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Reducing the Risk of HIV Transmission

If you think you are at risk for getting HIV, have recently been exposed to the virus, are pregnant and have HIV, or are HIV-positive with an HIV-negative partner, there are methods available for reducing the risk of HIV transmission.

Effective antiviral treatment

The current standard of care for HIV in the United States is treatment with antiretroviral therapy (ART). ART involves using different medications that can prevent the multiplication of HIV within the body. These medications are intended to be used daily and, if used as directed, can help reduce an individual’s viral load. A viral load is a measure of how much HIV is in the body. It’s important to note that ART is not a cure for HIV. Even those who take their medications exactly as instructed will still have HIV; however, the level of the virus in the blood can be incredibly low. Eventually, a person’s viral load can become “undetectable”, meaning that the amount of HIV in the blood is so low, that the virus is not detected when tested. Controlling viral load is essential for those with HIV to lead a longer life with fewer HIV-related complications.1

Recent research has suggested that those who achieve and maintain an undetectable viral load have virtually no risk of transmitting the virus to an HIV-negative partner. This idea has been referred to as “undetectable = untransmittable” or “U=U”. Therefore, the risk of HIV transmission to an HIV-negative partner can be reduced when an HIV-positive partner is on ART and taking their medications as prescribed.1-3

ART and mother-to-child transmission

Effective ART can also play a role in reducing the risk of mother-to-child transmission. Without ART, the risk of a mother transmitting HIV to her baby is anywhere from 15-45 percent. This risk may become as low as 5 percent or less when the HIV-positive mother is taking ART (and less than 1 percent in the United States). Many pregnant women will be tested for HIV and, if positive, will start ART as soon as possible to reduce the risk of transmission. The sooner treatment is started, the lower the risk.4-7

Condoms and lubrication

Using condoms during sex can help reduce the risk of HIV transmission by preventing HIV-containing fluids from passing through them. Condoms also reduce the risk of transmission of other sexually transmitted infections (STIs), which can further impact HIV risk. HIV is more likely to be transmitted when another STI is present in one or both partners, so using condoms to directly prevent the transmission of HIV and to stop the transmission of other STI’s may decrease overall risk. Latex or polyurethane condoms are the most effective at preventing the transmission of HIV. Condoms made out of other materials may not be as protective.8-11

Some estimates have suggested that always using condoms when having sex with an HIV-positive partner can reduce the risk of transmission by 63 percent and 72 percent for men who have insertive anal sex with other men and men who have receptive anal sex with other men, respectively. Further, always using a condom has been thought to reduce the risk of transmission by 80 percent in heterosexual couples. The risk of transmission can be reduced even more when condom use is accompanied by effective ART and/or daily pre-exposure prophylaxis (PrEP).8,9

The use of water-based or silicon-based lubricants during sex may also help reduce HIV transmission. Lubrication can help prevent tears or other abrasions during sex that may lead to the transmission of HIV. Additionally, lubrication may help prevent condoms from breaking during sex. Other homemade forms of lubrication like olive oil, baby oil, Crisco, or other oil-based products are not as effective in reducing friction, keeping condoms intact, and reducing the transmission of the virus.8-11

PrEP

Pre-exposure prophylaxis (PrEP) involves taking a daily pill to prevent the transmission of HIV. PrEP is intended to be used by individuals who may be at an increased risk of getting HIV, including those who have a sexual partner with HIV or injection drug users. PrEP contains the medications tenofovir and emtricitabine, and must be taken consistently each day to maintain its effectiveness. The current brand name for PrEP is Truvada. When taken as directed, PrEP may decrease the risk of HIV transmission by 92 percent in men who have sex with men, and 90 percent in heterosexual couples. PrEP may reduce the risk of HIV transmission in individuals who inject drugs by 70 percent and, in all situations, these numbers may increase or decrease based on how effectively and consistently PrEP is taken. When an individual is taking PrEP, they must follow-up with a healthcare provider every few months.8,11,12

PEP

Unlike PrEP, PEP (post-exposure prophylaxis) is a treatment option given after potential exposure to HIV has occurred. Situations in which PEP may be beneficial include a condom breaking during sex with an HIV-positive individual, instances of sexual assault, accidental needle stick, or potential exposure in the workplace for healthcare professionals. PEP is designed to be used in emergency situations only. PEP involves more medications at higher doses than PrEP and cannot be used on a regular basis. If you consistently have a higher risk of getting HIV, PrEP is a more beneficial, long-term option.8,11,13,14

