Sex and prevention concerns
for positive people

September 2002     View PDF     En español

What are the risks of passing HIV
to my HIV-negative partner?

A concern of many people living with HIV is passing HIV to their uninfected partner(s). While much evidence suggests that men transmit HIV more easily than women, women can still pass HIV to uninfected partners—both male and female. This is because HIV is present in blood (including menstrual blood), vaginal secretions and in cells in the vaginal and anal walls. In fact, high levels of HIV can be found in these areas even if there’s a low amount of HIV in your blood.

For women, HIV levels in vaginal fluids greatly increase when you have gynecological (GYN) conditions, like yeast infections or inflammation. Several studies in test tubes show that some sexually transmitted diseases (STDs), like chlamydia, increase HIV reproduction. Vaginal inflammation, a common symptom of these infections, causes tiny scrapes and cuts on the delicate skin of the vaginal area that can then harbor HIV. HIV levels can also temporarily increase after treating some of these conditions.

Likewise, men with active STDs, especially active herpes lesions, etc., are more likely to both acquire and transmit HIV. Less is known about whether HIV levels are actually higher in blood and semen during an active STD infection in men, but certainly any infection that causes a lesion, like herpes, provides a portal for HIV to pass through and makes transmission more likely. Studies do show that even when a man has undetectable levels of HIV in his blood, there are sometimes detectable HIV levels in semen and pre-cum fluid. HIV transmission from men with undetectable HIV levels in their blood has been documented several times.

In short, if you’re not practicing safer sex, there’s no way to know when you’re more or less likely to pass HIV to your partner(s). Exposure to vaginal or anal secretions, semen or other blood with high levels of HIV increases your risk of transmission. The risk further increases when one’s partner has an infection or inflammation. It’s also possible to have active infections or GYN conditions without having symptoms or knowing it. (For more information, read the general guidelines on safer sex practices.)

Finally, a number of known cases have shown multi-drug resistant HIV being passed from people living with HIV to their partners. What this means is that the newly infected partners have a form of the virus difficult to treat with anti-HIV drugs, leaving them with limited options to treat their infections.