To reduce the risk of HIV transmission, all partners in mixed-status relationships need to take preventive measures.

Sexual relationships between people with different HIV statuses were once widely considered off-limits. Now, there are many resources available to people in mixed-status relationships.

Antiretroviral therapy, preexposure prophylaxis (PrEP), and condoms can help each partner manage and maintain their health. Expert consultation can also help you understand your options for having children.

HIV can’t be transmitted from one person to another through kissing or simple skin-to-skin contact, such as hugging or shaking hands.

Instead, the virus is transmitted through certain bodily fluids. These include blood, semen, and vaginal and rectal excretions — but not saliva.

According to the Centers for Disease Control and Prevention (CDC), having anal sex without a condom is more likely to result in a person contracting HIV than any other sexual behavior.

Although the risk is higher for the receptive partner, the penetrating partner is still at risk. It’s also possible to contract HIV during vaginal sex. The risk of transmission during oral sex is lower.

Antiretroviral medications can be used to stop HIV from replicating or making copies of itself in the blood. This can help an HIV-positive partner develop and maintain an undetectable viral load.

People with an undetectable viral load have effectively no risk of transmitting HIV to their sexual partners, according to the CDC. Using condoms can also decrease the risk of transmission.

HIV-negative partners can take preventive medications to help decrease the risk of infection.

TasP is a term that describes the use of antiretroviral therapy to prevent transmission of HIV.

AIDSinfo, a service of the U.S. Department of Health and Human Services, recommends that all people with HIV receive antiretroviral therapy.

It’s important to begin antiretroviral therapy as soon as possible after a diagnosis.

Early treatment can decrease your risk of transmitting HIV as well as reduce your chances of developing stage 3 HIV, commonly known as AIDS.

HPTN 052 study

In 2011, the New England Journal of Medicine published an international study called HPTN 052. It found that antiretroviral therapy does more than stop the replication of the virus in people living with HIV. It also lowers their risk of transmitting the virus to others.

The study looked at more than 1,700 mixed-status couples, mostly heterosexual. Almost all study participants reported using condoms during sex, and all received counseling.

Some of the HIV-positive participants began antiretroviral therapy early when they had comparatively high counts of CD4 cells. Other participants had their treatment delayed until their CD4 counts fell to lower levels.

In couples where the HIV-positive partner received early therapy, the risk of HIV transmission was reduced by 96%.

Undetectable = untransmittable

Other research has confirmed that maintaining an undetectable viral load is key to preventing transmission.

In 2017, the CDC reported that there is “effectively no risk” of transmission when antiretroviral therapy suppresses HIV levels to undetectable levels. Undetectable levels were defined as less than 200 copies per milliliter (copies/mL) of blood.

These findings are the foundation for the Prevention Access Campaign’s Undetectable = Untransmittable programs. This campaign is also known as U = U.

If you’re HIV-negative, you can use a medication known as preexposure prophylaxis (PrEP) to reduce the risk of HIV infection.

PrEP is currently available in pill form under the brand names Truvada and Descovy. It’s also available as a bimonthly injection branded as Apretude.

Truvada contains two antiretroviral drugs: tenofovir disoproxil fumarate and emtricitabine. Descovy contains tenofovir alafenamide and emtricitabine. Apretude contains cabotegravir.


PrEP is most effective when taken consistently.

According to the CDC, studies have found that PrEP can decrease your risk of contracting HIV during sex by about 99%. PrEP reduces transmission risk by more than 74% for people who use injected drugs.

If PrEP isn’t taken consistently, it’s much less effective. Recent research, such as the 2016PROUD study, has reinforced the connection between adherence to PrEP and its effectiveness.

Best candidates for PrEP

Anyone who thinks they could benefit from using PrEP should consider making an appointment with a healthcare professional to learn more.

Although PrEP has historically been studied in people with male anatomy, generic or brand-name Truvada pills and Apretude shots have been approved for use in people with female anatomy, too.

PrEP may be especially useful for people who:

  • have a sexual partner who’s at risk for HIV or is HIV-positive
  • do not know a partner’s HIV status
  • have multiple sexual partners
  • have sex without condoms or other barrier methods
  • use intravenous drugs

Obtaining PrEP

Many health insurance plans cover PrEP now, and even more will after the US Preventive Services Task Force (USPSTF) recommended PrEP for all individuals with known risk factors for HIV.

So, if you have health insurance, contact your health insurance provider for more information.

Some people might also be eligible for a medication assistance program run by Gilead, the manufacturer of Truvada and Descovy. The Apretude Savings Program may help you save on the cost of Apretude.

Before having sex without condoms, it’s best to get tested for HIV and other STIs. Sharing your status with your partners and asking about their status is also important.

If you or a partner has tested positive for HIV or another STI, getting treatment will help prevent transmission.


Condoms can help stop the transmission of HIV and many other STIs. They’re most effective when used every time you have sex.

It’s also important to use them according to the package directions and discard expired, used, or torn condoms.

Antiretroviral therapy combined with PrEP

If you’re in a mixed-status relationship, a healthcare professional will likely encourage you and your partners to combine PrEP with antiretroviral therapy.

Options are available if you or a partner are HIV-positive and wish to become pregnant or have biological children.

Taking HIV medication as prescribed is the best way to reduce the risk of transmission during conception, pregnancy, childbirth, and nursing.

Maintaining an undetectable viral load is essential for all HIV-positive partners involved, regardless of gender, sexuality, or anatomy.

HIV-negative partners should also begin or continue to take PrEP to reduce the risk of transmission during condomless sex (limited to periods of peak fertility) or artificial insemination.

It’s also important to remember that there are also other ways to grow your family, including surrogacy and adoption.

If you haven’t already, consider making an appointment with a healthcare professional to discuss your options for pregnancy and parenting.

Treatment options have made it possible for many to live long and healthy lives with HIV. Important medical advances have also been made in the field of HIV prevention, increasing and improving the possibilities for mixed-status partners.

Many mixed-status partners have satisfying sexual relationships and even conceive children. If you or a partner have questions or concerns about HIV transmission, make an appointment with a healthcare professional to discuss your options for risk reduction.