The HIV virus is present only in certain body fluids: these include blood, semen (includingpre-ejaculatory fluids or precum), vaginal fluids, rectal fluids, and breast milk. These fluids are most likely to facilitate transmission of the virus to another person through the following means: unprotected sexual intercourse, needle sharing, blood transfusion, and mother-to-child transmission. Moreover, HIV virus must exist in sufficient amounts, or what is known as the viral load, to be able to infect the body.
How can HIV be transmitted through sexual intercourse
HIV can be transmitted through unprotected penetrative sex, which is possible through anal, vaginal, and oral sex.
As HIV can be found in the blood, semen, pre-ejaculatory fluid, or rectal fluid of a person infected with the virus, anal sex poses the highest risk for transmitting the virus. The bottom in anal sex is at higher risk of being infected as the lining of the rectum is thin and may allow HIV to enter the body during anal sex. However, the top is also at risk as the virus can enter through the urethra or through small cuts, abrasions, or sores on the penis.
Vaginal sex poses the second highest risk for HIV transmission. HIV can enter the body through the mucous membrane of the vagina and the cervix. Vaginal sex is the primary cause of infection for women. However, similar to anal sex, men can be infected with HIV through small cuts, abrasions, or sores on the penis.
Oral sex involves putting the genitals in the mouth – be it through fellatio (penis), cunnilingus (vagina), or the anus (anilingus or “rimming”). Generally these sexual practices pose little risk, but the risk for getting other sexually transmitted infections (STIs) is high. If fecal matter, even in unnoticeable amounts, gets into the mouth of the giver, transmission of Hepatitis A and B, and bacteria like Salmonella, E. coli and Shigella are possible. Diseases like herpes and gonorrhea are also easily transmitted through oral sex. Please be aware that STIs can increase your risk of getting HIV, as STIs can produce sores, abrasions, and lesions where HIV can enter.
Though not mentioned, it is possible for HIV to be transmitted by means of HIV-carrying bodily fluids coming into contact with the body through open cuts and wounds on the skin of the person.
How can sex be safe yet satisfying?
Condom use during anal and vaginal sex can lead to a significant reduction in the risk of getting infected by HIV. Combined with right lubrication through water-based lubricants, the correct use of condoms ensures satisfying sex while maintaining a lower risk of HIV transmission. Technology and product innovation have allowed the production of thinner, yet durable and sturdy condoms that make it feel as if one isn’t wearing a condom. A qualitative study in 2015 on condom use conducted by the Epidemiology Bureau of the Department of Health (DOH) cites physical pleasure as one barrier to using condoms, as a lot of respondents perceive sex without condoms as more pleasurable over protected sex, adding that more sensations are felt with unprotected sex.
While the idea does not sit very well with most people, wearing condoms during oral sex also reduces the already low risk posed by oral sex. The protection provided by a condom helps to ensure that transmission of blood or semen or pre-ejaculatory fluid is not passed on to either party. This is also a more efficient way of preventing transmission of other STIs.
There are other sexual practices that ensure satisfaction and ensure safety of both partners from possible HIV infection. Practices such as frottage or dry-humping, masturbation, phone sex, cyber sex, sexy or “dirty” talk, and non-sexual massage are often almost-zero-risk sexual activities. However, for dry humping and masturbation, getting ejaculatory fluid on an external lesion poses a risk of HIV infection. Nevertheless, these practices may actually benefit relationships between partners as both are made to find ways to add more variety to sexual pleasure, increasing intimacy and trust, and improve both verbal and nonverbal communication.
LoveYourself espouses the virtue of self-worth as instrumental to HIV prevention. Self-worth is the ability to perceive oneself as worthy of respect and that to engage in unsafe practices for the satisfaction of others is against one’s decision to take care of oneself, sexual health included. Armed with a sense of self-worth, one can decide to get oneself tested and take care of one’s health accordingly, and adhere to safe sex practices.
Moreover, treatments like PreP and TasP can be taken in concurrence with safe sex practices and give further protection. PreP or pre-exposure prophylaxis can be used by serodiscordant couples, or when one is reactive while the other is non-reactive, to reduce the risk of the non-reactive person from acquiring the virus. TasP on the other hand, which includes ART, enables a reactive person to still engage in sexual activities and live a normal lifestyle. It is important to emphasize that these treatments should be used with safe sex practices such as wearing condoms and using water-based lubricants.
We must remind everyone though that these safe sex practices and treatments do not give complete assurance that one will remain HIV-free. Sexually active people are always advised to get tested regularly and in a timely manner, and to be aware of the proper usage of condoms and lubricants. At the end of the day, it’s more important to find out about your status rather than assuming what it is.