Overview

Just because someone is living with HIV doesn’t mean they expect their partner to be an expert on it. But understanding HIV and how to prevent exposure is critical to maintaining a safe and healthy relationship.

Ask them questions and get educated on what living with the condition means. Maintain open communication and discuss the desire to be involved in the management of their HIV.

Emotional support may also help a person living with HIV manage their healthcare better. This can improve their overall health.

A healthy relationship can include:

  • helping a partner adhere to their treatment, if needed
  • talking to a healthcare provider about preexposure prophylaxis (PrEP) or postexposure prophylaxis (PEP), two types of medication
  • discussing and choosing the best prevention options available for both people in the relationship

Following each of these suggestions can decrease the chances of HIV transmission, ease unfounded fears with the help of education, and potentially improve the health of both people in the relationship.

Ensure a partner is managing their HIV

HIV is a chronic condition treated with antiretroviral therapy. Antiretroviral medications control the virus by lowering the amount of HIV found in the blood, which is also known as the viral load. These medications also lower the amount of the virus in other bodily fluids such as semen, anal or rectal secretions, and vaginal fluids.

Managing HIV requires close attention. Medications must be taken as directed by a healthcare provider. Additionally, managing HIV means going to a healthcare provider as often as recommended.

By treating their HIV with antiretroviral therapy, people living with the condition can manage their health and prevent the risk of transmission. The goal of HIV treatment is to lower the amount of HIV in the body to the point of achieving an undetectable viral load.

According to the Centers for Disease Control and Prevention (CDC), someone living with HIV with an undetectable viral load won’t transmit HIV to others. They define an undetectable viral load as fewer than 200 copies per milliliter (mL) of blood.

The support that someone without HIV can offer a partner living with HIV can positively affect how the HIV-positive partner manages their health. A study in the Journal of Acquired Immune Deficiency Syndromes showed that if same-sex couples were “working together to reach a goal,” the person living with HIV was more likely to stay on track with HIV care in all aspects.

This support can also strengthen other relationship dynamics. Another study in the same journal found that a medical routine that includes both people may encourage the partner living without HIV to be more supportive.

Take HIV medications to prevent HIV

People living without HIV may want to consider preventive HIV medications to avoid the risk of acquiring HIV. Currently, there are two strategies for preventing HIV with antiretroviral therapy. One of the medications is taken daily, as a preventive measure. The other is taken after potential exposure to HIV.

PrEP

PrEP is preventive medication for people who don’t have HIV but are at risk of acquiring it. It’s a once-daily oral medication that stops HIV from infecting cells in the immune system.

If a person without HIV has sex with a person living with HIV who has a detectable viral load, taking PrEP can decrease their risk of acquiring HIV. PrEP is also an option if engaging in sex with a partner whose status is unknown.

The CDC states PrEP will reduce the risk of contracting HIV from sex by more than 90 percent.

A PrEP regimen involves:

  • Regular medical appointments. This includes getting screened for sexually transmitted infections (STIs) and having kidney function intermittently monitored.
  • Being screened for HIV. Screening takes place before getting a prescription and every three months after.
  • Taking a pill each day.

PrEP may be covered by insurance. Some people might be able to find a program that subsidizes the medication. The website Please PrEP Me provides links to clinics and providers that prescribe PrEP, as well as information on insurance coverage and free or low-cost payment options.

Besides taking PrEP, also consider other options, such as using condoms. PrEP takes one to three weeks to offer protection, depending on the sexual activity. For instance, it takes longer for the medication to be effective at protecting the vagina against HIV transmission than it does the anus. Also, PrEP doesn’t protect against other STIs.

PEP

PEP is an oral medication taken after sex if there’s been a risk of exposure to HIV. This can include instances when:

  • a condom breaks
  • a condom wasn’t used
  • someone without HIV comes in contact with blood or bodily fluids from someone with HIV and a detectable viral load
  • someone without HIV comes in contact with blood or bodily fluids from someone whose HIV status is unknown to them

PEP is only effective if taken within 72 hours after exposure to HIV. It must be taken daily, or as otherwise prescribed, for 28 days.

Know the risk level of different types of sex

Anal sex increases the chances of HIV more than any other type of sex. There are two types of anal intercourse. Receptive anal sex, or being on bottom, is when a partner’s penis penetrates the anus. Receptive anal sex without a condom is considered the highest risk sexual activity for acquiring HIV.

Being on top during sex is known as insertive anal sex. Insertive anal sex without a condom is another way of contracting HIV. However, the risk of acquiring HIV this way is lower compared to receptive anal sex.

Engaging in vaginal sex has a lower risk of HIV transmission than anal sex, but it’s still important to protect oneself through methods such as correct condom usage.

Although extremely rare, it’s possible to contract HIV through performing oral sex. Using a condom or latex barrier during oral sex may also reduce the risk of contracting other STIs. Another option is to avoid oral sex in the presence of genital or oral ulcers.

Use protection

Using a condom during sex decreases the risk of HIV transmission. Condoms can also protect against other STIs.

Learn how to use a condom correctly to reduce the chance it breaks or malfunctions during sex. Use a condom made of durable materials such as latex. Avoid ones made from natural materials. Research shows they don’t prevent HIV transmission.

Lubricants may also lessen the risk of exposure. This is because they prevent condoms from failing. They may reduce friction and lessen the chance of microscopic tears in the anal canal or vagina.

When choosing a lubricant:

  • Opt for a lubricant that’s water- or silicone-based.
  • Avoid using oil-based lubricants with latex condoms since they degrade the latex. Oil-based lubricants include Vaseline and hand lotion.
  • Don’t use lubricants with nonoxynol-9. It can be irritating and may increase the chance of HIV transmission.

Don’t share intravenous needles

If using needles for injecting drugs, it’s crucial not to share intravenous needles or syringes with anyone. Sharing needles increases the risk of HIV.

The takeaway

By practicing sex with condoms, it’s possible to have a healthy and complete romantic relationship with someone living with HIV. Taking a preventive medication such as PrEP or PEP can reduce the chances of exposure to HIV.

If someone with HIV has an undetectable viral load, they can’t transmit HIV to others. This is another important way the partner without HIV is protected against the virus.