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What can increase HIV risk?

Many factors can increase someone’s chance of getting or transmitting HIV, either from having sex or sharing needles and syringes. Every exposure to HIV does not carry the same risk, and some factors, that you and your partner need to be aware of, can increase that risk. For example, having a high viral load greatly increases the chance of transmitting HIV, and having another sexually transmitted disease can increase the chances of getting or transmitting HIV.

Using drugs and alcohol, or certain things about your relationships with sex partners, can also increase the chance of an HIV exposure.

If you and your partner are aware of the factors that increase HIV risk, you can discuss and chose to do things to help you decrease HIV risk.

Viral load

Viral load is the amount of HIV in the blood of someone who has HIV. A viral load test tells how much HIV is in the blood. If you have HIV, you should get your viral load checked at least twice a year or more often if your health care provider recommends it.

More Information:

A viral load test is a laboratory test that measures the amount of HIV in a sample of blood. Results are shown as the number of copies of HIV virus per milliliter of blood.

The goal of HIV treatment is to reduce viral load to very low or undetectable levels. When the viral load is very low, it is called viral suppression. An undetectable viral load is when the amount of HIV in the blood is so low that a test can’t measure it. 

More Information: Having an undetectable viral load depends in part on what test is used to measure viral load because some tests are more sensitive than others. But in general, an undetectable viral load would mean someone has less than about 40 copies per milliliter of blood. Someone who has less than about 200 copies per milliliter of blood is virally suppressed. This tool uses the term undetectable, but staying virally suppressed has the same health and prevention benefits as keeping an undetectable viral load.

In general, the higher someone’s viral load, the more likely that person is to transmit HIV. Someone in the earliest phase of HIV infection, called acute HIV infection, has a very high viral load and is much more likely to transmit HIV.

What is having a detectable viral load (not being virally suppressed)? Viral load is the amount of HIV in the blood of someone who has HIV. If you have a detectable viral load, or you aren’t virally suppressed, you have a high level of HIV in your blood.

When your viral load is high, you have more HIV in your body. Someone who maintains a high viral load will have health problems and also has a high risk of transmitting HIV to sex and drug-injection partners, and from mother to child during pregnancy, childbirth and breastfeeding. That person will eventually develop AIDS if the virus is not treated. But, taking HIV medicine, called antiretroviral therapy or ART, can prevent this from occurring.

If people with HIV take HIV medicine as prescribed and keep an undetectable viral load(or stay virally suppressed),  they can live long, healthy lives. People who get and keep an undetectable viral load also have effectively no risk of transmitting HIV through sex.

More information: The risk of transmitting HIV to the baby can be 1% or less if the mother takes HIV medicine daily as prescribed throughout pregnancy, labor, and delivery, and her baby receives HIV medicine for 4-6 weeks after. Current recommendation in the United States is that mothers with HIV should not breastfeed their infants. Having an undetectable viral load also substantially reduces, but does not eliminate, the risk of transmitting HIV to an infant from breastfeeding.

More information:

We don’t know whether having an undetectable viral load prevents HIV transmission through sharing needles, syringes, or other injection equipment. It is reasonable to assume it reduces the risk by some amount, but we don’t know how much.

 

If you have HIV, getting in care and taking HIV medicine as prescribed will give you the greatest chance to get and keep an undetectable viral load, live a longer, healthier life, and protect your partners. You will have effectively no risk of transmitting HIV through sex as long as you keep an undetectable viral load. HIV treatment is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are.

If you’re HIV-negative and have a partner with HIV, encourage your partner to get in care or stay in care and always take HIV medicine as prescribed.

Even if the partner with HIV has an undetectable viral load, you or your sex partner(s) may want to use additional prevention options.  Using a  condom the right way every time you have sex  can protect you from other STDs.  Using condoms or having the HIV-negative partner take daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if the partner with HIV

  • Is unsure, for any reason, that they have an undetectable viral load
  • Has a higher viral load (200 copies/ml of blood or greater)
  • Has trouble taking HIV medicine regularly
  • Missed some doses since their last viral load test
  • Has stopped taking HIV medicine or may do so in the future

You and your partner(s) should learn about all the available prevention options and make the decisions that are right for both of you.

