, or other injection equipment.
• Dispose of syringes and needles safely after one use. You can use a sharps container or another container like an empty bleach or laundry detergent bottle. Make sure to keep used syringes away from other people. Some communities have drop boxes where you can dispose of your used syringes safely.