Even treated and controlled, HIV is a burden. You have to see your doctor much more often that people who don’t have HIV. You have to take your drugs precisely as prescribed, precisely when your doctor says to take them, some with food and some on an empty stomach. It can be like having a new, second full-time job.
So, your life will be better if you never get infected in the first place! And your life is not the only one you need to think about.
Do you have a partner who loves you? Do you have children or aging parents who depend on you? You want to be there for them. If you have HIV and are pregnant, both your HIV doctor and your obstetrician/gynecologist need to know, because some HIV medicines can harm your baby, while others, especially taken before and during birth, can protect the baby from being born with the virus.
So life is a lot simpler if you don't have the virus to begin with. And if you don’t have the virus, you can’t pass it on to someone else.
In principle, everyone who is old enough for sexual activity or recreational drug use is at risk for becoming infected with HIV. How can we make the risk less?
The best way to reduce your risk of becoming infected with HIV is to avoid behaviors that give the virus a chance to spread from someone else to you. The main behaviors are unsafe sex and unsafe shared drug use.
Safe(r) sex
There is no such thing as 100%-safe sex. Even if your partner and you have never had sex with anyone else, before you met or since you met, one of you might pass the virus to the other if you become infected through some other route.
If you aren’t 100% sure of your partner’s HIV status and your own, you need to make love carefully. No vaginal or anal intercourse without protection – use a condom every time. If the two of you enjoy oral sex, have a good time – but don’t ever take your partner’s semen into your mouth. And don’t bank on it when he says, “I won’t c*m in your mouth.” His self-control may be shaky during climax.
Beware one myth about HIV! Many people think that the partner being whose vagina or anus is being penetrated without protection is at risk, but not the partner doing the penetrating. Wrong, dead wrong. The virus can be passed in either direction. If you are the penetrating partner and you don’t care that much about your partner’s health, at least take care for your own and use a condom.
Safe(r) drug sharing
There’s also no such thing as 100%-safe drug sharing – not just because the drug sharing itself can give the virus a route to a new host, but because the drugs may lower your inhibitions and lead to unsafe sex.
If you are using injection drugs, the obvious first advice is, For God sake, stop, get help. Some injection drugs won’t or can’t do that, though. The drugs are intensely addictive, and most of the users started using them because they had major life issues.
So let’s talk about harm reduction. Never share needles. If your state allows pharmacy sales of up to ten syringes without prescription - most now do - buy the clean needles you need. If there is a needle exchange or clean needle distribution program near you, use it. If there isn’t, find a nurse or doctor who will teach you how to sterilize needles before and after use. If you are heating up drugs for both of you in a spoon, use two spoons. Too many people know sharing needles is risky but think sharing kit is safe. It isn't.
If you are snorting powders through tubes, our advice is, once again, Don’t do that. But if you must, at least reduce your risk by not sharing snorting tubes. A tube can make tiny cuts in the nose. If you pass a tube around, you are probably also passing around tiny amounts of blood and nasal fluid – and a tiny amount is all the virus needs to spread in.
So, if you must share drugs, at least reduce the risk of harm. No shared needles, no shared kit, no shared snorting tubes.
If you are about to have sex with someone who is not your regular partner, don’t be too quick to rely on what the two of you tell each other about your HIV statuses. Either of you could be infected and not know it. And either of you could know you are positive and be afraid of rejection. So have sex as if the two of you didn’t know each other’s statuses – because you don’t.
There may still be good reasons to “have the talk” with a new or casual partner. If you know you’re positive, you don’t want to wake up tomorrow thinking, This is someone I want to know for the rest of my life, and have to say, “I really like you, can we do this again? And by the way, I’m positive.” Share that information before the clothes come off, and you may end up sleeping alone tonight, but at least you will do it with his or her respect. Share it the morning after, and you are likely to have one very angry one-night stand on your hands.
If you are in a stable relationship, there’s no way around “having the talk.” You are committed to each other, and you have to share what you know. What you know may not be easy to talk about, though – what if you know that one of you has been straying outside the relationship or is shooting up, and you’re afraid of what talking about it could do to the relationship? Talk about it. If the relationship survives, it will be stronger. If it doesn’t, maybe it was time for it to end. If the relationship is unequal – if one of you tells the other, we don’t need to have this talk, I’ll tell you what you need to know – do something about the inequality. If the relationship is unequal and abusive, maybe it’s time to get out.
HIV raises special issues for women.