 

What is acute HIV infection? Acute Acute HIV infection is the earliest phase of HIV infection, occurring within 2 to 4 weeks after a person first gets HIV. It’s sometimes called acute HIV syndrome, acute retroviral syndrome, or primary HIV infection.

What we know about acute HIV Infection

Acute HIV infection is the phase of infection right after people are infected but before they develop antibodies to HIV. Some people with acute infection get flu-like symptoms, but not everyone with acute infection feels sick.

 

More Information Flu-like symptoms include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, or mouth ulcers. If you have these symptoms, that doesn’t mean you have HIV. But, if you have these symptoms after a potential exposure to HIV, see a health care provider and tell them about your risk. 

When people have acute infection, they’re much more likely to transmit HIV to others because the amount of virus in their blood is very high. This means that a person is much more likely to get HIV from someone who has acute infection than from someone who has been infected with HIV longer, even if the person who has been infected longer is not taking HIV medicine. The difference in transmission risk between a person with acute HIV and someone on treatment who has an undetectable viral load is even greater.

More Information For each sex act, the risk of getting HIV from someone not on treatment is about 7 times greater if they have acute HIV than the risk of getting HIV from someone who has asymptomatic HIV.

 

During acute infection, some tests may say you’re HIV-negative even though you really have the virus. That’s because some HIV tests work by looking for HIV antibodies. After a person gets HIV, their immune system starts making antibodies, but this takes some time. So there’s a window period during which a person has HIV, but an antibody test can’t show that yet. Two other kinds of tests—antigen/antibody tests or nucleic acid tests (NAT)—can find HIV in a person’s body sooner. They can be used to find out whether someone has acute infection.

If you feel like you have the flu and you had a possible HIV exposure in the past month, talk to your health care provider about what type of HIV test you should take and what its window period is. Some health care providers may not know about the NAT, but it can detect the virus earlier than any other test, about 10 to 33 days after infection.  You should avoid potentially exposing other people to HIV through sex and drug use until you get tested and know your results.  Using condoms the right way every time you have sex will reduce your HIV risk.

If you find out you have HIV, getting in care and taking HIV medicine as prescribed will give you the greatest chance to get and keep an undetectable viral load , live a longer, healthier life, and protect your partners. You will have effectively no risk of transmitting HIV through sex as long as you keep an undetectable viral load .

If you’re HIV-negative and have a partner with HIV, encourage your partner to get in care and take HIV medicine as prescribed.

Even if the partner with HIV has an undetectable viral load, you or your sex partner may want to use additional prevention options.  Using a condom the right way every time you have sex can protect you from other STDs.  Using condoms or having the HIV-negative partner take daily medicine to prevent HIV ( called pre-exposure prophylaxis or PrEP)can provide added peace of mind. Also consider using additional prevention methods if the partner with HIV

  • Is unsure, for any reason, that they have an undetectable viral load
  • Has a higher viral load (200 copies/ml of blood or greater)
  • Has trouble taking HIV medicine regularly
  • Missed some doses since their last viral load test
  • Has stopped taking HIV medicine or may do so in the future

You and your partner should learn about all the available prevention options and make the decisions that are right for both of you.

What are sexually transmitted diseases (or STDs)? Sexually transmitted diseases—often called STDs—spread from person to person through contact with genital fluid or through skin-to-skin contact. HIV is considered an STD if someone gets or transmits it through sex. Some of the most common STDs include gonorrhea, chlamydia, syphilis, trichomoniasis, human papillomavirus (HPV), genital herpes, and hepatitis.

