Protecting Yourself and Others from HIV

Becoming educated about HIV and understanding how it is transmitted is the first and perhaps most important way to prevent the spread of HIV. It is essential for people to make informed decisions about the level of risk they are willing to take, based on what is realistic for them.

Abstaining from sex and not sharing needles are the most effective ways for people to protect themselves from HIV and other sexually transmitted infections (STIs). However, abstinence is not a realistic option for everyone.

Safer Sex
When abstinence is not an option, the proper use of barrier protection, such as latex or polyurethane condom (external or internal, also known as “male” or “female”) with a water based lubricant, can be the next best thing for preventing HIV transmission during vaginal or anal sex. Barrier methods can also provide protection from some other STIs. For more information on barrier methods, see the section below, “How Do I Use External and Internal Condoms?”

PrEP: Taking HIV Drugs to Prevent Infection
Pre-exposure prophylaxis—often called PrEP for short—refers to any form of treatment that can be taken before exposure to a disease-causing germ in order to prevent infection. For persons who want to avoid being infected with HIV, PrEP involves taking antiretroviral drugs (ARVs) consistently.

The ARVs that have undergone the most testing for PrEP treatment are tenofovir and emtricitabine, taken in a once-a-day combination pill called Truvada. Several studies have shown that, when taken as directed, Truvada is very effective in preventing HIV transmission and usually has few, if any, major side effects.

It is important to note, however, that taking Truvada prevents only HIV infection. It does not protect a person from other STIs or blood-borne infections.

HIV Treatment as Prevention
Large studies have also shown that when an HIV-infected person is being treated effectively for HIV, their chance of transmitting HIV to an uninfected partner is dramatically reduced. This is sometimes called “HIV treatment as prevention.”

To keep their risk of HIV transmission to a minimum, it is important that HIV-infected persons take their medications consistently as directed and maintain a very low (“undetectable”) viral load. As with PrEP, described above, HIV treatment as prevention prevents only HIV infection. It does not stop transmission of other STIs or blood-borne infections.

The best way to reduce the risk of becoming infected with HIV while performing oral sex is to maintain good oral hygiene. That, in addition to not flossing or brushing your teeth right before or after performing oral sex, will also reduce the risk of transmission.

Performing Oral Sex on a Woman (“Go Down”, “Eat Pussy”)
When performing oral sex on a woman, a dental dam or common kitchen plastic wrap can be used as a barrier to protect from HIV transmission. It covers the area you are performing oral sex on (vagina or anus). If you do not have a dental dam, you can also use a new, unused, non-lubricated or flavored condom by stretching it out and cutting it down the side, then stretching it out in the same way you would a dental dam or plastic wrap.

Performing Oral Sex on a Man (“Blowjob”, “Giving Head”)
In addition to good oral hygiene, proper use of a non-lubricated or flavored condom on a man can significantly decrease risk of HIV transmission. If a condom is not available or an option, not accepting semen into the mouth or spitting rather than swallowing will reduce the risk. You can also use the “harmonica method” by focusing on the shaft of the penis while avoiding the head.

Performing Oral Sex on the Anus (“Rimming”, “Eating Ass”)
For oral to anal contact, or rimming, a dental dam, plastic wrap, or a condom can be used in the same way described above under the heading “Performing Oral Sex on a Woman.” This can be a great barrier against not only HIV, but possible hepatitis A exposure.

Receiving Oral Sex
Since HIV is not transmitted by saliva, there is generally no risk in receiving oral sex unless there is a lot of blood in the mouth of the person performing oral sex.

Most external (also known as male) condoms are made of latex. For people who are allergic to latex, polyurethane condoms can be used instead. If you’ve ever experienced irritation from latex, ask your doctor to test you for a latex allergy. When used properly, both latex and polyurethane condoms are effective ways of significantly reducing the risk of HIV transmission.

When using either latex or polyurethane condoms for vaginal or anal sex, water-based lubricants on the outside of the condom will help to reduce friction that could cause the condom to tear. If desired, a small amount can be placed inside the tip of the condom as well.

Important Notes: The use of oil-based lubricants such as Vaseline can deteriorate latex condoms and significantly increase their chance of breaking. Oil-based lubricants should only be used with polyurethane condoms. It is also worth noting that Lambskin (a.k.a. “natural”) condoms will not protect against HIV or STIs.

