"I have friends who keep skipping relationships every time the HIV issue comes up. They'll start a fight as an excuse to get out of the relationship, or just walk away. But people treat you based on how you treat yourself. When your confidence comes back and people see that you're ok with your HIV positive status, you're okay with your situation, it makes them ok with you. So, dating and sex becomes easier... I was really scared of the possibility of me infecting another person, so I always made sure that whenever I had an escapade a condom must be used." Simiso Msomi
What is safe sex? Safe sex is sexual activity in which people are careful to protect themselves and their sexual partners against HIV and other sexually transmitted infections (STIs). HIV does not have to come between you and your partner, you can still have good sex and a healthy relationship if you are HIV-positive. Practising safer sex will protect you and your partner from infection with STIs and you will not transmit HIV to your partner.
How is HIV Transmitted During Sex?
HIV lives in blood, semen, pre-ejaculate (pre-cum), vaginal fluids, amniotic fluid and breast milk. It can be transmitted from a person living with HIV to an uninfected person through any exchange of these body fluids. The most common way for this to happen is through sexual contact with a person who has HIV. Some sex acts are more likely to result in HIV being transmitted from one person to another than other acts. This is because of sexual fluids coming into contact with cuts or tears in the skin or soft internal tissues.
Sexual activity | Level of Risk | Who is most at risk? | Why is there a risk? |
Unprotected anal intercourse (the penis is inserted into the anus)
| High | The recipient of anal sex (whether male or female) | There is a high chance of the thin membranes around the anus tearing during sex and allowing HIV to enter through these cuts and tears. |
Unprotected vaginal intercourse (the penis is inserted into the vagina)
| High | The female partner | The thin lining of the vagina and the cervix may allow HIV to enter the body through cuts and tears. Semen contains a high amount of HIV and stays in the vagina for a long time after sex, increasing the chance of infection. |
Unprotected intercourse (the penis is inserted into the vagina or anus)
| High | The male partner | A man can contract HIV through the opening at the tip of his penis; through the foreskin if he is not circumcised; or through small cuts, scratches and open sores anywhere on the penis. |
Oral sex (sucking the penis or licking the vagina)
| Medium | The person giving the oral sex (using their mouth) | If the giving partner has mouth ulcers or bleeding gums and if the receiving partner ejaculates in their mouth or has genital sores or an STI, HIV can enter through the cuts in the mouth. |
Kissing and biting
| Low | The person using their mouth | There is only risk if there is blood present in the mouth. |
Foreplay and touching | None | Nobody | Touching that does not involve contact with semen, pre-cum or vaginal fluid is a safe way to share pleasure and to prevent transmitting HIV.
|
How Do Sexually Transmitted Infections Impact On HIV
STIs are infections that are spread from person-to-person through intimate sexual contact. They can be dangerous and spread easily. Having an STI can make it easier to get HIV. For example, an STI can cause a sore or break in the skin, which makes it easier for HIV to enter the body. Having HIV and another STI may also increase the risk of transmitting HIV to your partner.
Types of STIs
These are the most common infections that either affect the genital area or can be passed on through sexual contact.
