When it comes to sex and the risk of HIV and other sexually transmitted infections (STIs), it’s important to note that the risk level can vary depending on several factors, including the type of sexual activity, the presence of protective measures, and the HIV/other STI status of the individuals involved.
HIV transmission is only possible if the person ejaculating has a detectable “viral load,” which refers to the amount of HIV present in the blood. Antiretroviral medications reduce the number of viral cells in the body, which can eventually result in an undetectable viral load. For someone with an undetectable viral load, the chances of transmitting HIV through any sexual activity are effectively zero. (See U=U)
Many people don’t know that HIV is also an STI. It’s important to know that HIV and other STIs can infect different parts of the body. By understanding this it makes it a lot easier to understand potential risk of HIV and other STIs.
When is the risk of HIV higher?
HIV is more likely to pass to others during the early stages of the infection. Some factors that increase the risk of transmission include:
- sores or cuts in the mouth
- sores in or around the vagina or penis
- bleeding gums or gum disease
- contact with menstrual blood
- the presence of any other sexually transmitted infection
- the presence of a throat infection
- damage to the lining of the throat or mouth
Here’s a general overview of some common sexual practices and their associated risk levels, along with suggestions for minimizing the risk:
- Mutual Masturbation (non-penetrative sexual activity involving self-stimulation or stimulation of a partner’s genitals)
- HIV: No risk, as long as there is no exchange of bodily fluids.
- STIs: Low risk
STI transmission is unlikely to occur during mutual masturbation but there is a low risk if you come in direct contact with any types of lesions, growths, or discharges from your partner. STIs that can be transmitted by skin-to-skin contact include herpes, HPV (warts), crabs and syphilis.
Risk Minimisation: Avoid contact with semen, vaginal fluids, or blood. Hand hygiene before and after the activity is recommended.
2. Oral Sex
Fellatio or ‘blowjob’ (oral stimulation of the penis):
- HIV: Low risk. However, it could happen if someone with HIV ejaculates semen into the mouth of a sexual partner, especially if they have any sores or cuts in their mouth. This transmission is only possible if the person ejaculating has a detectable “viral load,” which refers to the amount of HIV present in the blood.
- STIs: High risk for herpes, syphilis, gonorrhoea, and chlamydia. All these STIs spread through contact with the vagina, penis, anus, or mouth of a person with any of these STIs.
Cunnilingus (oral stimulation of the vulva):
- HIV: The risk of HIV transmission from cunnilingus is extremely low.
- STIs: High risk for certain STIs like herpes, syphilis, gonorrhoea, and chlamydia. All these STIs spread through contact with the vagina, penis, anus, or mouth of a person with any of these STIs.
Anilingus or ‘rimming’ (oral-anal contact):
- HIV: Low risk
- STIs: Anilingus can transmit hepatitis A and B, intestinal parasites like Giardia, and bacteria like E. coli. Other STDs such as syphilis, herpes, gonorrhoea and chlamydia can also be transmitted during oral sex.
Risk Minimisation: Using barriers such as condoms or dental dams can further reduce risk. Regular HIV and STI testing and open communication with partners are also essential.
3. Vaginal Intercourse (penis-vagina penetration)
- HIV: High risk
- STIs: High risk for various STIs, including gonorrhoea, chlamydia, syphilis, herpes, and HPV.
Risk Minimisation: Consistent and correct use of condoms, along with regular STI testing and open communication with partners, can significantly reduce the risk. Consider discussing HIV/STI status with partners and practicing monogamy or mutual testing before engaging in sexual activity. Consider effective HIV prevention strategies like PrEP (pre-exposure prophylaxis).
4. Anal Intercourse (penis-anus penetration)
- HIV: High risk
- STIs: High risk including gonorrhoea, chlamydia, syphilis, herpes, and HPV. Increased risk of HIV transmission compared to vaginal intercourse.
Risk Minimisation: Consistent and correct use of condoms, along with water- or silicone-based lubricants, and/or PrEP (specifically for HIV), can help reduce the risk. Regular STI testing and open communication with partners. Consider effective HIV prevention strategies like PrEP (pre-exposure prophylaxis).
Condoms remain your best defence against HIV and most STIs. People should use a new condom whenever they start a different sexual activity. For example, a person should change their condom if they go from oral sex to anal sex. Don’t reuse a condom again.
PrEP (pre-exposure prophylaxis)
PrEP, which usually takes the form of a daily pill, helps reduce a person’s risk of contracting HIV. In fact, if a person takes PrEP every day, it is 99,9% effective at preventing HIV. It’s important to note that PrEP does not protect against other STIs. A person may be suitable for PrEP if they:
- do not regularly use condoms
- have a sexual partner who has HIV (and is not on ARVs with an undetectable viral load)
- have a sexual partner who is at high risk of having HIV
- have anal or vaginal sex with many partners, especially without the use of condoms
- have recently had another STIs, such as chlamydia or gonorrhoea
- do sex work that includes vaginal or anal sex
- have used injected drugs, shared needles, or had treatment for drug use within the past 6 months
It’s important to consult healthcare professionals, access accurate information, and prioritise open communication and consent with sexual partners. Regular testing for HIV and other STIs, as well as practicing safer sex, can significantly reduce the risk of transmission.
Article courtesy of Engage Men’s Health, which offers free PrEP, ARVs, and other friendly and confidential sexual health services in Joburg, NMB, and Buffalo City for gay, bi, and MSM. For more info or to make an appointment, call/WhatsApp 082 607 1686.