Sex and prevention concerns for positive people

January 2011    View PDF    Ask a question    En español

Safer sex and prevention messages are often targeted solely to HIV-negative people. Yet, preventing HIV and other infections remains an important issue for people living with HIV as well. Whether your partner is HIV-positive, HIV-negative, female, male or transgendered, there are many reasons to be concerned about safer sex and prevention. This publication explores some of the most common sexual transmission concerns for people living with HIV, as well as infections related to handling food and animals.

Can I pass HIV to my negative partner?

Many people living with HIV are concerned with passing HIV to their uninfected partner(s). While men generally pass HIV more easily than women, women can still pass HIV to their 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.

For women, HIV levels in vaginal fluids greatly increase when they have gynecological (GYN) conditions, like yeast infections or inflammation. Sexual infections, like chlamydia, can increase HIV reproduction. Vaginal (and anal) inflammation, a common symptom of these infections, causes tiny scrapes and cuts on the delicate skin that can then harbor HIV. HIV levels can also temporarily increase after treating some of these conditions.

Both men and women with active sexual infections, especially those with active lesions like herpes, are more likely to both get and pass HIV. Studies show that even when a man has undetectable levels of HIV in his blood, sometimes there’s a detectable HIV level in his semen and pre-cum fluid. Cases of this type of transmission have been documented many times.

In short, there’s no way to know when you’re more or less likely to pass HIV to your partner(s) in the absence of protected sex. Exposure to vaginal or anal secretions, semen or blood with high levels of HIV increases your risk of transmission. The risk further increases when you or your partner has an infection or inflammation present. It’s also possible to have active infections or GYN conditions without having symptoms or knowing it.

We’re both positive. What are our concerns?

“If I’m positive and my partner is positive, then why do we have to practice safer sex?” There are 2 reasons: to prevent passing new infections and to prevent passing drug-resistant virus to each other.

Infections like CMV, HPV, herpes, hepatitis B and C and others remain major concerns. All of these are potentially deadly infections in people with HIV, but they can be prevented to some degree through practicing safer sex. Consult page 3 for more information.

Re-infection with drug-resistant or more aggressive strains of HIV remains a theoretical possibility. It must be considered when negotiating safer sex between positive partners.

If you’re on therapy that HIV has become resistant to, it’s possible for you to pass that drug-resistant strain to your partner, possibly crippling the benefits of using those drugs for your partner, and vice versa.

The reality of safer sex

You put yourself at risk for infections through unprotected sex with a partner—activities that expose you to your partner’s blood, urine, feces, semen or vaginal or anal fluids. Every sexual activity carries some level of infection risk. In some cases these infections may never harm your partner, but they might be life-threatening to you should your immune system weaken as a result of HIV.

Negotiating and engaging in safer sex requires willing partners. This is especially difficult for women because of the lack of safe and low-cost woman-initiated methods of HIV prevention. In situations of domestic violence, this willing involvement can be almost impossible. In this case, seeking family violence prevention services is probably the safest and smartest plan of action.

HIV and STDs: woman-to-woman

Sexual activity between women has generally been associated with a lower risk of passing HIV, although some cases have been reported. The risk of passing HIV and other STIs between women has not been thoroughly studied. But the few studies to date note that many women who have sex with women engage in a number of high-risk behaviors that may increase their risks of both getting and passing HIV and other STIs (including types of HPV associated with cervical and anal cancer). So in the meantime, it’s best to play safe and refrain from making easy assumptions about this issue.

Multi-drug resistant HIV

A major concern in having unsafe sex is possibly passing or getting a drug-resistant strain of HIV. Several 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 HIV drugs, leaving them with limited treatment options.

According to a US study in 2002, about 1 in 5 people get a drug-resistant HIV, and about half of those were multi-drug-resistant. The concern here is if this rate continues to climb over time; however, a 2005 European study seems to suggest differently. Out of nearly 3,000 people from 20 countries, about 1 in 10 had gotten a drug-resistant strain of HIV. This observation points to real possibilities of passing or getting a drug-resistant virus and underscores the importance of including safer sex in your life, even when you and your partner(s) are both living with HIV.

Why is prevention important?

Prevention isn’t just about protecting someone else from getting HIV; it’s also about protecting yourself from other harmful infections, because many of them can cause serious harm in people living with HIV. These infections can be passed through common activities like sex, changing diapers, gardening, eating raw food or traveling. But you can do something about many of them — by having safer sex, eating safe food and properly handling animals, among others.

A few examples of these more serious infections are hepatitis (that can be passed through sex or tainted food), HPV (passed through sex and can cause cervical and anal cancers), and CMV (that can be passed through sex or being in close contact with children). A fuller list of these infections are found on page 4.

It’s important for people living with HIV to protect themselves from these unwanted and possibly dangerous infections. Lab tests can detect these infections, so you could start by getting a full physical that includes these tests. Then, use the results to build a prevention plan that helps protect you from getting new infections.

Safer sex guidelines

Practicing safer sex reduces the risk of passing or contracting other diseases too, like chlamydia, gonorrhea, herpes and hepatitis. These can be especially troublesome in people with weaker immune systems. A few tips on how to protect you and your partner are found below.

