“Safer sex” is a term that can mean many things:
- Avoiding bodily fluid exchange
- Using prophylactics (such as male or female condoms)
- Using HIV medications to prevent transmission of the virus.
- Limiting the number of sexual partners
- Curtailing alcohol and drug use (which can impair judgment
In fact, safer sex often involves a combination of these approaches.
While we know that some types of sexual activities are much lower risk than others (with some activities only being a theoretically risk, not a proven risk) and the proven effectiveness of condoms, there are no guarantees. It is difficult to be 100 percent certain that you did not engage in any risk behavior, especially if you have any sort of unprotected sexual activity with a person known to be HIV positive or you do not know what his or her HIV status is. Abstinence—or sexually activity only in a monogamous relationship in which both partners are HIV negative—is the only way to eliminate the risk of HIV infection.
The only way to know for sure whether you have been infected, even after an activity that is considered to be very low risk for HIV transmission, is to get tested. Also, if you’ve been infected with another sexually transmitted infection, getting tested for HIV too is a good idea.
Several studies have demonstrated that male condoms made of either latex or polyurethane are effective barriers against HIV. The theory behind using condoms is clear: they cover the penis and provide an effective barrier to exposure to secretions such as semen and vaginal fluids, thereby blocking sexual transmission of HIV infection.
Laboratory studies have been conducted to support this theory. These studies involved placing a solution containing HIV inside the condoms. No leakage of HIV across the latex or polyurethane condoms was demonstrated. Similar studies have also demonstrated that other common sexually transmitted viral infections, such as herpes simplex virus (HSV) and hepatitis B virus (HBV), are also prevented with the use of these two types of condoms.
Condoms made of “natural” materials—such as lambskin—are not a consistently effective barrier against many viruses. In one laboratory study, HIV was found to pass through microscopic holes in lambskin condoms. Studies involving HSV and HBV reported similar results.
There have been a number of epidemiological studies—studies that are conducted in real-life setting, where one partner is infected with HIV and the other partner is not—that have demonstrated consistent use of latex (or polyurethane) condoms provide a high degree or protection against HIV. The key to effective protection is consistent and correct use of condoms.
Incorrect use of condoms can increase the risk of condom slippage or breakage, which diminishes their protective effect. Inconsistent use—for example, failure to use condoms with every act of vaginal or anal intercourse—can lead to HIV transmission.
Polyurethane condoms are an effective alternative to latex condoms, especially for people with an allergy to latex. There have been at least six epidemiological studies of polyurethane condoms. Three of the studies found that that slippage and breakage occurs equally (and rarely) with both latex and polyurethane condoms. The three other studies found that polyurethane condoms are more likely to break than latex condoms (with one of the studies also demonstrating that polyurethane condoms are more likely to slip than latex condoms). Still, if used consistently and correctly, they are considered to be a highly effective barrier against the sexual transmission of HIV.
The female condom, approved in 1993 for use in the United States, is a polyurethane pouch with flexible polyurethane rings and each end. It is inserted deep in the vagina, much like a diaphragm. The ring at the closed end holds the pouch in the vagina. The ring at the open end stays outside the vulva (vaginal opening). If inserted properly, it lines the vagina and the cervix, which helps to prevent pregnancy, along with HIV and other sexually transmitted infections.
While female condoms are not approved for use during anal intercourse, some MSM have reporting using them for anal sex. However, at least one study has reported problems for the receptive partner using the female condom, including difficulty inserting the condom, discomfort, and rectal bleeding (removing the inner ring may alleviate some of the problems experienced during anal insertion and removal). Several studies have also indicated that female condoms are not as effective as male condoms, largely because of the difficulty in using them correctly.
Only water-based and silicone-based lubricants should be used with latex condoms. K-Y Jelly, Wet, and Astroglide are three examples of water-based lubricants that can be used with latex condoms. Examples of silicone-based lubricants include Millennium ID and Eros Bodyglide
Never use oil-based lubricants, including hand or body lotion, baby oil, vegetable oil or shortening, massage oil, mineral oil, or petroleum jelly (e.g., Vaseline). Oil-based lubricants can damage latex and cause latex condoms to tear more easily.
Some pre-lubricated condoms and separately sold lubricants contain a chemical called nonoxynol-9. While nonoxynol-9 has been shown to kill sperm (and potentially reduce the risk of pregnancy) and various sexually transmitted infections, some men and women are allergic to this chemical. This can cause irritation inside the vagina and anus, which can increase the risk of HIV transmission if the condom breaks.
Antiretroviral (ARV) Therapy
HIV medications can also be used to prevent sexual transmission of the virus. Pre-exposure prophylaxis (PrEP) is an HIV prevention tool in which an HIV-negative person takes antiretroviral medication to reduce the risk of contracting HIV. Post-exposure prophylaxis (PEP) involves taking a short course of ARV drugs, usually for a month, after a high-risk exposure. Treatment-as-prevention (TasP) involves prescribing ARVs to those who are infected with HIV in order to reduce the amount of virus in their blood (and genital fluids) so that they are less likely to infect others.