The most dangerous possibility for HIV transmission occurs when a partner is infected but doesn’t know it, says Marilyn Henderson, BSN, RN, the director of the science department at the Medical Institute for Sexual Health in Austin, Texas. If you’re HIV positive, you can help protect your partner from becoming infected while still maintaining a close relationship by putting smart, safer sex practices in place. And with the right precautions, even that most intimate of connections — conceiving a child together — can safely be accomplished.
What Are the Chances of Getting HIV Through Anal or Vaginal Intercourse?
One way to address the anxiety about infecting a partner is to understand the exact level of risk involved with different types of sexual activity. Among heterosexuals, vaginal intercourse is a common route of HIV transmission, with the woman at greater risk for HIV infection than the man. Says Henderson, “The risk for infection for the female is about twice that of the male partner.” The type of sexual behavior that poses the greatest risk for passing on the HIV virus is receptive anal intercourse, Henderson says, explaining that “the person receiving the penis in the anus is the receptive person. In heterosexual sex, that is the woman.” She notes that according to the Centers for Disease Control and Prevention (CDC), receptive anal intercourse carries a risk for HIV transmission 17 times greater than receptive vaginal intercourse. In men who have sex with men, anal intercourse also poses a risk of infection for the insertive partner, Henderson says, although the danger is 13 times greater for the receptive partner.
Condoms Can Help Protect You
When used correctly and consistently, condoms can decrease the risk of HIV transmission during male-male intercourse, Henderson says. Figures from the CDC indicate that condoms reduce the risk of HIV transmission for the receptive partner by 73 percent, and for the insertive partner by 63 percent. Using a condom during vaginal intercourse is especially effective at protecting against HIV transmission: When applied and used correctly, condoms can lower a woman’s risk of infection by 80 to 85 percent. However, given that condoms aren’t 100 percent effective, the CDC recommends taking additional precautionary steps.
How to Have Safer Sex With Your HIV-Positive Partner
In recent years, several advances have made intimacy between a couple with one HIV-positive partner somewhat safer. People who are aggressively managing their HIV with medications called antiretroviral therapy, or ART, usually have lower levels of HIV in their blood and bodily fluids. This, Henderson explains, also decreases the chances that they’ll transmit the virus to someone else. According to the CDC, people who maintain “undetectable” viral loads — that is, the level of HIV in the blood is lower than can be detected with current technology — have virtually no chance of infecting a sexual partner. Individuals at high risk for contracting HIV can also take a combination of medicines called pre-exposure prophylaxis, or PrEP, which works to prevent the virus from establishing a permanent infection in the body, Henderson explains. PrEP involves taking an antiretroviral pill every day and seeing a healthcare provider every three months to take an HIV test and get a prescription refill. Though it’s often given in an emergency room in urgent situations, post-exposure prophylaxis, or PEP, offers an option for people who have just participated in high-risk sex, such as having had anal intercourse with a man who is HIV positive. Henderson notes that PEP has to be taken within 72 hours of possible exposure to the virus. Henderson also points out that the risk of infecting a partner with HIV is increased if either partner has another sexually transmitted infection, such as chlamydia or gonorrhea.
What Are the Chances of Getting HIV Through Kissing and Oral Sex?
Not as much is known about the potential risk of getting HIV through oral intercourse, Henderson says. The CDC considers oral intercourse to be a low-risk behavior regarding HIV, though the presence of another STD may increase the risk of transmission. The risk is also greater if the person performing oral sex has mouth sores, bleeding gums, or comes into contact orally with menstrual blood. The riskiest form of this behavior is mouth-to-penis oral sex, especially if ejaculation occurs in the mouth, Henderson says. Using a condom or a dental dam may help reduce the risk of HIV transmission in these situations.
Getting Pregnant and Having Children With an HIV-Positive Partner
According to the British government organization AIDSMap, HIV-positive women can have healthy pregnancies and healthy babies, without passing HIV to their child. But this takes careful planning, and extra steps are necessary to reduce the risk. Talk to your doctor if you’re planning to become pregnant, since your best options may be affected by whether you’re on ART, whether your health is generally good, and which person in the relationship has HIV. Other options for couples affected by HIV include:
In vitro fertilizationArtificial inseminationAdoptionUsing a sperm donorUsing a surrogate mother
People find intimacy in different ways, of course. But for many the sheer act of physical touch — even hugging and kissing — can be an enormous source of comfort and solace.
