Courtesy of Centers for Disease Control & Prevention
HIV and AIDS remain a persistent problem for the United States and countries around the world. While great progress has been made in preventing and treating HIV, there is still much to do.
Currently, about 50,000 people get infected with HIV each year in the United States. At the end of 2010 about 1.1 million people in the United States were living with HIV and of those people, about 16% did not know they are infected.
In the United States, HIV is spread mainly by having anal or vaginal sex without a condom or by sharing drug-use equipment with an infected person. Substance use can contribute to these risks indirectly because alcohol and other drugs can lower people’s inhibitions and make them less likely to use condoms.
About 34 million people are living with HIV around the world with about 2.5 million new cases of HIV in 2011.
Today, more tools than ever are available to prevent HIV. In addition to limiting your number of sexual partners, never sharing needles, and using condoms correctly and consistently, you may be able to take advantage of newer biomedical options such as pre-exposure and post-exposure prophylaxis.
• Low perception of risk. A majority of 15- to 24-year-olds in the United States responding to a Kaiser Family Foundation survey said they were not concerned about becoming infected with HIV, which means they may not take measures to protect their health.
• Low rates of testing. It is estimated that in 2010, almost 60% of youth aged 13 to 24 with HIV in the United States were unaware of their infection, compared to 16% for all ages. In a 2011survey, only 13% of high school students (22% of those who had ever been sexually active), and in a 2010 survey, only 35% of adults aged 18 to 24 had been tested for HIV.
• Low rates of condom use. In a 2011 survey in the United States, of the 34% of high school students reporting sexual intercourse in the previous 3 months, 40% did not use a condom.
• High rates of sexually transmitted infections (STIs). Some of the highest STI rates in the United States are among youth aged 20 to 24, especially those of minority races and ethnicities. The presence of an STI greatly increases a person’s likelihood of acquiring or transmitting HIV.
• Substance use. Nearly half (47%) of youth aged 12 to 20 reported current alcohol use in 2011, and 10% of youth aged 12 to 17 said they were current users of illicit drugs. Substance use has been linked to HIV infection because both casual and chronic substance users are more likely to engage in high-risk behaviors, such as sex without a condom, when they are under the influence of drugs or alcohol.
• Homelessness. Runaways, homeless youth, and youth who have become dependent on drugs are at high risk for HIV infection if they exchange sex for drugs, money, or shelter.
• Inadequate HIV prevention education. Young people are not always reached by effective HIV interventions or prevention education—especially young gay and bisexual men, because some sex education programs exclude information about sexual orientation.
• Feelings of isolation. Gay and bisexual high school students may engage in risky sexual behaviors and substance abuse because they feel isolated and lack support.
Courtesy of the Centers for Disease Control and Prevention
Not having sex is the most effective way to prevent HIV. If you are sexually active, the following steps can reduce your risk of getting HIV:
Choose one partner and agree to be sexually active only with each other (mutual monogamy). It is still important that you and your partner get tested for HIV and share your test results with one another. Some people choose to keep using condoms in a mutually monogamous relationship for further protection from HIV and other sexually transmitted infections (STIs).
Limit the number of people you have sex with, if you have more than one partner. The fewer partners you have, the less likely you are to have sex with someone who is infected with HIV or another STI.
Use condoms correctly, every time you have sex.
Choose less risky sexual behaviors. Anal and vaginal sex are the highest-risk sexual activities for HIV transmission. Oral sex carries much less risk.
Get tested and treated for STIs and insist that your partner does too. STIs increase the risk of getting or spreading HIV. Find an STI testing site.
Talk to your doctor about HIV medicine to prevent HIV infection (known as pre-exposure prophylaxis, or PrEP) if you routinely have unprotected sex with someone who may be HIV-positive.
See a doctor right away (within 3 days) if you have a single experience of unprotected sex with someone who is or may be HIV-positive. Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it for a month reduces the chance of getting HIV.
Get tested for HIV. To find a testing site near you, call 1-800-CDC-INFO (232-4636), visit the National HIV and STD Testing Resources page, text your ZIP code to KNOW IT (566948), or use a home testing kit.
