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What are my prevention concerns if I am HIV positive?Safer sex and prevention messages are often targeted solely to HIV-negative people. Yet, preventing HIV and other infections remains an important issue for people living with HIV as well. Whether your partner is HIV-positive, HIV-negative, female, male or transgendered, there are many reasons to be concerned about safer sex and prevention. The following explores some of the most common sexual transmission concerns for people living with HIV. What Are the Risks of Passing HIV to My HIV-Negative Partner? What Kinds of Infections Can I Protect Myself From Getting? Transmission of Multi-Drug Resistant HIV We're Both Positive -- What Are Our Concerns? Preventing Your Risk of Infections You Can Prevent Common Infections at Home! What Are the Risks of Passing HIV to My HIV-Negative Partner?A concern of many people living with HIV is passing HIV to their uninfected partner(s). While much evidence suggests that men transmit HIV more easily than women, women can still pass HIV to uninfected partners -- both male and female. This is because HIV is present in blood (including menstrual blood), vaginal secretions and in cells in the vaginal and anal walls. In fact, high levels of HIV can be found in these areas even if there's a low amount of HIV in your blood. For women, HIV levels in vaginal fluids greatly increase when you have gynecological (GYN) conditions, like yeast infections or inflammation. Several studies in test tubes show that some sexually transmitted diseases (STDs), like chlamydia, increase HIV reproduction. Vaginal inflammation, a common symptom of these infections, causes tiny scrapes and cuts on the delicate skin of the vaginal area that can then harbor HIV. HIV levels can also temporarily increase after treating some of these conditions.
Likewise, men with active STDs, especially active herpes lesions, etc., are more likely to both acquire and transmit HIV. Less is known about whether HIV levels are actually higher in blood and semen during an active STD infection in men, but certainly any infection that causes a lesion, like herpes, provides a portal for HIV to pass through and makes transmission more likely. Studies do show that even when a man has undetectable levels of HIV in his blood, there are sometimes detectable HIV levels in semen and pre-cum fluid. HIV transmission from men with undetectable HIV levels in their blood has been documented several times.
In short, if you're not practicing safer sex, there's no way to know when you're more or less likely to pass HIV to your partner(s). Exposure to vaginal or anal secretions, semen or other blood with high levels of HIV increases your risk of transmission. The risk further increases when one's partner has an infection or inflammation. It's also possible to have active infections or GYN conditions without having symptoms or knowing it. (For general guidelines on safer sex practices, see below.)
Finally, a number of known cases have shown multi-drug resistant HIV being passed from people living with HIV to their partners. What this means is that the newly infected partners have a form of the virus difficult to treat with anti-HIV drugs, leaving them with limited options to treat their infections. What Kinds of Infections Can I Protect Myself From Getting?Prevention isn't just about protecting someone else from getting HIV; it's also about protecting yourself from other harmful infections. You can do something about many common and serious infections. The risks of unsafe sex are numerous because many STDs can cause serious harm in people living with HIV. Cytomegalovirus (CMV) is such a condition. While most adults are infected with CMV, it doesn't cause disease in healthy, HIV-negative people. Therefore, most people carry the virus but don't have active CMV disease. However, once CMV becomes an active infection, it's the leading cause of blindness and among the major causes of death in people with AIDS. Ways to prevent CMV infection include practicing safer sex.
CMV prevention is probably much more relevant to women than to men, particularly adult gay men. The rate of CMV infection among women is generally lower (40% among women living with HIV) than what's seen among adult gay men (80-90% of whom are already infected with CMV, regardless of HIV status). The bottom line is that if you're not infected with CMV, safer sex remains a potent tool in helping to prevent CMV disease.
Like CMV, human papilloma virus (HPV) is another STD. HPV is the virus that causes genital warts in some people. These warts may or may not be visible by external examination, yet might be present in the anus or cervix. As one of the major causes of anal and cervical cancer, HPV is common and difficult to treat among people living with HIV. Some types of HPV are more likely to develop into cancer than other types.
Both men and women are at risk for anal cancer associated with HPV. Some studies suggest that a woman living with HIV is more at risk of developing anal cancer as opposed to cervical cancer associated with HPV infection. Unlike other conditions associated with HIV disease, the rate of anal and cervical cancer associated with HPV infection does not appear to be dramatically declining with increased use of anti-HIV therapy. Unfortunately, condom and other barrier protections may not protect you from HPV infection and transmission, but they might decrease the risk of transmission.
Hepatitis, cryptosporidiosis, parasites and other infections can also be passed during sexual activity. Every condition described above can be deadly in anyone living with HIV, especially with a weakened immune system. (For more information on how to prevent these infections, see below.)
It's important for people living with HIV to protect themselves from these unwanted and possibly dangerous infections. Lab tests can detect these infections, but your medical coverage may not pay for them. You can ask your doctor about possibly getting these tests. Then, use the results to build a prevention plan that helps protect you from getting new infections.
