HIV: Sexual Transmission, Risk Factors, & Prevention

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Top things to know:

  • HIV is transmitted through the exchange of certain bodily fluids such as blood, semen, breast milk, and vaginal fluids.
  • HIV cannot be transmitted through saliva, tears, sneezing, or physical contact.
  • HIV can be transmitted through unprotected anal sex, penis-vagina sex, and occasionally oral sex.
  • There is no cure for HIV, but medications are available that can keep the viral load low and even prevent HIV transmission, as well as others that can greatly reduce the risk of contracting HIV.

What is HIV/AIDS?

HIV and AIDS are terms that are often used together and are often misunderstood. HIV, or the Human Immunodeficiency Virus, is a virus that attacks and weakens the immune system. If a person tests positive for HIV, it means that they have the virus in their body. HIV progressively damages the immune system, specifically a type of white blood cell called CD4 cells. As the HIV infection progresses, the person becomes more and more immunodeficient until they are diagnosed with AIDS, or Acquired Immunodeficiency Syndrome. This is the final stage of an HIV infection and occurs when the person's immune system is so weak that they are unable to fight off infections, diseases, or cancers. Unfortunately, there is no cure for HIV, but there are treatments that can help people with the virus maintain their health.

How is HIV Transmitted?

HIV is primarily transmitted between humans through the exchange of certain bodily fluids, such as blood, semen, breast milk, and vaginal fluids. It is not transmitted through saliva, tears, sweat, ordinary physical contact, air, water, or pets and insects. HIV is often transmitted through sexual activity and drug use in adults in the United States, and it can also be transmitted from mother to child during childbirth. It is important to take precautions to avoid HIV transmission, but it is also important to remember that it is not unsafe to be around people with HIV and to avoid perpetuating discrimination and stigma against those with the virus.

HIV and Sex

HIV is often transmitted through sexual activity, so it is important to understand which activities put you at a higher risk of contracting the virus. Unprotected sex, meaning sex without the use of a condom or other barrier, increases the risk of HIV transmission. To reduce the risk of contracting HIV, it is recommended to avoid having unprotected vaginal, anal, or oral sex with anyone who is known to have HIV or whose HIV status is unknown. Different types of sexual contact carry different levels of risk for HIV transmission.

Anal sex

Unprotected anal sex carries the highest risk of HIV transmission. Both partners who engage in this activity are at risk of contracting HIV and other STIs, but the receptive partner is at greater risk due to the thin lining of the anus which can easily tear and allow the virus to enter the body through semen or blood. The insertive partner is also at risk of contracting HIV through the urethra or any cuts or sores on the penis. Studies suggest that one transmission occurs for every 72 instances of unprotected receptive anal sex. It's important to note that anal sex is not limited to just men who have sex with men and that couples of any gender can engage in this activity. To protect against HIV, it's crucial to use a condom during anal sex.

Penis-vagina sex

Vaginal sex can transmit HIV if one partner is infected and the other is not. This is because the soft tissue of the vagina and anus can become irritated during sex, potentially allowing HIV to enter the body through semen, pre-cum, or blood. The risk of HIV transmission through unprotected penis-in-vagina sex is relatively low, with an estimated 1 in 1250 receptive sexual acts resulting in HIV transmission. However, this risk can be increased by various factors. People with penises can also contract HIV through penis-in-vagina sex, but the risk is lower, with transmission occurring in about half as many cases. Using a condom can protect both partners from HIV transmission during sexual activity.

Oral sex

It is uncommon, but possible, to transmit HIV through oral sex. If a person performing oral sex has any cuts or sores in their mouth and they come into contact with HIV-infected semen, sexual fluids, or blood, they may be at risk of contracting the virus. To reduce the risk of HIV and other sexually transmitted infections during oral sex, it is important to use a condom or other barrier method to protect both partners.

HIV and Drugs

Injecting drugs can increase your risk of contracting HIV. The most effective way to reduce this risk is to seek support to stop using drugs, either through counseling or medical treatment. You can reach out to a healthcare provider, a loved one, or a substance abuse treatment center for assistance.

Having sex while under the influence of drugs/alcohol

Individuals who are under the influence of drugs or alcohol may be more likely to engage in sexual activities without using protective measures, such as condoms. This can increase their risk of contracting HIV.

HIV and maternal transmission

HIV can be transmitted from a mother to her child during pregnancy, childbirth, or breastfeeding. Without treatment, there is a risk of transmission ranging from 15-45%. However, taking antiretroviral therapy (ART) can significantly reduce this risk to less than 1%. If you think you may have been exposed to HIV during pregnancy, it is important to speak to a healthcare provider about getting tested and starting treatment as soon as possible. It is also important to note that HIV-positive individuals should not breastfeed their children, as breast milk can transmit the virus, even if the individual is taking ART and has an undetectable viral load.

HIV Prevention and Treatment

HIV is a virus that can be transmitted through sexual contact or through the sharing of HIV-infected bodily fluids. While it is not a cure, antiretroviral therapy (ART) is a type of medication that can lower a person's HIV viral load, or the amount of HIV in their blood. When a person's viral load is undetectable, they have a very low risk of transmitting HIV to someone else. However, it is still important to use condoms or other barrier methods during sexual activity to help prevent the spread of HIV. If you have HIV and have an undetectable viral load, it is important to tell your sexual partner about your HIV status before having sex. If you have been exposed to HIV, post-exposure prophylaxis (PEP) medication can be taken to decrease your risk of contracting HIV. Pre-exposure prophylaxis (PrEP) medication can also be taken daily to reduce the risk of HIV transmission if you are exposed to the virus.

Getting treatment for Sexually Transmitted Infections (STIs)

Having a sexually transmitted infection (STI) can increase the risk of both transmitting and contracting HIV. If a person has both HIV and an STI, they are more likely to transmit HIV to someone else during sexual activity. Conversely, a person who does not have HIV but has an STI has an increased risk of contracting HIV if they have unprotected sex with someone who has HIV. This is because some STIs, such as syphilis, genital herpes, HPV, or chancroid, can cause open sores or irritation on the skin that can provide an entry point for HIV during all types of unprotected sex. Even STIs that do not cause open sores, such as chlamydia, gonorrhea, and trichomoniasis, can increase the risk of HIV transmission by causing inflammation in the genital area, which attracts more immune cells to the area, which are targeted by HIV.

Using lube

Using lubricant not only enhances sexual pleasure, but it also increases the safety of sex. Lubricant reduces friction between skin or condoms, leading to smooth and enjoyable movements and decreasing the risk of condom breakage or tearing during anal sex. Both water-based and silicone-based lubricants can be safely used with female and male condoms. However, oil-based lubricants and other oil-based products such as petroleum jelly or mineral oil should not be used with latex condoms as they can weaken the latex and cause the condom to break.

Penile circumcision

Penile circumcision is the surgical removal of the foreskin from the penis. This procedure is often performed as a cultural or religious choice on newborn babies, and sometimes for medical reasons. There is a link between circumcision and reduced HIV transmission during penis-vagina sex. For this reason, some governments in Africa with high HIV prevalence and the World Health Organization recommend that boys and men who do not have regular access to healthcare undergo voluntary medical male circumcision (VMMC) as an additional way to reduce HIV transmission. Circumcision does not completely eliminate the risk of HIV transmission, so condoms should still be used. Despite advances in HIV treatment and prevention, there are still approximately 37 million people living with HIV worldwide, according to the World Health Organization. Prevention, safer sex practices, accessible STI testing, and treatment are important in preventing the spread of HIV.