Too many women find themselves in life situations where they can't negotiate safe(r) sex or rely on their male partners to behave safely outside the relationship. Read the previous heading, Talking straight with your partner or date. If you're in a situation where you can't be honest about HIV status or can't negotiate safe(r) sex, seek help!
Laws making it criminal for people with HIV to have sex without disclosing their status are enforced most often against poor women of color. Jump to our Positive Voice newsletter to read one woman's story. And then come back and read the next heading, HIV and the law. The law isn't always fair, and you don't want to do time or lose your kids.
If you have HIV, it doesn't mean you can't or shouldn't have children. It does mean that you have to be very careful not to infect your partner or the new baby. Read HIV and getting pregnant.
Women with HIV have a higher risk of cervical cancer. When your gynecologist says it's time to do a pap smear, ask her to check specifically for HPV (Human Pappiloma Virus).
We don't endorse the content of external sites, but here are four we think you may find useful:
For women's special health issues, visit HealthyWomen and WomensHealth.gov.
For HIV-specific criminal laws as they apply to women in your state, visit the Center for HIV Law and Policy.
For reproductive justice issues, both legal and as they relate to women's rights and power in relationships, visit SisterLove.
One very good reason for protecting yourself from HIV is that many states have special criminal laws just for people living with HIV. So if you don't have the virus, keep up the good work! And if you do, you have a whole new area where you have to be careful about what you do.
Two areas where state criminal laws handle people with HIV differently are assault and battery and having sex without disclosing your status.
Assault and battery
Ever get so P!SSED with an abusive police officer that you wanted to spit on him? Bad idea! An HIV-positive Texas man got sentenced to 35 years in state prison for doing that. It's bad science, but some state legislatures think your blood, semen, and - yes - saliva are Weapons of Mass Destruction, even if you are taking "cocktail" antiviral drugs and there is no detectable live virus in your body fluids.
So keep your temper on its leash. Don't give an unfriendly court system an opportunity to do something stupid.
Having sex without disclosing your status
Many states make it a crime to have sex without telling your partner you are HIV-positive. It's bad public policy, because these laws have been proved not to change people's behavior, and it's the responsibility of both partners to "have the talk" and be honest about it.
Just because they are bad laws, though, doesn't mean you can ignore them. In some states, you can be convicted even if there has been no transmission of the virus, and even if transmission was virtually impossible because you did safe sex and did it right. Once again, don't give an unfriendly court system - or an angry former partner - an opportunity to do something stupid. Have the talk, every time, before the clothes come off.
For more on HIV and the law, visit the Center for HIV Law and Policy.
In a relationship where only one of you is positive? The good news is, one of you is still negative, and you both want to keep it that way.
So you have to talk. You need to talk to your doctors about risk, commit to what each of you is going to do to stay healthy, and balance risk and desire in negotiating what you will and will not do in bed.
If the positive partner hasn’t started taking an HIV drug “cocktail,” this might be a good time to start. There are reasons for starting early or waiting, and the two of you should talk together with your HIV doctor about whether and when to start. One of the strongest arguments for starting early is that “cocktail” drugs, used well, can stop the virus from reproducing, so there will be almost no live virus in your blood and body fluids. Only live virus can spread HIV. On your drugs, you still have a slim chance of passing the virus through unprotected sex, but the risk is much less. Condoms or dental dams are still the safest thing, but you can wake up a little less worried if the two of you got carried away last night and the condom’s still unopened on the bed-side table.
Don’t share razors – whether you can see it or not, there are often minute flecks of blood on the blade after use. Don’t share toothbrushes – if one of you forgets yours, reach for the mouthwash and promise yourself an extra-thorough brush-and-flossing tomorrow. Don’t brush your teeth just before making love, use mouthwash before and brush after. Don’t make love after one of you has just had dental work, because your gums may be bleeding even though you can’t see it in the bathroom mirror. If one of you has a cold, the flu, or another upper respiratory bug, it’s a good night to remember the old song, What do you get when you kiss a guy? Another chance to catch pneumonia, and just snuggle. It’s not a bad way to pass the night with someone you love.
What if you are not just an opposite-status couple, but an opposite-sex couple, and you want to have children?
HIV+ women can and do become pregnant and bring healthy babies to term. It takes attention and commitment, though, to do it safely. When the woman hoping to become pregnant is positive, there’s the baby to be protected. When the couple want to conceive by vaginal intercourse, it has to be done in a way that protects the HIV-negative partner.