Disease | How you get it | Symptoms | Treatment | Partners |
Diseases that are transmitted sexually | ||||
Chlamydia
| By having unprotected vaginal or anal sex with someone who has the infection; from mother-to-baby (eye and chest infection) | Women often have no symptoms or may have an abnormal smelly vaginal discharge; pain during sexual intercourse; lower abdominal pain; bleeding in between periods. Men may have no symptoms or may have watery or thick discharge from penis; pain when urinating; painful testicles. | Antibiotics. | Recent sexual partners need treatment. Don't have sex until 7 days after starting treatment and until sexual contacts have been treated. |
Gonorrhoea
| By having vaginal, anal or oral sex without a condom with someone who has the infection; from mother-to-baby (eye infections). | Women usually have no symptoms, but may have pain with sex, vaginal discharge, and lower abdominal pain. Men may have no symptoms or discharge from penis, discharge from anus, pain in testicles, and pain when urinating. | Antibiotics. | Sexual partners must be tested and treated if positive. Avoid sex until 7 days after treatment is completed. Condoms provide some protection, but not total. |
Syphilis
| By having vaginal, anal or oral sex without a condom with someone who has the infection; from mother-to-baby across placenta during pregnancy (congenital syphilis). | Painless ulcer (chancre) usually on genitals; later swollen glands, rash, hair loss. | Antibiotics with follow-up blood tests. | Sexual partners must be tested and treated if positive. Current health regulations advise no sex until you are cleared. |
Genital warts
| HPV transmitted by direct skin-to-skin contact, usually during sex; from mother-to-baby. Sometimes no identifiable source of transmission. | Fleshy or flat lumps on or around genitals, anus, groin or thigh. | Visible warts can be treated, but the infection cannot be cured. Discuss vaccination with your health professional. | Condoms provide some protection, but not total. |
Genital herpes
| Close skin contact with someone with the virus; from mother-to-baby. | Painful, red blisters, tiny sores, flu-like symptoms, and sometimes a discharge. | Genital herpes cannot be cured but symptoms can be treated. Antiviral medication can be used to can make outbreaks less frequent and help clear up symptoms more quickly. | Partners may or may not catch herpes. It is best not have sex when open sores are present. Condoms provide some, but not complete, protection. |
Trichomoniasis
| During sexual intercourse with an infected person. | Women may have no symptoms, but there may be a yellowy-green frothy vaginal discharge. Men usually have no symptoms. | Antibiotic tablets and/or vaginal pessaries. | Treat with antibiotics to avoid re-infection. Don't have sex until 7 days after starting treatment and until sexual contacts have been treated. |
Disease | How you get it | Symptoms | Treatment | Partners |
Diseases that can be transmitted sexually or may be transmitted in other ways | ||||
Hepatitis A
| Mainly through contaminated food or water by not hand-washing after toilet use and or before food consumption; anal sex and oral-to-anal contact (rimming). | Often no symptoms, or may have mild flu-like illness, or vomiting, abdominal pain, dark urine and yellowing of the skin and whites of the eyes. | There is no cure for this Hepatitis, but a vaccine is available to protect you against the virus. Avoid alcohol and drugs. Eat a well-balanced low-fat diet. Protection is offered to babies on the immunisation schedule and to children under 16 years. | Vaccine is available to protect your partner against infection; avoid anal sexual practices until recovered. Always use a condom if partner is not immunised. |
Hepatitis B
| By having vaginal, anal or oral sex without a condom with someone who has the infection; form mother-to-baby; contact with infected blood. | |||
Hepatitis C (HCV)
is a liver infection, transmitted through contaminated blood | After contact with infected blood; through sexual contact. | |||
Pelvic inflammatory disease (PID)
| Usually by having vaginal sex without a condom with someone who has gonorrhoea or chlamydia. | Pain during sex, sore abdomen or back, heavy, irregular or painful periods, spotting, high temperature, feeling sick; sometimes no symptoms. | Antibiotics and rest. | Need to check for STIs and be treated to avoid reinfection. No sex until treatment is completed and until sexual contacts have been treated. |
Pubic lice - crabs
| By close body contact, usually during sex with an infected person. Can be spread via infected bedding and clothing. | Intense itching in the pubic area, small nits (eggs) on pubic hair. | Special shampoo, cream or spray applied to pubic area. Wash all clothing and bed linen. | Treat partners of the last 3 months in the same way at the same time. |
What if I have an STI?
If you think you may have an STI;
- Talk to your healthcare worker for a check-up. You might need to give a urine or blood sample, have a swab of the vagina or penis for secretions, and be examined for sores or bumps on the genitals.
- It is important take your treatment as prescribed by your healthcare worker and to finish it.
- Go to any follow-up appointments you are advised to have. This will ensure you get the correct treatment and are completely cured of the STI, if that is possible.
- Any sexual partners you have had since the time you may have been infected should also go for a sexual health check, as they may also need to be treated. This will take away chances of re-infection.
- It is advisable not to have sex (even with a condom) until any treatment is finished, and sometimes for a while after that. Your healthcare worker will advise you when it is safe to have sex again.