Many people with an STD may not know they have one because they don’t have symptoms. Some common symptoms include

  • Discharge from the vagina, penis, or anus .
  • Pain or burning sensation when urinating or having a bowel movement.
  • Sores or ulcers on your penis, vagina, or anus.

The only way to know for sure if you have an STD is to get tested. There are vaccines to prevent some STDs like hepatitis A and B viruses and HPV. There are no vaccines to prevent HIV, gonorrhea, chlamydia, syphilis, genital herpes, and hepatitis C.

If you have another STD, you’re more likely to get or transmit HIV to others. 

Using condoms the right way every time you have sex can reduce your chances of getting or transmitting STDs that spread through genital fluids, such as gonorrhea, chlamydia, and HIV. But condoms are less effective at preventing STDs that spread through sores or cuts on the skin, like human papillomavirus or HPV, genital herpes, and syphilis.

What you can do: Sexually transmitted disease (STDs)

Finding out if you have an STD and getting treatment can lower your chances of getting or transmitting HIV and other STDs. If you’re sexually active, you and your partners should get tested for STDs (including HIV if you’re HIV-negative) regularly, even if you don’t have symptoms.

Always use a condom to protect yourself from STDs that can be transmitted through genital fluid. Here are some tips for learning to use a condom the right way.

If you’ve never had hepatitis A or B or HPV and haven’t been vaccinated, talk to your health care provider to see if vaccination is right for you. CDC recommends that everyone born from 1945 to 1965 get tested for hepatitis C at least once. Based on your age and other risk factors, your health care provider may recommend that you get tested for hepatitis C and can refer you for care if you learn that you have hepatitis C.

Visit CDC.gov or call 1-800-CDC-INFO (1-800-458-5231) to find places near you that offer confidential HIV testing and STD testing and treatment. Some sites may offer free tests.

What is sharing needles or works? Sharing needles, syringes, or other drug injection equipment (for example, cookers) means using a needle or syringe after someone else used it to inject drugs or medicine or for tattoos or piercings. It also means letting someone else use a needle or syringe you’ve already used.

What we know about sharing needlesThe risk for getting or transmitting HIV is very high if an HIV-negative person uses needles, syringes or  other drug  injection equipment (for example, cookers) after someone with HIV has used them.   This is because the needle, syringe or injection equipment may have blood in them, and blood can carry HIV. Likewise, you’re at risk for getting or transmitting hepatitis B and C if you share needles, syringes and other injection equipment because these infections are also transmitted through blood.

More Information

About 1 out of every 10 HIV diagnoses in the United States is attributed to injection drug use or male-to-male sexual contact and injection drug use (men who reported both risk factors).

More information

On average, an HIV-negative person has about 1 in 420 chance of getting HIV from a needlestick if the needle or syringe contains HIV-infected blood.

More information

There may be extremely tiny amounts of blood in syringes or other injection equipment that you may not be able to see, but could still carry HIV. Be aware that HIV can survive in a used syringe for up to 42 days depending on temperature and other factors.

More Information

Hepatitis B and C are viruses that infect the liver. Many people with hepatitis B or C don’t know they have it because they don’t feel sick. Even if you don’t feel sick, you can transmit the virus to others. The only way to know for sure if you have hepatitis B or C is to get tested. Your health care provider will recommend a hepatitis B or C test if you have risk factors for these infections, such as injection drug use. If you don’t have a health care provider, click here to find contact information for your local health department.

There are medicines to treat hepatitis B. If you’ve never had hepatitis B, there’s a vaccine to prevent it. There are medicines to treat hepatitis C, but they aren’t right for everyone. There’s no vaccine to prevent hepatitis C. Talk to your health care provider to learn more about hepatitis B and C.

If a person with HIV takes their HIV medicine as prescribed and gets and keeps an undetectable viral load , their chance of transmitting HIV through sharing needles, syringes, or other drug injection equipment is reduced.