When the mother is positive, it’s crucial that the baby be protected from her infection. The risk of mother-to-child transmission is highest during the baby’s bruising trip through the birth canal, so an HIV+ mother should have an awfully good reason not to be taking at least a short-term course of “cocktail” drugs before and during vaginal delivery. Some doctors recommend caesarean delivery instead to reduce the risk of transmitting the virus to the baby during birth. It’s something both of you should discuss together with your HIV doctor and your gynecologist. You may also want to give the doctors clearance to share with each other everything they know from their different points of view about the hopeful mother’s condition.
If you plan to conceive by vaginal intercourse, remember that this is, by definition, unprotected sex. You should talk together to your HIV doctor and gynecologist about how this can be accomplished with minimum risk. They may counsel you to use artificial insemination, using donated sperm or the HIV-positive male partner’s sperm rinsed of its accompanying fluids. If you decide to do it the old fashioned way, your doctors may put both of you on "cocktail" drugs while you are trying to conceive. (This is called pre-exposure prophylaxis, of PrEP.) Even if the negative partner is exposed to live virus during intercourse, it’s comparatively difficult for the virus to get established if his or her blood is already full of drugs that prevent it from reproducing.
Click HERE for more on pre-conception care guidelines for HIV-positive women.
Breastfeeding a newborn can be a very good thing. It strengthens the bond between the mother and baby and supports the baby's developing immune system.
Unfortunately, a mother's HIV can be passed to the baby through the breast milk.
So, if you are an HIV-positive new mother, you should talk to your HIV doctor and pediatrican before deciding to nurse your baby. If you are taking HIV drugs and live virus in your blood ("viral load") is undetectable, the risk of transmission is greatly reduced, although not eliminated entirely. Only your doctors and you can decide how to balance the risks and benefits.
Couples trying to become pregnant without passing HIV from the positive to the negative partner are not the only people who may want to consider taking a daily pill to protect themselves. Some of us just don't like the mechanics and mess of safe sex. Others - especially sex workers - may not be in a position to negotiate safe sex with their partners.
So it was very good news, in late fall, 2010, when a controlled study showed that taking a daily emtricitabine and tenofovir (FTC/TDF) pill reduced the rate of new infections in a study population of initially HIV-negative gay men. It works - up to a point.
Key cautions:
(1) PrEP can greatly reduce the risk of HIV infection, but it does not eliminate it altogether. Condoms are still recommended.
(2) Even if the daily PrEP pill protects you from HIV, it will not protect you from other sexually transmitted infections, including gonorrhea, syphilis, hepatitis B and C, human papillomaviruses, and herpes. Some of them can't be cured. Others can be, but the treatments are no picnic. Again, condoms are still recommended.
(3) The degree of protection appears to depend heavily on how well you adhere to the one pill a day regimen. You can't miss a dose, tell yourself, No worries, I took one yesterday, and head off to the dating bar thinking you're protected, because you may not be. It takes discipline to take that one pill, every day, at the same time of day.
The Food and Drug Administration (FDA) approved use of Truvada for pre-exposure prophylaxis in July, 2012. NAPWA welcomes the FDA's action as a step forward in practical HIV prevention, but urges all people considering starting PrEP not to do so without proper medical advice and supervision.
Click HERE to see the Fenway Institute's PrEP guidelines for patients and providers, updated January 28, 2011.
Click HERE to see the CDC's interim PrEP guidance for men who have sex with men, issued January 28, 2011.
Click HERE to see the CDC's interim PrEP guidance for heterosexually active adults, issued August 10, 2012.
Think you did something risky last night? Condoms break, we get carried away and forget to use them, or we were so high on alcohol or drugs last night that we aren’t quite sure what we did and who we did it with.
If you act now you can do something about it. You can go immediately to your doctor and ask to be put on a four-week course of “cocktail” drugs. This is called post-exposure prophylaxis (PEP). If you start soon enough, you may have just enough time to stop the virus from taking hold.
Or you can wait three months to get tested. By then, if you’re positive, the virus will be fully entrenched, and you can look forward to a lifetime of HIV meds and all the life and social complications being HIV-positive brings with it.
Time is of the essence. If you think you may have been exposed, you need to start your PEP treatment the next day if possible, and no later than seventy-two hours after the time of exposure. Click to access HRSA guidance on PEP after possible "occupational" (while providing health care) and "non-occupational" (other) exposure to HIV.
And, if you have an “accident,” don’t beat yourself up too much. We’re all human, and humans make mistakes. It’s a lot more productive to think clearly about what made the mistake possible, so you know how to avoid making it again.
NAPWA believes that preventing the spread of HIV is the responsibility of both partners who choose to have sex. Click HERE to read and download NAPWA's prevention guidelines for people living with HIV who want to take responsibility for not spreading it further.
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