How to Reduce Your Risk of Sexual Transmission

1. Preventing Sexual Transmission
2. Preventing Transmission During Substance Use
3. Preventing Transmission Through Pregnancy
4. Preventing Transmission in Occupational and Controlled Settings

Safer Sex
Sexual activity is the most common way for HIV to be transmitted. People have varying ideas of what they think of as sexual activity. When determining your risk for HIV and ways to reduce that risk, consider the range of sexual activities you engage in.

It is important to understand that the risk of HIV transmission from various sexual activities falls along a continuum. Once you understand where your sexual activities are on this continuum, you can decide what steps to take to lower your risk.

The goal of safer sex practices is to avoid getting the blood, semen or vaginal fluid of sexual partners who are HIV-positive or whose HIV status you don’t know in your body. It also means to avoid having your blood, semen or vaginal fluid enter your partner if you are HIV-positive or do not know your HIV status.

Risks of sexual practices

Please note that the risks described below are specific to HIV transmission. Some STDs are transmitted more easily than HIV. After assessing your risk for HIV, visit www.ashastd.org to learn about other STDs.

Anal Sex

Anal sex without a condom (often referred to as barebacking) is the riskiest activity for HIV transmission. The receptive partner (or "bottom") is at the greatest risk because anal tissue is easily bruised or torn during sex which then provides easy access to the bloodstream for HIV carried in semen. The insertive partner (or "top") is also at some risk because the membranes inside the urethra can provide entry for HIV, into the bloodstream. The presence of other STDs can increase the risk of HIV transmission during anal sex.

To reduce your risk, use a latex or polyurethane condom when engaging in anal sex. Some people prefer to use “bottom condoms” which can be inserted into the rectum before engaging in anal sex .. No matter what type of condom you prefer, be sure to use plenty of water-based lubricant, when you have anal sex. Don't use oil-based lubricants, such as petroleum jelly or hand lotion, because oil destroys the condom and causes it to break.

Vaginal Sex

Unprotected vaginal sex is also considered risky for HIV transmission. The female is at the greatest risk because the lining of the vagina is a mucous membrane which can provide easy access to the bloodstream for HIV carried in semen. The male is also at some risk because the membranes inside the urethra can provide an entry for HIV into the bloodstream. The presence of other STDs can increase the risk of HIV transmission during vaginal sex.

To reduce your risk, use a latex or polyurethane condom when engaging in vaginal sex. Some people prefer to use female condoms which can be inserted into the vagina before engaging in sexual activity. Use plenty of water-based lubricant, when you have vaginal sex. Don't use oil-based lubricants, such as petroleum jelly or hand lotion, because oil destroys the condom and causes it to break.

Oral sex with a man

There are a few documented cases where it appears that HIV was transmitted orally. The risk of transmission with oral sex is low because the mouth is an unfriendly environment for HIV. Saliva contains enzymes that break down the virus and the mucous membranes in the mouth are more protective that anal/vaginal tissue.

Documented cases of oral transmission are all attributed to ejaculation into the mouth. The minimal risk of transmission from oral sex with a man is only for the person performing the oral sex. Open cuts and abrasions in the mouth or bleeding gums also can create an entry point for HIV and increase the risk of transmission. When performing oral sex on a man you can completely eliminate this risk by using condoms.

A person receiving oral sex is generally not at risk, because that person is coming into contact only with saliva, which can not transmit HIV. There is a theoretical risk of transmission if the person performing oral sex had blood in her/his mouth, but there are no well documented cases of this occurring.

The presence of other STDs can increase the risk of HIV transmission during oral sex.

Oral Sex with a woman

The risk of transmission with oral sex is low because the mouth is an unfriendly environment for HIV. Saliva breaks down the virus and the mucous membranes in the mouth are more protective that anal/vaginal tissue.

The minimal risk of transmission with oral sex with a woman is only for the person performing the oral sex as their mouth is in contact with vaginal fluid. However, there is little data documenting HIV transmission via oral sex from an infected woman to an uninfected person. Performing oral sex on a woman who is menstruating increases the risk because blood has more HIV than vaginal fluid. When performing oral sex on a woman you can completely eliminate this risk by using a barrier (dental dams or plastic wrap).

A person receiving oral sex is generally not at risk, because that person is coming into contact only with saliva, which is not an infectious fluid. There is a theoretical risk of transmission if the person performing oral sex had blood in her/his mouth, but there are no well documented cases of this occurring.

The presence of other STDs can increase the risk of HIV transmission during oral sex.

Oral-anal sex

Rimming (oral-anal contact) poses minimal risk for HIV transmission. However, rimming is a risk for transmission of hepatitis, parasites, and many other sexually transmitted diseases. When engaging in oral-anal sex you can completely eliminate the HIV risk by using a barrier (dental dams or plastic wrap).

Safe Sex activities

Kissing does not pose a risk for HIV transmission. Saliva does not transmit HIV.

Mutual masturbation does not pose a risk for HIV transmission. The skin is an effective barrier against all sorts of organisms, and will stop HIV. An intact scab is as effective as unbroken skin. Data has not indicated cases of HIV transmission through mutual masturbation. Solo masturbation poses no risk as only your fluids are present.

Body massage, touching and rubbing do not pose a risk for HIV transmission. There are no bodily fluids exchanged in these activities.

Abstinence and Monogamy
One way to protect yourself from HIV infection is to abstain from sexual intercourse. Many people today are choosing not to be sexually active until they enter a monogamous relationship. There are many ways to be intimate and sexual that don't include intercourse. Some options include massage, bathing together, kissing and talking about your sexual fantasies.

Abstinence isn't always foolproof. Making the commitment to refrain from sex is difficult for many people. It takes as much work as other practices to reduce risk for HIV.

Having only one sexual partner and knowing his or her HIV status is another great way to reducing your risk. For this to be a reliable strategy, you must develop open and honest communication with your partner about sexual history. If you are in a monogamous relationship, it is important to practice the safer sex tips below until you are both certain of your HIV status. You and your partner can get conclusive HIV tests 3 months after each of your last sexual risks. Once you both have conclusive HIV test results, you can discuss what types of precautions you feel are necessary in your sexual activity.

Last Updated: Tuesday, March 3, 2009
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