HIV/AIDS NEWS

Sexual Intimacy With an HIV-Positive

Partner
When one person contracts HIV, the couple’s approach to sex, intimacy, and
childbearing must change to protect the other.

By Andrea Peirce
Medically Reviewed by Sanjai Sinha, MD
November 15, 2017

Everyday Health Archive

Medically Reviewed

Sigrid Olsson/Alamy

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 When one person in a couple is diagnosed with the human immunode ciency
virus, or HIV, it has a signi cant e ect on the couple’s romantic relationship —
there’s always a chance that the infected person can transmit HIV to his or her
partner.

The most dangerous possibility for HIV transmission occurs when a partner is
infected but doesn’t know it, says Marilyn Henderson, BSN, RN, the director of
the science department at the Medical Institute for Sexual Health in Austin,
Texas.

If you’re HIV positive, you can help protect your partner from becoming infected
while still maintaining a close relationship by putting smart, safer sex practices
in place. And with the right precautions, even that most intimate of connections
— conceiving a child together — can safely be accomplished.

What Are the Chances of Getting HIV Through Anal or

Vaginal Intercourse?

One way to address the anxiety about infecting a partner is to understand the
exact level of risk involved with di erent types of sexual activity. Among
heterosexuals, vaginal intercourse is a common route of HIV transmission, with
the woman at greater risk for HIV infection than the man. Says Henderson, “The
risk for infection for the female is about twice that of the male partner.”

The type of sexual behavior that poses the greatest risk for passing on the HIV
virus is receptive anal intercourse, Henderson says, explaining that “the person
receiving the penis in the anus is the receptive person. In heterosexual sex, that
is the woman.”

She notes that according to the Centers for Disease Control and Prevention
(CDC), receptive anal intercourse carries a risk for HIV transmission 17 times
greater than receptive vaginal intercourse. In men who have sex with men, anal

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 intercourse also poses a risk of infection for the insertive partner, Henderson
says, although the danger is 13 times greater for the receptive partner.

Condoms Can Help Protect You

When used correctly and consistently, condoms can decrease the risk of HIV
transmission during male-male intercourse, Henderson says. Figures from the
CDC indicate that condoms reduce the risk of HIV transmission for the receptive
partner by 73 percent, and for the insertive partner by 63 percent.

Using a condom during vaginal intercourse is especially e ective at protecting

against HIV transmission: When applied and used correctly, condoms can lower
a woman’s risk of infection by 80 to 85 percent. However, given that condoms
aren’t 100 percent e ective, the CDC recommends taking additional
precautionary steps.

How to Have Safer Sex With Your HIV-Positive Partner

In recent years, several advances have made intimacy between a couple with
one HIV-positive partner somewhat safer. People who are aggressively
managing their HIV with medications called antiretroviral therapy, or ART,
usually have lower levels of HIV in their blood and bodily uids. This, Henderson
explains, also decreases the chances that they’ll transmit the virus to someone
else. According to the CDC, people who maintain “undetectable” viral loads —
that is, the level of HIV in the blood is lower than can be detected with current
technology — have virtually no chance of infecting a sexual partner.

Individuals at high risk for contracting HIV can also take a combination of
medicines called pre-exposure prophylaxis, or PrEP, which works to prevent the
virus from establishing a permanent infection in the body, Henderson explains.
PrEP involves taking an antiretroviral pill every day and seeing a healthcare
provider every three months to take an HIV test and get a prescription re ll.

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 Though it’s often given in an emergency room in urgent situations, post-
exposure prophylaxis, or PEP, o ers an option for people who have just
participated in high-risk sex, such as having had anal intercourse with a man
who is HIV positive. Henderson notes that PEP has to be taken within 72 hours
of possible exposure to the virus.

Henderson also points out that the risk of infecting a partner with HIV is
increased if either partner has another sexually transmitted infection, such as
chlamydia or gonorrhea.

What Are the Chances of Getting HIV Through Kissing and

Oral Sex?

Not as much is known about the potential risk of getting HIV through oral
intercourse, Henderson says. The CDC considers oral intercourse to be a low-
risk behavior regarding HIV, though the presence of another STD may increase
the risk of transmission. The risk is also greater if the person performing oral
sex has mouth sores, bleeding gums, or comes into contact orally with
menstrual blood.

The riskiest form of this behavior is mouth-to-penis oral sex, especially if

ejaculation occurs in the mouth, Henderson says. Using a condom or a dental
dam may help reduce the risk of HIV transmission in these situations.

Getting Pregnant and Having Children With an HIV-Positive

Partner

According to the British government organization AIDSMap, HIV-positive women

can have healthy pregnancies and healthy babies, without passing HIV to their
child. But this takes careful planning, and extra steps are necessary to reduce
the risk. Talk to your doctor if you’re planning to become pregnant, since your
best options may be a ected by whether you’re on ART, whether your health is
generally good, and which person in the relationship has HIV. 

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 Other options for couples a ected by HIV include:

In vitro fertilization
Arti cial insemination
Adoption
Using a sperm donor
Using a surrogate mother

People nd intimacy in di erent ways, of course. But for many the sheer act of
physical touch — even hugging and kissing — can be an enormous source of
comfort and solace. 

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