When Using an External Condom:

1. Keep it fresh! Always store condoms in a cool dry place (not a wallet) and check the expiration date.
2. Check it! Squeeze the package gently to make sure there are no punctures and be sure not to use your teeth to open the package. Your teeth could rip the condom!
3. Heads Up! Unroll the condom a little before putting it on and make sure it’s able to roll easily down the penis. Squeeze the tip (so semen can collect) and roll the condom from the tip of the penis all the way to the base. If uncircumcised, pull the foreskin back before putting the condom on.
4. Don’t Double Up! Be sure to never use more than one condom at a time. Doubling up can lead to friction and possibly the condom breaking. One condom is sufficient.
5. Lube it Up! Apply lots of water based lubricant to the condom to prevent friction which could cause breakage.
6. Take It Easy! After ejaculation (cumming), remove the penis from the vagina, anus, or mouth while still erect and carefully unroll and remove the condom. Be careful to not spill any semen on your partner.

Never use a condom more than once. Always use a new condom each time you have sex, or when you switch from oral to vaginal or anal sex. This will reduce the risk of the condom breaking.

Using an Internal or Reality Condom (Also Known as a Female Condom)
Although it is sometimes referred to as the female condom, the Reality condom can be used by both men and women. When using the internal condom, make sure to put it into place before your partner’s penis comes into contact with the vagina or anus. Once in place, carefully guide the penis into the condom, making sure to enter the condom and not outside of the condom’s external rim.

For Vaginal Sex:

1. Press the inner ring between your fingers to narrow it and make it easier to insert.
2. Hold the condom with its open end pointing down, and insert the closed end into the vagina, letting the wider end remain around the opening of the vagina (it’s easier to insert if the knees are spread apart). You can also place the internal condom on an erect penis or dildo to insert it.
3. Push the condom up into the vagina, until it is just past the pubic bone (you can tell where the pubic bone is by curving the index finger when it has gone a couple inches into the vagina).
4. When removing the internal condom, squeeze the end, twist the condom to keep the semen inside, and pull out. DO NOT FLUSH.

For Anal Sex:

1. Remove the internal ring and place the condom on the partner’s erect penis or a dildo.
2. Use the penis or dildo to carefully insert the condom into the anus of the receptive partner.
3. To remove, squeeze the end of the condom, twist to hold the semen inside, and remove.

While certain sexual activities, such as mutual masturbation, barrier-protected oral sex, and oral to anal contact (rimming, fingering) have little or no risk of HIV transmission, some of these activities may have the potential for transmitting other STIs. While HIV is transmitted only by blood, semen, vaginal fluid, and breast milk, other STIs can be transmitted by simple genital skin-to-skin contact or oral sex.

Since HIV and hepatitis C are blood-borne viruses (viruses that exist in and are transported via the bloodstream), any direct blood-to-blood contact is a risk for HIV and hepatitis C transmission.

Sharing needles or works (cotton, cookers, water, and so forth) presents a significant risk for transmitting these blood-borne viruses. Whenever possible, it is best for each person to use their own needles and works.

Needle exchange sites have been set up to trade in used needles and get new ones. There are five state-funded Needle Exchange Sites in the following Massachusetts cities and towns: Boston, Cambridge, Holyoke, Northampton, and Provincetown.

If you are not near a Needle Exchange site, or cannot get to one, there is another way to get clean syringes. The Massachusetts Pharmacy Access Bill allows individuals 18 and older to purchase needles at a pharmacy without a doctor’s prescription.

Proper disposal of used needles is important as well. Used needles should not be disposed of in the garbage since this creates a risk for anyone handling the trash who may get stuck by an infected needle. Sharps containers are heavy-duty containers used for disposal of needles, and can be acquired through some pharmacies. If a sharps container is not available, an empty plastic liquid detergent or bleach bottle can be used as well. These should then be turned into a designated needle disposal site.

Needle Safety
The only way to completely avoid potential transmission of blood-borne illnesses when injecting drugs is by not sharing needles. If people do share needles, cleaning the needles and works properly with bleach and water before and after each person uses them will help reduce the risk.

How Do I Clean My Used Needles?

The most effective way to sterilize used syringes is the 3x3x3 method:

1. Fill your syringe with water, shake it, and push out the water. Do it three times.
2. Fill your syringe with bleach, shake it, and push out the bleach. Do it three times.
3. Fill your syringe again with clean water, shake it, and push out the water. Do it three times.

If bleach isn’t available, you can use soap and clean water, or even just water to clean your works. ANY steps you take to clean syringes before use will reduce your risk of HIV and hepatitis C transmission.

Where can I get clean needles/syringes?
Prior to September 2006 the only way to acquire clean needles in Massachusetts was via a prescription or through a needle exchange programs. As a result of the Pharmacy Access Bill, it is now legal for pharmacies to sell medical syringes over the counter without a prescription. Anyone 18 or older (with proof of age) can purchase clean needles at many pharmacies in Massachusetts. They are relatively inexpensive. Although pharmacies are allowed to sell syringes, they are not required to do so. A phone call to the pharmacy in advance can save a trip to the drug store.

If you have specific questions about HIV prevention or other HIV-related health issues, please contact AIDS Action’s Health Library at 617.450.1432 or visit the Health Library page.