Transmission of Multi-Drug Resistant HIV
There is increasing concern over the transmission of drug-resistant virus and multi-drug resistant HIV. People infected with multi-drug resistant HIV are unlikely to optimally benefit from most, if not all, of the available anti-HIV therapies. While many known cases of AZT-resistant HIV transmission have occurred in the past, transmission of multi-drug resistant virus is being seen increasingly. These observations underscore the importance of including safer sex in your life, even when you and your partner(s) are both living with HIV.
We're Both Positive -- What Are Our Concerns? For people whose partner(s) also live with HIV, prevention messages and reasons to practice safer sex sometimes become unclear. A common question is: "If I'm positive and my partner is positive, then why do we have to practice safer sex?" Simply put, safer sex remains important among positive partners. This is because in addition to preventing new infections as discussed above, other factors place positive sex partners at risk. One of these factors is re-infection with HIV. While the issue of re-infection remains unclear, some new evidence shows that it can and does happen. If you're on therapy that HIV has become resistant to, it's possible for you to transmit the drug-resistant strain to your partner, possibly crippling the benefits of those therapies for your partner. On the other hand, if your partner is on anti-HIV therapy, you could become infected with his or her drug-resistant strain(s) and have decreased benefits from therapy. (For more information on drug-resistant virus, see above.)
Finally, it's important to remember that your partner's viral load (amount of HIV in blood) may not relate to the level of virus in semen or vaginal or anal fluids. Therefore, while HIV levels in blood may be undetectable by a lab test, they still may be present in high levels elsewhere. (Note: Standard viral load tests do not measure HIV in semen or vaginal or anal fluids. Also, in studies, even when viral load tests of semen came back undetectable, HIV-infected cells could still be found in the semen. These cells are believed important for passing HIV from person to person.)
When both partners live with HIV, consider these points when discussing safer sex:
Woman-to-woman sexual activity has generally been associated with a lower risk of passing HIV, although a number of cases have been reported. The risk of passing HIV and other STDs between women has not been thoroughly studied. But the few studies to date note that many women who have sex with women engage in a number of high-risk behaviors that may increase their risks of both getting and passing HIV and other STDs (including the types of HPV associated with cervical and anal cancer). So in the meantime, it's best to play safe and refrain from making easy assumptions about HIV and STD transmission during woman-to-woman sex.
You put yourself at risk for infections through unprotected sex with a partner -- activities that expose you to your partner's blood, blood products, urine, feces, semen or vaginal or anal fluids. In some cases these infections may never harm your partner, but they might be life-threatening to you should your immune system weaken as a result of HIV. If your partner(s) is also living with HIV, neither of you is immune to new infections. Be aware of both the real and theoretical risks as you discuss and negotiate safer sex. Every sexual behavior or activity carries some level of infection risk. It's generally believed that some activities are less risky than others, but low risk obviously doesn't mean no risk.
Negotiating safer sex and using risk reduction to prevent passing or getting HIV or other infections is not easy. Safer sex requires the involvement of willing partners. This is especially difficult for women because safe and low-cost woman-initiated methods of HIV prevention do not currently exist. For people in situations where domestic violence occurs, this willing involvement can be almost impossible. In this case, seeking family violence prevention services is probably the safest and smartest plan of action.
In addition to protecting from HIV infection and transmission, practicing safer sex also reduces the risk of passing or contracting other diseases, like chlamydia, gonorrhea, herpes and hepatitis. These can be especially troublesome in people with weakened immune systems. A few tips on how to protect yourself and your partner during sex are found below.
One Word:
Plastics!
Protect the
Environment and Your Condoms!
Read the Label!
Wrap It to Go!
Try a Breath Mint
Instead!
Let Your Fingers
Do the Walking!
Good Clean Fun!
On the Wild Side!
Preventing Your Risk of Infections People living with HIV must consider taking precautions to avoid exposing themselves to common infections, which are possibly deadly in people with a weakened immune system. Although safer sex is usually thought of in regards to preventing HIV infection, exposure to many major infections and STDs can be reduced if safer sex is followed. Avoiding oral-anal contact can greatly reduce the risk of getting parasites that can cause diarrhea and other symptoms. (Examples of parasites include tape worms, scabies and more common among people with HIV are toxoplasma and cryptosporidium.) Safer sex is not the only way to prevent exposure to infections, however. There are a number of things you can do to decrease your risk of potentially harmful infections.
In general, people with HIV should not eat raw or undercooked meats, poultry or seafood. Avoid unpasteurized dairy products, which may contain parasites, bacteria or viruses that in turn can cause severe illness. For example, eating raw shellfish can result in hepatitis A infection. Risks can be reduced further by following guidelines for "safer" food preparation.
You Can Prevent Common Infections at Home!
Put on the flea collar!
When Fluffy has the runs, run!
On your next archeological dig, bring Endust!
Don't feed the birds!
Put down the baby, and move away from the goat!
For more information on preventing infection with crypto, call Project Inform's Hotline.
Safer sex is hot sex (and it's not just about HIV infection!).
Put down the mop and move away from the chicken coop!
These recommendations only apply to people who are NOT antibody positive to toxoplasma.
This document was provided by Project Inform. |
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