Contact a healthcare provider as soon as you think you may have been exposed to HIV. PEP needs to be started within three days (72 hours) of the exposure, and the sooner the medication is started, the better it is at protecting you. PEP is taken one to two times a day for 28 days. It is important to take PEP exactly as prescribed by your doctor.14

Safer drug injection

Of course, the most effective way to reduce your risk of getting HIV from injection drug use is to reduce these behaviors as much as possible, if not completely. However, for many, this is not an easy task. For those who are using injection drugs, and are at a higher risk of HIV transmission, there are several steps that can be taken to help reduce the chances of getting the virus. Several of these include:

  • Utilizing a syringe services program (SSP) in your area, if available (programs that supply sterile syringes and needles, as well as places to dispose of used equipment safely)
  • Fixing drugs in sterile water
  • Cleaning skin with an alcohol swab before injection
  • Using bleach to clean used needles
  • Safely disposing needles and other supplies after each use
  • Consulting a healthcare provider regularly for HIV testing (at least once a year) and to see if you are a candidate for PrEP
  • Avoiding direct contact with the blood or other potentially HIV-containing bodily fluids of others around you 15,16

While none of these methods will completely eliminate the risk of getting HIV, they will help significantly reduce it. If you or a loved one is struggling with injection drug use and needs assistance, the Substance Abuse and Mental Health Services Administration (SAMHSA) may be able to help. They also have a 24/7 helpline that can be reached at 1-800-662-HELP (1-800-662-4357).

Written by: Casey Hribar | Last reviewed: September 2019
  1. HIV Treatment: The Basics. United States Department of Health and Human Services: AIDSinfo. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/51/hiv-treatment--the-basics. Published January 15, 2019. Accessed June 15, 2019.
  2. Eisinger RW, Dieffenbach CW, Fauci AS. HIV viral load and transmissibility of HIV infection: Undetectable equals untransmittable. JAMA. 5 Feb 2019; 321(5), 451-452.
  3. The Science is Clear: With HIV, Undetectable Equals Untransmittable. National Institutes of Health: National Institute of Allergy and Infectious Diseases (NIAID). https://www.nih.gov/news-events/news-releases/science-clear-hiv-undetectable-equals-untransmittable. Published January 10, 2019. Accessed June 15, 2019.
  4. Mother-To-Child Transmission of HIV. World Health Organization. https://www.who.int/hiv/topics/mtct/about/en/. Accessed June 15, 2019.
  5. Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Avert: Global Information and Education on HIV and AIDS. https://www.avert.org/professionals/hiv-programming/prevention/prevention-mother-child. Published March 9, 2019. Accessed June 15, 2019.
  6. Fowler MG, Qin M, Fiscus SA, et al. Benefits and risks of antiretroviral therapy for perinatal HIV prevention. N Engl J Med. 3 Nov 2016; 375(18), 1726-1737. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214343/. Accessed June 15, 2019.
  7. Bailey H, Zash R, Rasi V, Thorne C. HIV treatment in pregnancy. The Lancet HIV. 1 Aug 2018; 5(8), PE457-E467. Available from: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30059-6/fulltext. Accessed June 15, 2019.
  8. Effectiveness of Prevention Strategies to Reduce the Risk of Acquiring or Transmitting HIV. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/risk/estimates/preventionstrategies.html. Published March 7, 2017. Accessed June 15, 2019.
  9. Smith DK, Herbst JH, Zhang X, Rose CE. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 1 Mar 2015; 68(3), 337-44.
  10. Condoms for the Prevention of HIV Transmission. Public Health Agency of Canada: CATIE. https://www.catie.ca/en/fact-sheets/prevention/condoms. Published 2018. Accessed June 15, 2019.
  11. HIV/AIDS Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/prevention.html. Published January 16, 2019. Accessed June 15, 2019.
  12. Pre-Exposure Prophylaxis (PrEP). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/risk/prep/index.html. Published May 28, 2019. Accessed June 15, 2019.
  13. Pett W. Factsheet: Post-Exposure Prophylaxis (PEP). National AIDS Manual (NAM) AIDSmap. http://www.aidsmap.com/Post-exposure-prophylaxis-PEP/page/1044883/. Published February 2019. Accessed June 15, 2019.
  14. PEP. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/pep.html. Published July 23, 2018. Accessed June 15, 2019.
  15. Injection Drug Use and HIV Risk. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/risk/idu.html. Published May 28, 2019. Accessed June 15, 2019.
  16. Getting Off Right: A Safety Manual for Injection Drug Users. Harm Reduction Coalition. https://harmreduction.org/wp-content/uploads/2011/12/getting-off-right.pdf. Published 2011. Accessed June 15, 2019.