Information on this page supports your choices for safer sex while still having great sex with your sexual partners regardless of HIV status, maximising pleasure, enabling disclosure and minimising risk.
Below you’ll find information that supports
- your own choices when negotiating sex
- while managing the risk of HIV transmission and other sexually transmitted infections (STIs) and
- using a range of HIV prevention strategies during sexual encounters on your own terms.
This page offers ways you can
- manage HIV transmission along with sexual risk and pleasure
- discuss topics like disclosure and handling rejection or when making decisions on whether to use condoms or not
- want to access Pre-Exposure Prophylaxis (PrEP) which is used to protect against contracting HIV
- want to access Post-Exposure Prophylaxis (PEP) after you’ve been exposed to HIV to help prevent contracting HIV.
If you live with HIV and have any questions about HIV and sex, call Positive Life NSW on on (02) 8357 8386, 1800 245 677 (freecall outside metro) or email email@example.com
Sex without condoms
Having sex without condoms, also called ‘raw sex’ or ‘barebacking’, is based on informed choice between all partners. It can be awesome when you know your own level of risk and you’re feeling confident to have sex how you want. It also can bring up the risk of getting or passing on HIV.
Men and women who are HIV positive or negative and/or are Hep C positive or negative, have a range of strategies to prevent the transmission of HIV and/or Hep C during sex.
Condoms are still the only protection against sexually transmitted infections (STIs) like gonorrhoea, chlamydia, syphilis and hepatitis C and provides the best protection against these infections.
There are different ways to protect yourself or your sexual partners against HIV. Some of these strategies suit some people more than others. Some are easier to manage than others.
Speaking the Same Language
There are many terms, acronyms and phrases, on mobile apps, in personal ads or texting, emails and play spaces which imply someone might be have HIV or not, be Hep-C positive or negative or assume the other person has or doesn’t have an STI.
Talking about HIV and HCV status is easier for some people than others. It’s easy to make assumptions about HIV, Hep C or other STIs. Assuming someone’s status or relying on other people to know or disclose their status can put you and your partners at risk for STIs, including HIV and/or HCV. Are you sure you and your partner/s are talking about the same thing?
Some people living with HIV or HepC are open about their sexual health, STIs and put these on their mobile app profiles, while others are not. Many people make assumptions what a term or acronym means. It’s risky to rely on the implied meaning of a term or acronym and hope that someone else will pick up on the meaning.
We need to talk to our sexual partners about risk, HIV and HCV including other STIs regardless of HIV status.
Asking about HIV, Hep C or STIs and talking with each other about your limits and what you are or aren’t prepared to do, means you can make informed decisions about the type of sexual activity you want. If the conversation about your HIV or Hep C status with a new sexual partner doesn’t happen, this can put you and your partners at risk for HIV and/or HCV. It’s easy to be in a hot moment and not have the conversation. Better to be safe than sorry.
Other strategies like serosorting, strategic positioning, and other negotiated sex safety options suit some guys more than others and are easier to manage than others.
HIV and the Law
The NSW Public Health Act 2010 says that if you have a sexually transmissible medical condition you do not need to disclose to your partner prior to sexual intercourse. However in the event of non-disclosure, you must take ‘reasonable precautions’ to prevent any transmission of any STIs, including HIV. NSW Health lists the ‘reasonable precautions’ which includes the proper use of condoms and water based lube; taking HIV medication to maintain an undetectable viral load of less than 200 copies/mL; getting confirmation from your sexual partner that they are taking PrEP; or taking a prescribed antibiotic course for any bacterial STI. If the condom breaks during sex then telling your partner you are living with HIV and referring them for PEP could be an additional ‘reasonable precaution’.
PrEP and PEP
For people who do not have HIV there are two main pharmaceutical (medicine-based) ways to protect yourself against HIV. Both use a form of prophylaxis – which means to prevent the spread of an infection or disease.
- PrEP (or pre-exposure prophylaxis) is for people who do not have HIV but who are at risk of contracting (or getting) HIV. It is a daily medication to protect yourself from contracting HIV.You can get PrEP prescribed at your GP and then pick the medication up from your local chemist. It’s important to know that PrEP does not provide any protection against sexually transmitted infections (STIs) such as gonorrhoea, chlamydia, syphilis and hepatitis C. Using condoms still provides the best protection against these infections.
- PEP (or post-exposure prophylaxis) is for anyone who has been exposed to HIV. It is a month-long course of anti-HIV drugs if you have been exposed to HIV, which can prevent HIV from taking hold in your body. If you have been exposed to HIV, the sooner you start PEP the better. It must be started within 72 hours after your possible exposure to HIV.
You can get PEP from any sexual health clinic, The Albion Centre or the Emergency Department of most public hospitals.
PEP Hotline 1800 737 669 (1800 PEP NOW)
Mon-Fri 9am–9pm, Sat-Sun 8am–9pm, Public holidays 8am–9pm
The HIV PEP Hotline is a partnership with Albion Centre and St Vincent’s Hospital that provides information, assessment and a referral service for people from NSW who believe they require HIV PEP after a possible high risk exposure to HIV.
Controlling the Risk and Undetectable Viral Load (UVL)
All of us can control the risk to our own health and our partners’ health. There are different ways today to protect yourself or your sexual partners against HIV. These include talking about risk, taking PEP or PrEP, or when people living with HIV maintaining an ‘undetectable viral load’ (UVL).
Whether you are living with HIV or HepC , your ‘viral load’ (VL) is the measure of virus present in your bloodstream.
HIV and Viral Load (VL)
For people living with HIV, an ‘undetectable viral load’ (UVL) means there is no measurable level of HIV in your blood and indicates how well your HIV medication is suppressing the virus and therefore the risk of passing HIV onto your sexual partner.
An ‘undetectable viral load’ (UVL) means you cannot pass on HIV if:
- your viral load has been undetectable over six months
- you take your medication as prescribed without missing too many doses
- you are not in the process of changing your HIV medication.
As long as you have an UVL, you cannot pass on HIV even if you have sex without condoms.
HCV and Viral Load (VL)
If you have contracted the hepatitis C virus (HCV), your HCV VL can be measured. The VL estimates how much HCV is circulating in your blood and can indicate the risk of passing HCV onto your sexual partner.
While HCV is easier to transmit than HIV and can be sexually transmitted, is it possible to cure people with HCV and completely destroy the HCV virus with medication.
If you haven’t discussed HCV cure with your doctor, talk about it soon to work out when you’re ready to start treatment.
HIV or HCV and a Detectable Viral Load
Whether a person has HCV or HIV (or both), around 5% of people with HIV cannot achieve an UVL due to a range of reasons. Some of these include genetics, complex treatment resistance factors, immuno-compromised systems or various multi-morbidity health conditions. There are also times during a positive person’s life where they cannot maintain an UVL.
The reasons for a detectable viral load are:
- not on antiretroviral treatment
- developing resistance
- recently commenced treatment
- experienced a viral blip
- cannot achieve undetectable viral load
People who are HIV positive or Hep C positive and want to know more about protecting your sexual partners, keeping your own health safe is one of the main ways to make sure your partners are safe from HIV
If you live with HIV and have any questions about HIV and sex, call Positive Life on (02) 8357 8386, 1800 245 677 (freecall outside metro) or email firstname.lastname@example.org