Plastics and water-based lubes
Use latex condoms and gloves and plenty of water-based lubricant for vaginal and anal sex. If you’re sensitive (allergic) to latex, try polyurethane condoms. The female condom is also made of polyurethane. However, polyurethane condoms may have slightly more problems with breaking or slipping than latex. Examples of oil-based lubes are Crisco, Vaseline, baby oil, lotion or whipped cream. Although oil-based lubes can be safely used with polyurethane condoms, good water-based lubes last longer and often feel better.

Read the label
Many people avoid products with the spermicide Nonoxynol-9. Some studies show it can cause irritation that may promote STIs, like HIV.

Wrap it to go
For oral sex with a man, it’s safest to use a condom. For oral sex on a woman or oral-anal sex (rimming), it’s safest to use a dental dam (latex square), plastic wrap, or a condom or latex glove cut to make it flat.

Try a breath mint instead
Avoid brushing or flossing your teeth up to two hours before or after oral or anal sex to minimize small cuts. Be aware of bleeding gums, cuts or sores on or in the mouth.

Good clean fun
If you share sex toys (like dildos or vibrators), put on a fresh condom for each user and/or when going to/from the anus and vagina. Clean toys with bleach, alcohol or soap and water between uses.

On the wild side
Avoid contact with blood, semen and vaginal and anal fluids. Sex toys like whips or knives can break the skin and should not be used on another person until they’re disinfected with bleach or cleaning solution.

Prevent common infections at home!

Bartonella (Cat Scratch Fever)
A bacterial infection that causes fevers, headaches and anemia.

  • Avoid cats under one year old.
  • Avoid cat scratches. Promptly wash all cat scratches or wounds.
  • Use flea control for cats.

Campylobacter
A bacterial infection that causes diarrhea, abdominal pain and vomiting.

  • Avoid contact with animals that have diarrhea.
  • Get someone else to handle pet potty duties.

Coccidioidomycosis (Valley Fever)
A fungal infection that causes fevers, difficult breathing and night sweats.

  • Avoid excavation sites and dust storms. It may be impossible to avoid exposure to this in some parts of the country such as the Southwest.

Cryptococcosis
A fungal infection that primarily infects the brain.

  • Avoid areas with bird droppings. Avoid handling birds, even pet birds.

Cryptosporidiosis
A parasite that can cause diarrhea.

  • Wash hands after touching diapers, feces or soil.
  • Avoid contact with young farm animals or animals with diarrhea.
  • Wash hands after handling pets and avoid contact with pet feces.
  • Boil water for at least one minute or use a water system that filters out Cryptosporidium.
  • Avoid swimming in water that may be contaminated by Cryptosporidium through human or animal waste.

Cytomegalovirus (CMV)
A virus that infects the entire body. (Left untreated, CMV can cause diarrhea, blindness, inflammation of the brain, etc.)

  • Avoid touching your face.
  • Wash hands after fecal contact and when around children.
  • Engage in safer sex.
  • If blood transfusions are required, only CMV antibody negative or leukocyte-reduced blood products should be used.

Hepatitis A, B and C Virus
These viral infections can cause liver damage, failure and sometimes cancer.

  • Consider getting vaccines for hepatitis A (especially when traveling to high-risk areas) and B.
  • Engage in safer sex.

Herpes
A viral infection that causes lesions around the mouth, genitals and rectum.

  • Engage in safer sex.

Histoplasmosis
A fungal infection that can cause fevers, anemia and difficult breathing.

  • It may be impossible to avoid exposure to it in areas like the Midwest river valleys. Avoid chicken coops, bird roosting sites or caves.

Human Papilloma Virus
A viral infection that can cause warts and some cancers.

  • Engage in safer sex, though condoms cannot fully prevent HPV.

Listeriosis
A bacterial infection that can cause inflammation in the brain.

  • Avoid eating non-pasteurized dairy products, such as soft cheeses like Brie and goat cheese.
  • Heat ready-to-eat foods like hot dogs to steaming hot.

Microsporidiosis
A parasite that can cause diarrhea.

  • Wash hands frequently and follow good hygiene.

Salmonella
A bacterial infection that causes food poisoning and diarrhea.

  • Avoid the following: Caesar salads or anything with raw eggs; under-cooked eggs and poultry; contact with animals that have diarrhea; and contact with reptiles like snakes, lizards and turtles.

Toxoplasmosis
A parasite that mostly infects the brain. These apply to people who are NOT antibody positive to Toxoplasma.

  • Avoid eating raw or under-cooked meats. (Cook to an internal temperature of 150°F or 65.5°C.)
  • Wash hands after contact with raw meat and after touching soil.
  • Wash fruits and vegetables in filtered water or in a .05% bleach solution before eating them raw.
  • Wash hands after changing a cat’s litter box or preferably let someone else do it.
  • Cats should be kept indoors and be fed canned or dried commercial cat food, not raw or undercooked meats.

Tuberculosis
Primarily infects the lungs and can cause cough, weight loss and fatigue.

  • If possible, avoid working or volunteering in places at high risk for TB, such as health care and correctional facilities and homeless shelters.

Varicella-Zoster
A viral infection better known as chicken pox and shingles.

  • People who have NOT had either disease should avoid contact with people with active disease.