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Human immunodeficiency virus (HIV) is a sexually transmitted infection (STI) that affects your immune system by targeting a type of white blood cell called CD4 cells. These cells—which are also sometimes referred to as T-cells, T-lymphocytes, or helper cells—play a central role in immunity. The attack on these cells damages the immune system, which in turn increases the risk of serious infections (and even some types of cancer).
HIV also goes through three stages of infection: acute infection, chronic infection, and AIDS (HIV.org, n.d.).
There are ways you can reduce your chances of HIV transmission, but it’s important to note that an HIV-positive diagnosis is not a death sentence. Antiretroviral therapy (ART, previously known as HAART) has transformed what life with HIV looks like. The average life expectancy for a 20-year-old diagnosed with HIV in 1996 was just 39 years. By 2011, researchers found that it had jumped to almost 70 (Narrowing the Gap, n.d.). It continues to grow thanks to education and effective treatments. ART may also prevent HIV from ever becoming AIDS.
Who is at risk for HIV?
HIV can be transmitted through bodily fluids such as sperm, vaginal fluid, blood, and breast milk. That means people who need blood transfusions or those who share needles or have unprotected sex are at risk. HIV can also pass to children during pregnancy, birth, or through breast milk while breastfeeding, so children of mothers with HIV are also at risk. HIV cannot be passed through day-to-day contact such as hugging, shaking hands, or sharing food or drinks. In that way, it differs from some other STIs such as herpes simplex virus type 1 (oral herpes), which can be passed by sharing straws or silverware.
Everybody is at risk. However, HIV transmission is more common among certain groups—such as men who have sex with men (MSM), transgender women, and African Americans. “Increased HIV vulnerability is often associated with legal and social factors,” according to the World Health Organization (WHO), “which increases exposure to risk situations and creates barriers to accessing effective, quality and affordable HIV prevention, testing and treatment services” (WHO, n.d.).
8 ways to reduce your risk of HIV transmission
Below, you’ll find ways to reduce your HIV risk if you are HIV-negative.
1. Get tested for STIs regularly and treated, if needed
Having other sexually transmitted infections may up your odds of getting HIV. Having herpes simplex virus type 2 (HSV-2), for example, is associated with a higher risk of contracting HIV, a systematic review of studies found. It’s believed that herpes may increase your odds of HIV infection in two ways: first, by damaging epithelial tissue (the lining of your cavities and your organs) during outbreaks (i.e., you may have open sores that the virus could pass through), and second by bringing more CD4 T-cells into the genital area, which can then be targeted by HIV (Looker, 2017).
HIV testing: development, accuracy, and types of tests
2. Use clean needles and avoid sharing needles
HIV can be transmitted by sharing needles while using intravenous drugs and through accidental needlesticks in a medical setting. The Centers for Disease Control and Prevention (CDC) estimates that sharing needles results in the transmission of HIV 63 out of every 10,000 times. For accidental pricks, they estimate that 23 out of every 10,000 incidents result in transmission (CDC-b, 2019). There’s also a risk of transmission with tattoo needles if they’re not sterilized properly between customers.
3. Consider PrEP
People who engage in behaviors that have a high risk of HIV transmission should speak with their healthcare providers about lowering this risk by taking a medication that acts as pre-exposure prophylaxis (PrEP). This is available under brand names such as Truvada and Descovy. These types of medications are designed to help prevent the virus from taking hold and spreading in the body—and they have a good track record. When taken daily, PrEP has been shown to decrease the risk of infection through sex by up to 99% (Anderson, 2012). People who don’t know the HIV status of their partner(s), who use intravenous drugs, or who have a partner or partners with a known risk factor for HIV are good candidates for PrEP.
4. Consider PEP, if necessary
PrEP is taken before an encounter that’s considered high-risk for contracting HIV, but post-exposure prophylaxis (or PEP) is taken after. PEP requires someone to take antiretroviral therapy (ART) after potentially being exposed to HIV in order to prevent becoming infected. You may want to consider talking to your healthcare provider about taking PEP if you may have been exposed to HIV through sex (the condom broke), you were sexually assaulted, or you shared needles. Although PEP needs to be started within 72 hours to prevent infection, the sooner it’s started, the better. PEP can prevent HIV infection if taken correctly, but it’s not 100% effective (CDC-c, 2019).