Oral sex involves giving or receiving oral stimulation (i.e., sucking or licking) to the penis (fellatio), the vagina (cunnilingus), or the anus (anilingus). Most types of oral sex carry little to no risk of HIV. The highest oral sex risk is to individuals performing fellatio on an HIV-infected man, with ejaculation.
Factors that may increase the risk of HIV transmission through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted infections.
Although anilingus (rimming) carries little to no risk of transmitting HIV, it does come with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
To reduce your risk of HIV or other infections during oral sex or oral-anal contact, you can use barriers such as condoms, natural rubber latex sheets, dental dams, or cut-open non-lubricated condoms. See Tips for Using Condoms and Dental Dams.
When used correctly and consistently—every time you have sex—condoms are highly effective in preventing HIV infection. Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies. Natural membrane (such as lambskin) condoms are porous, meaning that infections can pass through them, and therefore do not protect against HIV and certain other sexually transmitted infections (STIs).
Because condoms cover only the penis, they are more effective at preventing STIs transmitted through body fluids, like gonorrhea, chlamydia, and HIV. Condoms provide less protection against STIs spread through skin-to-skin contact like human papillomavirus (genital warts), genital herpes, and syphilis.
We do not yet have research on how well female condoms prevent HIV and other STIs when used for anal sex. But we do know that HIV cannot pass through a female condom. Also, unlike latex male condoms, it is safe to use any kind of lubricant with female condoms (see “Can using a lubricant help reduce my HIV risk?”).
For more information, see Tips for Using Condoms and Dental Dams.
Yes. For anal sex, using water- or silicone-based lubricant with a latex condom helps to minimize damage to the rectum during sex, reduce condom breakage, and prevent the transmission of HIV and some other STIs. For vaginal sex, if dryness is a concern, using water- or silicone-based lubricant can prevent irritation and the condom breaking.
Oil-based lubricants and products containing oil such as hand lotion, Vaseline, or Crisco should not be used with latex condoms because they can weaken the condom and cause it to break. For condoms made of polyurethane or polyisoprene, it’s safe to use lubricants that contain oil.
Lubricants containing nonoxynol-9 should not be used because they can irritate the lining of the vagina or anus and increase the risk of getting HIV.
Yes. You should consider pre-exposure prophylaxis (PrEP) if you routinely have sex without using a condom, especially if your sex partner is HIV-positive or has HIV risks (for example, they inject drugs or are having sex with other people) or if you have recently been diagnosed with a sexually transmitted infection. PrEP involves taking a pill (brand name Truvada) every day that contains two HIV medicines. These are the same medicines used to reduce the level of virus in people who are already infected.
You and your health care provider may consider the following factors in deciding whether PrEP is right for you:
Only people who are HIV-negative should use PrEP. HIV testing is required before starting PrEP and every 3 months while taking PrEP.
PrEP should never be seen as the first line of defense against HIV. Researchers have only studied it when used with other prevention efforts like regular HIV testing and condoms.
Because PrEP involves daily medicine and frequent visits to a health care provider, it may not be right for everyone.
PrEP can cause side effects like an upset stomach or loss of appetite but these are mild and usually go away within the first month.
Post-exposure prophylaxis, or PEP, is a 4-week course of drugs that may prevent HIV infection for people who think they may have been recently exposed. PEP is used to prevent HIV after possible exposure during a single event; it is not intended for long-term use. For example, health care workers can be exposed on the job through infected needles, sharp instruments, or body fluids. Others can be exposed through sexual assault or during episodes of unprotected sex or needle-sharing injection drug use.
PEP consists of two or three antiretroviral medicines prescribed on the basis of your likely exposure risk. These medicines keep HIV from making copies of itself and turning into infection. To be effective, PEP must begin as soon as possible, but always within 72 hours (3 days) of a possible exposure. Keep in mind that PEP should only be used in situations right after a potential exposure. It is not a substitute for other proven HIV prevention methods, such as correct and consistent condom use.
Because there still may be some risk of HIV infection, you should continue to use condoms with sex partners while taking PEP. This will help avoid spreading the virus to others if you do become infected.
For more information on preventing exposure to HIV, see the PEP Q&A , the CDC fact sheet, Occupational HIV Transmission and Prevention Among Health Care Workers, or the PEPline page.