 

People use needles, syringes and other injection equipment for many reasons—to inject drugs for medical purposes (like insulin to treat diabetes), get high, change their appearance, or for tattoos and piercings. No matter the reason, never share your needles, syringes or other injection equipment with anyone to lower your chances of getting or transmitting HIV and hepatitis B and C.

If you inject drugs to get high, therapy, medication-assisted treatment, and other methods are available to help you stop or cut down on your drug use.  Talk with a counselor, doctor, or other health care provider about substance use disorder treatment.

More Information  Some treatment programs provide medicines such as methadone or buprenorphine to people on an outpatient basis to help them quit using drugs like heroin, OxyContin, Opana, or Vicodin. 

To find a substance use disorder treatment center near you, check out the locator tools on SAMHSA.gov or HIV.gov. Through the HIV.gov locator, you can also find mental health service providers, HIV testing sites, housing assistance, family planning services, and health centers near you.

  • Use only your own new, sterile syringes and injection equipment each time you inject.
  • Use bleach to clean used needles, syringes, cookers and surfaces where drugs are prepared when you can’t get new ones. Bleaching a used syringe may reduce the risk of HIV and hepatitis C but doesn’t eliminate it. Here are instructions on using bleach to clean your syringes.
  • Use sterile water to fix drugs. You can buy sterile water from a store. If you can’t get sterile water, use water that has been boiled for 10 minutes or clean tap or bottled water.
  • If you inject around other people, be careful not to get someone else’s blood on your hands, needles, syringes, or other injection equipment.
  • Dispose of syringes and needles safely after one use.  You can use a sharps container or another container like an empty bleach or laundry detergent bottle. Make sure to keep used syringes away from other people. Some communities have drop boxes where you can dispose of your used syringes safely.

Learn about other things you can do to prevent getting or transmitting HIV. 

  • Get tested for HIV. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested more often. People with more than one sex partner, people with other sexually transmitted diseases (STDs), and people who inject drugs are likely to be at high risk for HIV and should get tested at least once a year.
  • If you have HIV, take HIV medicine, calledantiretroviral therapy (ART), and follow your health care provider’s advice. If you learn that you have HIV, the most important thing you can do is to take ART as prescribed. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. This is the most important thing you can do to protect your health.
  • If you have HIV, take HIV medicine to get and keep an undetectable viral load. HIV medicine, called antiretroviral therapy (ART), can reduce the amount of HIV (viral load) in your body. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and have effectively no risk of transmitting HIV through sex. Having an undetectable viral load also reduces your risk of transmitting HIV by sharing needles, syringes, or other injection equipment (for example, cookers).
  • If you’re HIV-negative, consider taking daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP ). If taken daily, PrEP is highly effective preventing HIV from injection drug use. PrEP is much less effective when it is not taken consistently. PrEP may be right for you if you inject drugs and have an injection partner with HIV, or have shared needles, syringes or other injection equipment. Talk to your health care provider about PrEP. If you don’t have a health care provider, click here to find contact information for your local health department.
  • Don’t have sex if you’re high. If you do have sex, taking medicines to prevent or treat HIV and using a condom the right way every time you have sex can reduce your risk of getting or transmitting HIV. Condoms and medicine to prevent or treat HIV are highly effective if they are used correctly. But the medicines are much less effective if you don’t take them consistently, and condoms can sometimes break or come off during sex. Using a water-based or silicone lubricant can help prevent condoms from breaking or slipping.

People who misuse alcohol or drugs may be at increased risk for getting or transmitting HIV. For example, when you’re drunk or high, you’re more likely to make decisions that put you at risk for HIV, such as having sex without using a condom or medicine to prevent or treat HIV.  Also, people who inject drugs are at risk for getting or transmitting HIV if they share needles, syringes or other injection equipment (for example, cooker).

What is alcohol misuse? There are different levels of alcohol use, from not drinking at all to serious drinking problems. 

More Information A standard drink is the amount of alcohol found in

  • 12 ounces of beer,
  • 8 ounces of malt liquor,
  • 5 ounces of wine, or
  • 1.5 ounces or a "shot" of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka or whiskey).

