Relationships & sex
Living with HIV doesn't mean giving up sex – quite the opposite. Here is information to help yourself and your sexual partners have fun and keep safe.
Research has shown that using condoms during sex is one of the most effective ways of preventing the transmission of HIV and many other STIs.
We now know that, for people living with HIV who reach an undetectable viral load (UVL) and maintain it for more than six month by adhering to their medication, HIV is not transmitted through sex. You may have heard the term Undetectable = Untransmittable (U=U) being used, which is one of the ways this important message is being spread.
PrEP (Pre-Exposure Prophylaxis) is another option for preventing HIV for those who struggle with condom use with casual partners. PrEP is medication that is taken by HIV negative people to prevent HIV. When taken as prescribed, PrEP builds up in a person’s system and significantly reduces their chances of HIV infection.
It is important to remember that neither PrEP nor UVL prevent the transmission of other STIs. So, consider keeping condoms in the mix with casual partners.
If you’re not ready to have intercourse, there are many other intimate sexual activities that you can enjoy that involve little or no risk, such as kissing, massaging, mutual masturbation and oral sex.
Frequently asked questions
What does ‘safer sex’ mean?
Safer sex means using condoms every time you have vaginal or anal penetrative sex.
When do I have to disclose to sexual partners?
In New Zealand, as long as you’re practicing safe sex (using condoms every time you have vaginal or anal penetrative sex), you are not legally obligated to disclose your HIV status.
If I’m not having penetrative sex do I need to worry?
HIV is not transmitted through kissing, touching, rubbing, massaging or using fingers to penetrate the anus or vagina. However, if your hand or your partner’s hands have cuts, sores or scratches, it is advisable to use latex gloves and water-based lubes. Menstrual blood contains HIV and you can use dams during oral sex to minimise the risk of transmission.
Do my partner or I have to wear a condom during oral sex?
Giving or getting a blowjob has a very low risk of transmitting HIV. Some things you could do to further minimise the risk are to avoid brushing your teeth for at least one hour before oral sex, visit a dentist at least once a year to make sure your gums and teeth are healthy, check your mouth for ulcers, cuts or bleeding sores and avoid ejaculation into the mouth.
If both my partner and I are HIV positive, can we have sex without condoms?
There is a small chance that if you’re already living with HIV and are exposed to HIV repeatedly, it can lead to exposure to a different strain of the virus (not if you both have UVL). This may result in resistances to the treatment you are on. Although, there is no risk if both partners have undetectable viral loads. You can read more about this in the super/co- infection section below.
Can I still pass on HIV through sex if I have an undetectable viral load?
No! If you have an undetectable viral load, then HIV cannot be transmitted sexually. See below for more information.
Undetectable viral load and HIV transmission
If you are living with HIV and are taking your medication as prescribed, you may achieve an undetectable viral load. Which, evidence shows, if maintained for more than six months, means there is no risk of HIV transmission through sex. HIV treatments are very effective at suppressing the HIV virus when taken daily as prescribed, although it is important not to assume that you are undetectable just because you’re on treatment. Getting a regular viral load test is important for your own health and that of your sexual partners.
When considering the role of undetectable viral load in preventing HIV it is important to remain consistent in taking medications and continue to keep your specialist appointments. This ensures you are equipped with the knowledge and confidence to make these decisions.
More information here.
When a person living with HIV is infected again through exposure to a different strain, it is known as super-infection. This may sometimes lead to the person becoming resistant, or not responding, to the combination
of anti-HIV drugs they’re on. This reduces their options for treatment. Risk factors for super-infection are a detectable viral load, having a concurrent sexually transmitted infection and, most of all, unprotected sex. There is no risk if both partners have undetectable viral loads.
Sexually transmitted infections (STIs)
STIs are bacterial or viral infections that are transmitted from person to person during unprotected anal, vaginal and oral sex. Research has shown that infection with an STI may also increase the likelihood of HIV being acquired or transmitted.
Your nearest NZAF centre provides STI tests for HIV and syphilis. There are STIs that are preventable by vaccines – hepatitis A, hepatitis B and human papillomavirus (HPV) – although, the vaccines may not be funded. It is best to discuss this with your doctor.
Condoms and lube
Condoms and lube are an effective way to protect you and your partner from contracting HIV or STIs during sex. When condoms are used consistently and correctly, the latex acts as a barrier that HIV can’t pass through.
Using lube will help stop the condom from ripping or coming off. It’s important to use water-based lube, as oil-based lubricants may damage the condom.
Condoms can be obtained free via the Ending HIV website.
Pre-exposure prophylaxis (PrEP)
Pre-exposure prophylaxis or PrEP refers to the using of certain HIV medications as an HIV negative person in the prevention of contracting HIV. When taken on a daily basis, taking PrEP ensures there is enough of the medication in the system to significantly reduce the risk of contracting (up to more than 99%) if exposed to HIV during unprotected sex. Also, PrEP is now funded here in NZ, head to the link at the end of this section for more information about PrEP and whether you meet the funding criteria.
There are a few key things to be aware of when it comes to PrEP:
- PrEP works by maintaining a certain level of drug in the body that can prevent HIV establishing an infection. This means that people must take the pill every day to maintain this level of drug. Studies have shown that if it is taken every day as prescribed it reduces the risk of getting HIV by at least 92% and up to more than 99%.
- PrEP does not provide protection from any other STIs like syphilis or gonorrhoea which can increase the possibility of HIV infection. So, it’s important to keep condoms in the mix and test at least every three months for these other STIs.
- It’s important to test for HIV before starting PrEP and every three
- months while a person is on it – if someone uses PrEP when they already have HIV it can cause the virus to develop resistance and reduce their options for HIV treatment.
- PrEP can affect kidney function, and has other potential side effects. People on PrEP need to have their kidneys checked before they go on PrEP and regularly once they start the medication.
More about PEP here.
Post-exposure prophylaxis (PEP)
PEP is a short course of anti-HIV medication that may be able to prevent infection of someone who has recently been exposed to HIV. If your partner is HIV negative and is exposed to HIV during sex, they should visit the emergency department of their local hospital as soon as possible.
PEP needs to be taken within 72 hours of exposure to be effective and the sooner you start it, the more effective it is. Evidence shows that while PEP can reduce the chance of contracting HIV, it is not as effective as using condoms and lube for sex.