5. Use condoms for oral, vaginal, and anal sex
Condom use is extremely effective at preventing HIV transmission, according to the CDC, as long as they’re used correctly and consistently. Since HIV is spread through bodily fluids, condoms can protect against transmission by preventing the exchange of body fluids (CDC, 2013). They should be used for oral, vaginal, and anal sex and are especially important for protecting the “recipient” from the virus as receptive vaginal sex and receptive anal sex both have a higher transmission rate than their penetrative equivalents. In fact, your risk is 13 times higher with receptive anal sex than it is with insertive anal intercourse (CDC-a, 2019). The CDC considers oral sex a low-risk behavior in terms of HIV transmission risk, but condoms are still important for preventing the spread of other diseases and should be used (CDC-b, 2019).
6. Be sure to communicate with partners about their HIV status
It’s simple: you can’t take proper precautions to protect yourself from HIV transmission if you don’t know that you need to. If you don’t know the HIV status of your partner(s) or have a partner with known risk factors for HIV, talking to your healthcare provider about PrEP may be a good option.
7. Limit sexual partners
This point is similar to the previous one. The more people with whom you have sexual activity without knowing their HIV status, the greater the risk may be exposing yourself to HIV. If limiting your sexual partners—or knowing their HIV status—doesn’t fit in your lifestyle, talk to your healthcare provider about whether taking PrEP is a good option for reducing your risk of HIV transmission.
PrEP’s role in reducing HIV transmission rates
8. Help make sure your HIV-positive partner is taking HIV medicine
If you are HIV negative and in a relationship with somebody who is HIV positive, one thing you can do is help make sure your partner is taking HIV medication. Known as ART, HIV treatment can lower the amounts of virus in the body when taken as prescribed. Eventually, the level of virus (known as the viral load) may become “undetectable,” meaning that it is too low for tests to detect it. Research shows that when somebody has an undetectable level of the virus, he or she has “effectively no risk” of transmitting HIV to their sexual partners (CDC, 2020). Antiretroviral therapy treatment, if taken daily throughout pregnancy, labor, and delivery, is also an extremely effective risk reduction for child transmission of the virus. The risk of passing HIV to your baby, if antiretroviral treatment is taken correctly, can 1% or less (CDC-d, 2019).
- Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., et al. (2012). Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men. Science Translational Medicine, 4(151). doi: 10.1126/scitranslmed.3004006. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22972843
- Centers for Disease Control and Prevention (CDC). (2013, March 5). Condom Fact Sheet for Public Health Personnel. Retrieved from https://www.cdc.gov/condomeffectiveness/latex.html
- Centers for Disease Control and Prevention (CDC-a). (2019, November 12). HIV and Gay and Bisexual Men. Retrieved Feb. 24, 2020 from https://www.cdc.gov/hiv/group/msm/index.html
- Centers for Disease Control and Prevention (CDC-b). (2019, November 13). HIV Risk Behaviors. Retrieved Feb. 24, 2020 from https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html
- Centers for Disease Control and Prevention (CDC). (2020, March 3). HIV Treatment as Prevention. Retrieved Feb. 24, 2020 from https://www.cdc.gov/hiv/risk/art/index.html
- Centers for Disease Control and Prevention (CDC-c). (2019, August 6). PEP. Retrieved Feb. 24, 2020 from https://www.cdc.gov/hiv/basics/pep.html
- Centers for Disease Control and Prevention (CDC-d). (2019, November 12). Pregnant Women, Infants, and Children. Retrieved Feb. 24, 2020 from https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
- HIV.gov. (n.d.). Clinical Guidelines. Retrieved from https://clinicalinfo.hiv.gov/en
- Looker, K. J., Elmes, J. A., Gottlieb, S. L., Schiffer, J. T., Vickerman, P., Turner, K. M., et al. (2017). P3.119 The effect of HSV-2 infection on subsequent hiv acquisition: an updated systematic review and meta-analysis. Epidemiology, Monitoring and Evaluation. doi: 10.1136/sextrans-2017-053264.354. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28843576
- Narrowing the gap in life expectancy for HIV compared with HIV- individuals…Life Expectancy Gap Between HIV and HIV- Narrows But Persists. (n.d.). Retrieved Feb. 24, 2020 from https://www.natap.org/2016/CROI/croi_25.htm
- World Health Organization (WHO). (n.d.). HIV/AIDS. Retrieved Mar. 5, 2020 from https://www.who.int/news-room/fact-sheets/detail/hiv-aids
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.