Drinking in moderation is defined as having up to one drink per day for women and up to two drinks per day for men. Drinking more than this amount can lead to getting drunk.

When people drink a lot of alcohol in a short period of time to get drunk, they’re said to be binge drinkers. People are considered binge drinkers if they have four (for women) or five (for men) or more drinks within 2 hours.

Chronic alcohol misuse can result in abuse or dependence. Alcohol abuse is a pattern of drinking that harms a person’s health, relationships with other people, or ability to work. Symptoms of alcohol abuse include the following:

  • Failing to fulfill major responsibilities at work, school, or home.
  • Drinking in dangerous situations, such as drinking while driving or operating machinery.
  • Having legal problems related to alcohol, such as being arrested for drinking and driving or for physically hurting someone while drunk.
  • Continuing to drink despite ongoing relationship problems that are caused or made worse by drinking.

Alcohol dependence, also known as alcohol addiction and alcoholism, is a chronic disease. People with alcohol dependence have a strong craving for alcohol; continue to drink despite repeated physical, psychological, or relationship problems; and can’t limit their drinking.

What we know about alcohol misuse

Drinking too much can increase a person’s risk of getting or transmitting HIV or other sexually transmitted diseases (STDs) by affecting the choices that person makes about sex. For example, someone who’s drunk might have more sex partners, sex with someone they don’t know, sex without using a condom, or medicine to prevent or treat HIV, or a harder time using a condom  the right way every time they have sex.

Drinking alcohol is dangerous for people with hepatitis B or C and other forms of liver disease because it makes them get sick faster and makes the side errects of treatment worse.

More Information Hepatitis B and C are viruses that infect the liver. Many people with hepatitis B or C don’t know they have it because they don’t feel sick. Even if you don’t feel sick, you can transmit the virus to others. The only way to know for sure if you have hepatitis B or C is to get tested. Your health care provider will recommend a hepatitis B or C test if you have risk factors for these infections, such as injection drug use. If you don’t have a health care provider, click here to find contact information for your local health department.

There are medicines to treat hepatitis B. If you’ve never had hepatitis B, there’s a vaccine to prevent it. There are medicines to treat hepatitis C, but they aren’t right for everyone. There’s no vaccine to prevent hepatitis C. Talk to your health care provider to learn more about hepatitis B and C. 

Drinking too much can lead to other health problems. Immediate health risks include injuries, violence, and alcohol poisoning. Over time, drinking too much can lead to chronic diseases and other serious problems including high blood pressure, heart disease, stroke, liver disease, digestive problems, and cancer of the breast, mouth, throat, esophagus, liver, and colon.

Therapy and other methods are available to help you stop or cut down on alcohol use if you have a problem. Talk with a counselor, doctor, or ot health care provider about substance abuse treatment options.

To help protect yourself from getting or transmitting HIV, don’t drink too much alcohol. When you drink too much, you are more likely to take sexual risks and increase your chance of getting or transmitting HIV or other STDs.

If you’re going to a party or know you’ll be drinking, you can bring a condom so that you can reduce your risk if you have vaginal or anal sex. You can also consider sexual activities that are lower risk for HIV.

 

What is drug use? People take drugs illegally to get high. Illegal drug use includes street drugs like heroin, cocaine, or methamphetamine. It also includes prescription drugs used without a prescription or just for the high they cause. This website describes the common and street names of many misuesed drugs, how they’re taken, and their potentially harmful health effects.

Using drugs can cause you to do things that increase your risk of getting or transmitting HIV. Drugs like methamphetamine, poppers, and ecstasy, for example, are linked to having more sex partners or sex without using a condom, both of which increase your chances of getting or transmitting HIV and other sexually transmitted diseases (STDs). And someone who injects drugs is at risk for getting or transmitting HIV and hepatitis B and C if they share needles, syringes or  other injection equipment (for example, cookers) used to prepare drugs, like cotton, cookers, and water, because they may contain blood that is infected with HIV.

