Topic II - Risk Reduction Measures

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Methods for reducing the risk of sexual and drug-related transmission of HIV include:


Sexual Abstinence

Sexual abstinence (not engaging in anal, vaginal or oral intercourse or other sexual activities where blood, semen or vaginal fluid can enter the body) is a completely safe and 100% effective method for preventing the sexual transmission of HIV. Non-penetrative sex, where the penis does not enter the vagina or anus, nor are penetrative sex toys shared, is a safer sex method that greatly decreases your risk of getting infected with HIV. This practice will not transmit HIV, provided that there is no exchange of blood, semen, vaginal fluids or breast milk in the sexual contact. Non-penetrative sexual intercourse may still be a risk factor for the transmission of other sexually transmitted diseases.

Monogamous Relationships

Monogamous long-term relationships (having sex with only one person who only has sex with you) is another choice to prevent/reduce the risk of HIV infection. If neither partner is infected with HIV or other STDs, and neither has other sexual or injection equipment-sharing contacts, then neither partner is at risk of exposure to HIV or other STDs. In order for monogamy to protect against HIV and STDs both partners must be free of disease and both partners must remain Monogamous.


Limiting Partners Both Partners infected

The decision to limit the number of sexual or drug-injecting partners may reduce the risk of HIV transmission, but is not a guarantee of safety. The fewer the partners, the greater the reduction of risk.


Safer Sexual Practices

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Latex condoms:

when used correctly and consistently during sexual intercourse, (anal, vaginal and oral) are highly effective in preventing the transmission of HIV. Only water-based lubricants should be used to prevent tearing of latex condoms. Oil-based lubricants like petroleum jelly or cooking oils should not be used because the oil in these products breaks down the condom. Other safer sexual measures include:

Polyurethane condoms:

Male - These condoms are made of a soft plastic. They look like latex condoms but are thinner. Lab tests show that sperm and viruses (like HIV) cannot pass through polyurethane.

Female or insertive - The female/insertive condom fits inside the vagina or anus. It is made of polyurethane, which blocks sperm and viruses (like HIV). These condoms may be inserted several hours before intercourse.

Dental dams/other barriers:

Dental dams, large pieces of new, unused, clear, nonmicrowaveable plastic wrap, and latex condoms may be used to provide a barrier to reduce the risk of HIV transmission during oral intercourse on a female. The latex condom can be cut into a square for use as a dental dam. Simply cut off the tip and then down one side, and open it into a square. Water-based lubricant may be used with the dental dams, plastic wrap or cut-open condoms to enhance sensitivity and reduce friction.
 
**CAUTION: Natural membrane condoms ("skins") do not provide protection from HIV, HBV and some other STDs. (They can help prevent pregnancies and some STDs, such as syphilis).

 

Pre-Exposure Prophylaxis (PrEP)


What is PrEP? Pre-Exposure Prophylaxis or PrEP is a way for HIV negative people to prevent getting infected with HIV by taking a pill every day. The pill contains two medicines that are also used to treat HIV. If a person is taking PrEP and is exposed to HIV through sex or injection drug use, the medicines can work to keep the virus from taking hold and infecting the body. Coupled with other prevention methods like condoms, PrEP offers protection against HIV if taken properly. PrEP can only be prescribed by a health care provider and must be taken as directed to work. When taken as directed PrEP can lower the risk of getting HIV infection up to 92%.


Who Can Take PrEP? The CDC recommends PrEP be considered for people who are HIV negative and at high risk for HIV infection. This includes anyone who:

  • Is in an ongoing relationship with an HIV-infected partner
  • Is not in a mutually monogamous relationship with a partner who recently tested HIV-negative and is a
    • Gay or bisexual man who has had sex without a condom or been diagnosed with a sexually transmitted infection with the past six months
    • Heterosexual man or woman who does not regularly use condoms when having sex with partners known to be at risk for HIV (e.g. injecting drug users, or bisexual male partners of unknown HIV status)
    • Has, within the past six months, injected illicit drugs shared equipment or been in a treatment program for injection drug use.


Treatment with HIV medications


People who are infected with HIV can reduce their chance of transmitting the virus to others by receiving appropriate medical treatment which includes properly using antiviral medications. People living with HIV who consistently take antiviral medications as directed by a healthcare provider are likely to be virally suppressed. This means that lab tests show no, or very small amounts, of virus in their blood. The greatly reduced presence of HIV in bodily fluids that can transmit HIV means that these fluids become much less infectious. Consistent and correct use of antiviral medications can reduce the chance that a person with HIV will infect another by more than 90%.

 

If Two People are Infected with HIV do They Still Need to Have Protected Sex?


Some people think it's safe for HIV-infected people to have unprotected sex with each other. Latex condoms are advised when both partners are HIV-positive. Each additional exposure to the virus may further weaken an immune system already damaged by HIV if the partners transmit different strains. Other STIs are transmitted through unprotected sex. Any additional viral or bacterial infection stresses the immune system and should be avoided.


Avoidance of Injection Drug Use

Not injecting drugs is another way to avoid the risk of transmission of HIV. If entering drug treatment or abstaining from using injecting drugs is not possible, then use a clean needle each time and do not share injection equipment. This includes people who use needles to inject insulin, vitamins, steroids or prescription or non-prescription drugs.


Syringe Exchange

Syringe exchange, or needle exchange, is a disease prevention program for people who use illegal drugs. It provides new sterile syringes in exchange for used ones. People who trade in their used syringes/needles for clean ones at needle exchanges significantly reduce their risk for sharing needles and becoming infected with HIV or hepatitis. Syringe exchanges are also referral sources for drug treatment. Participants may be able to access drug treatment through the intervention of the syringe exchange staff. Public support for syringe exchange has grown in recent years. Many local health departments in Washington State, some in conjunction with other organizations, operate syringe exchanges in their communities. For more information, contact your local health department/district's HIV/AIDS Program.

Public support for syringe exchange has grown in recent years. Some local health departments in Washington State, operate or support syringe exchanges in their communities. For more information, contact your local health department/district's HIV/AIDS Program.