More Information

About 1 out of every 10 HIV infections  in the United States is among people who inject drugs. This includes gay and bisexual men who inject drugs. On average, an HIV-negative person has about a 1 in 160 chance of getting HIV every time they share syringes or other injection equipment with someone who has HIV.

If the person with HIV is taking HIV medicine as prescribed and has an undetectable viral load, they have effectively no risk of transmitting HIV through sex. We don’t know whether taking HIV medicine as prescribed and keeping an undetectable viral load prevents HIV transmission through sharing needles, syringes or other injection equipment. It is reasonable to assume it provides some risk reduction, but we don’t know how much.

More Information Hepatitis C is a virus that infects the liver. Many people with hepatitis C don’t know they have it because they don’t feel sick. Even if you don’t feel sick, you can transmit the virus to others. The only way to know for sure if you have hepatitis C is to get tested. Your health care provider will recommend getting tested if you inject drugs or have other risk factors. If you don’t have a health care provider, click here to find contact information for your local health department.

There are medicines to treat hepatitis C, but they aren’t right for everyone. There’s no vaccine to prevent hepatitis C. Talk to your health care provider to learn more about hepatitis C.

Some people think that using prescription drugs to get high is safer and less addictive than street drugs, but that’s not true. Any form of illegal drug use can lead to abuse and dependence and cause serious and life-threatening side effects or even death.

Therapy, medication-assisted treatment, and other methods are available to help you stop or cut down on using drugs. Talk with a counselor, doctor, or other health care provider about options that might be right for you.

If you’re going to a party or another place where you know you’ll use drugs, you can bring a condom with you to reduce your risk if you have vaginal or anal sex.  Here are some tips on how to use a condom. Or you can consider having other types of sex that are lower risk for HIV such as oral sex

More Information Learn how to talk to your partner about using condoms. Here are some tips to help start the conversation.

If you inject drugs, talk to a health care provider to see if taking medicines daily to help prevent HIV  (pre-exposure prophylaxis or PrEP) is right for you.

There may be things about your sex partners that can put you at increased risk for getting or transmitting HIV. If you have sexual partners with a different HIV status than you, then every time you have anal or vaginal sex you could be at risk for getting or transmitting HIV. However, every exposure to HIV does not carry the same risk. Having a high viral load greatly increases the chance of transmitting HIV, and having another sexually transmitted disease (STD) can increase the chances of getting or transmitting HIV. Having more than one partner can increase the chance that you have sex with a partner who has a different HIV status than you. Power differences in relationships can also that make it harder to have safer sex.

What is having a different HIV status than your partner? This is when one partner is HIV-positive and the other partner is HIV-negative.

Knowing each other’s status is the first step toward preventing HIV transmission. It’s important to be open with your partner about your HIV status and ask them to tell you theirs. If you’re HIV-negative, having sex with a partner who had HIV increases your chances of getting HIV. Each time you have sex with this person, your risk of being exposed to HIV goes up unless they take HIV medicine (called antiretroviral therapy or ART) as prescribed and keep an undetectable viral load. If a person with HIV takes HIV medicine as prescribed and keeps an undetectable viral load, they have effectively no risk of transmitting HIV through sex.  If a person with HIV takes HIV medicine as prescribed and keeps an undetectable viral load, they have effectively no risk of transmitting HIV through sex.

More Information If you’re HIV-negative, keep in mind that your partners may not know or may be wrong about their status, and some may not tell you they have HIV even if they know they have it. If you have HIV, be aware that in some states, you can be charged with a crime if you don’t tell your partner your HIV status, even if your partner doesn’t get HIV. You can visit HIV.gov to learn about laws that might affect you.

There are also other things you can do to reduce your HIV risk, including using condoms  the right way every time you have sex,and taking daily medicine to prevent HIV.

There are many actions you can take to lower your risk of getting or transmitting HIV if your partner’s HIV status is different from yours. The more actions you take, the safer you can be.

• If you have HIV, take ART as prescribed. ART can reduce the amount of virus (viral load) in your body. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and have effectively no risk of transmitting HIV through sex.

Choose less risky sexual behaviors than anal or vaginal sex, such as oral sex.

• Use condoms the right way every time you have sex.

• If you’re HIV-negative, talk to your health care provider to see if taking daily medicine to prevent HIV (called pre-exposure prophylaxis, or PrEP) is right for you.

• If you’re HIV-negative and might have been exposed to HIV recently (within the last 3 days), talk to your health care provider right away about medicine to prevent getting HIV (called post-exposure prophylaxis, or PEP). For example, if the condom breaks during sex and you’re partner is not taking ART and doesn’t have an undetectable viral load, PEP might keep you from getting HIV. But it must be started within 72 hours of the exposure.

• Get tested for HIV and encourage your partner to do the same. 

More information: The only way to know for sure if you have HIV is to get tested. Before having sex for the first time, you and your partner may want to get tested for HIV and learn the results. Be aware that there’s a window period, which is the time between when a person gets HIV and when most HIV tests will show that a person has it. If you have sex before you learn your test results, using a condom the right way every time you have sex can lower your risk for getting or transmitting HIV.

• Get tested and treated for other STDs and encourage your partner to do the same.

More information: Having other STDs increases your risk for getting or transmitting HIV. If you are sexually active, get tested for STDs at least once a year.

Your health care provider may also suggest a herpes test.

Having Multiple Sexual Partners

What is having multiple sex partners? This can refer to situations where one or both partners have sex with other people, or when one person is not in a monogamous relationship and has more than one sex partner.

If you or your partner have sex partners who overlap in time, your risk for getting or transmitting HIV or other sexually transmitted diseases (STDs) increases. This is because the more sexual partners you have in your lifetime, the more likely you are to have a sex partner who has HIV and doesn't have an undetectable viral load or who has another sexually transmitted disease (STD). 

More Information STDs spread rapidly in populations where people have multiple partners who overlap in time. This happens because a person with a new infection can transmit an STD to more than one uninfected partner while the person with the new infection is most contagious.

Not having sex is a 100% effective way to prevent getting or transmitting HIV. If you are sexually active, you can choose to have fewer partners in the future. You can also  choose sexual activities that are lower risk for HIV than anal or vaginal sex.

A monogamous relationship, which means that both you and your partner are having sex only with each other, can also reduce your risk of infection.  You can do other things to reduce your HIV risk, including using a condom the right way every time you have sex and taking medicine to prevent or treat HIV

More Information Monogamy only reduces your risk of getting HIV if both partners are certain that they’re HIV-negative and stay monogamous. You may not always know if your partner is having sex with other or doing other things that increase the risk for getting HIV or other STDs. Having open and honest communication with your partner is important. Talk to your partner about your decision to be monogamous and what you would do if one of you had sex with another person.  Be sure you and your partner understand any agreements you have about sex and talk about  changes in your HIV status or sexual activity.

And, if you’re just beginning a monogamous relationship, it’s a good idea for both of you to  get tested for HIV before you have sex.

More Information Even though it may be difficult, you can learn how to talk with your partner about condoms and safer sex.

Talking openly and frequently with your partner about sex can help you make decisions that may decrease your risk of getting or transmitting HIV. Learn more about how to get the conversation started. 

More Information

  • When was the last time you had an HIV test and what was the result of that test?

The only way to know for sure if you have HIV is to get tested. Before having sex for the first time, you and your partner may want to get tested for HIV and learn the results. Be aware that there’s a window period, which is the time between when a person gets HIV and when most HIV tests will show that a person has it. If you have sex before you learn your test results, using a condom the right way every time you have sex can lower your risk for getting or transmitting HIV.

If you learn that you have HIV, the most important thing you can do is to take antiretroviral therapy (ART) as prescribed. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and have effectively no risk of transmitting HIV through sex.

  • Are you living with HIV and on treatment?

    If you have HIV, the most important thing you can do is being on treatment (ART). If you take ART as prescribed and keep an undetectable viral load, you can stay healthy and have effectively no risk of transmitting HIV through sex. If you’re taking ART, follow your health care provider’s advice. Visit your health care provider regularly and take your medicine as prescribed. This will give you the greatest chance of having an undetectable viral load.

    Even if you have undetectable viral load, you or your sex partner(s) may want to use additional prevention options.  Using a condom the right way every time you have sex  can protect you from other STDs.  Using condoms or having your partner take daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if you

    • Are unsure, for any reason, that you have an undetectable viral load
    • Have a higher viral load (200 copies/ml of blood or greater)
    • Have trouble taking HIV medicine regularly
    • Missed some doses since your last viral load test
    • Have stopped taking HIV medicine or may do so in the future

You and your partner(s) should learn about all the available prevention options and make the decisions that are right for both of you. 

  •  If your partner has HIV, encourage your partner to take ART too.

If you’re HIV-negative and have a partner with HIV who is taking ART as prescribed,  they have effectively no risk of transmitting HIV to you through sex as long as they keep an undetectable viral load. Even if your partner has an undetectable viral load, you or your sex partner may want to use additional prevention options.  Using a condom the right way every time you have sex  can protect you from other STDs.  Using condoms or taking daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP) can provide added peace of mind. Also consider using additional prevention methods if you are unsure, for any reason, that your partner has an undetectable viral load.

If you are HIV-negative and have a recent possible exposure to HIV and you’re not taking PrEP, you can take post-exposure prophylaxis (PEP). For PEP to work, you must start it as soon as possible, and always within 72 hours of a recent possible exposure.

  • How many other sex partners do you currently have?

Having multiple sex partners increases your risk for HIV.

  • Do you have any other STDs?

Having other STDs increases your risk for getting or transmitting HIV

Your health care provider may also suggest a herpes test.

  • Do you use syringes to inject drugs?

Sharing needles, syringes or other drug injecting equipment (includes cookers) increases your risk for HIV.

What are power differences in sexual relationships? In some relationships, one partner may have more power than the other and may use that power to control their partner. For example, one partner may make more money or be older than the other. Or one person may depend on the other person for their basic needs, such as housing, money, or food. Physical violence also may create or keep power differences in relationships.

What we know about power differences in relationships

Sometimes people do what their partners want because they are afraid of their partner’s reaction. For example, one partner may be afraid to ask the other to wear a condom during sex.  Not using a condom increases a person’s chances of getting or transmitting HIV. This is an example of how power differences can be harmful to the relationship and each partner.

Some relationships become abusive and violent because the power differences are so great. In these relationships, it might be even harder to ask a partner to use condoms or to have less risky types of sex. People in abusive relationships may have sex with others outside the relationship who feel safer or seem more caring or supportive.

Think about how power affects your relationship and the things you do for your sex partner. If you can, talk to your partner about your preferences before you have sex. Being able to talk openly is important for getting what you need in a relationship and staying healthy. However, if you feel threatened or have experienced violence in your relationship, it may not be helpful to talk with your partner without help from other people. A counselor can help you think of ways to talk to your partner and find other resources to get out of an abusive relationship.

If you are using power to control or otherwise abuse your partner, seek support from a counselor or find other resources to help you learn different ways of being in a relationship. Communicating with your partner, managing uncomfortable emotions like anger and jealousy, and treating others with respect are a few ways to keep relationships healthy and nonviolent.

If you need immediate help, contact the National Domestic Abuse Hotline at 1-800-799-SAFE. Hotline advocates are available for victims, abusive partners, and anyone calling on their behalf to provide crisis intervention, safety planning, information and referrals to agencies across the country.

Content last updated May 28, 2020

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