No. There is currently no vaccine that will prevent HIV infection or treat those who have it.
No. Microbicides are gels, films, or suppositories that can kill or neutralize viruses and bacteria. Researchers are studying both vaginal and rectal microbicides to see if they can prevent sexual transmission of HIV, but none are currently available for use.
If you are living with HIV, antiretroviral therapy (ART) reduces the amount of virus (viral load) in your blood and body fluids. ART can dramatically improve your health and extend your life, but there are also prevention benefits to treatment: If you have an undetectable viral load you are much less likely to infect others through sex or sharing needles. However, the risk of spreading infection is still not zero, which means that you should still use other prevention methods, such as condoms.
If you are taking ART, follow your health care provider’s advice. Stay in care and always take your medicine when and how you are supposed to.
You should also be aware that your partners may benefit from pre-exposure prophylaxis (PrEP), daily medicine to prevent HIV for people at ongoing risk, or post-exposure prophylaxis (PEP), a 4-week course of medicine to prevent HIV after possible exposure during a single event.
Viral load refers to the amount of HIV in the blood. An undetectable viral load is when the amount of HIV in the blood is so low that it can’t be measured. The goal of antiretroviral therapy (ART) is to reduce viral load, ideally to an undetectable level. If a person’s viral load goes down after starting ART, then the treatment is working.
Having an undetectable viral load is good for an HIV-positive person’s overall health. It also reduces the chance of transmitting the virus to a sexual or drug-using partner who is HIV-negative.
However, people with an undetectable viral load still have HIV in their body, which means there is a chance that they can transmit HIV through sex or sharing needles or injection equipment. An HIV-positive person can infect a partner even if they have an undetectable viral load, because:
HIV may be found in genital fluids (e.g., semen, vaginal fluids). The viral load test only measures virus in blood. Although antiretroviral therapy also lowers viral load in genital fluids, HIV can sometimes be present in genital fluids even when it is undetectable in the blood.
Your viral load may go up between tests. When these “blips” happen, you may be more likely to pass HIV to sexual partners.
Sexually transmitted infections (STIs) increase viral load in genital fluids. This means that an HIV-positive person with an STI may be able to transmit HIV to sexual partners even if the blood viral load is undetectable.
Injecting drugs, including hormones, steroids, or silicone, can transmit HIV directly through needles or equipment (works). In addition, some drugs, such as methamphetamine, cocaine, or alcohol, may put you at risk for HIV by lowering your inhibitions and making you more likely to engage in risky behavior.
The best way to reduce your risk of HIV is to stop using drugs. If you cannot stop using drugs, talk with your doctor or health care provider, counselor, loved one, or someone else you trust about getting into a treatment program. Find a treatment facility near you or call 1-800-662-HELP (1-800-662-4357).
If you are injecting drugs and believe you cannot stop using yet, here are some other ways to reduce your risk of getting HIV or spreading it to others:
Use only new needles, syringes, and other injection equipment (works, such as cookers, cotton, or water) each time you inject. Many communities have programs where you can get new needles and syringes, new injection works, and other new supplies, as well as health care services.
Use only new syringes that come from reliable sources (e.g., pharmacies or syringe service programs/needle-syringe programs).
Never share needles, syringes, or other injection works.
Clean used needles and syringes with bleach only when new ones are not available. Bleaching a used needle and syringe may reduce the risk of HIV but does not eliminate the risk. Needle and syringe programs often provide free bleach kits and can teach you how to use the kit. See Syringe Disinfection for Drug Users for more information.
Use sterile water to prepare drugs. You can buy sterile water from a store. If sterile water is not available, you can use water that has been boiled for 10 minutes or clean tap or bottled water.
Clean the injection site with a new alcohol swab before you inject.
Be careful not to touch another person’s blood.
Dispose of needles and syringes safely after one use. Use a sharps container or make sure to keep used needles and syringes away from other people.
Use condoms correctly and consistently for every act of vaginal, anal, or oral sex.
Get an HIV test at least once every year.
Ask your doctor about pre-exposure prophylaxis, or PrEP. PrEP involves taking certain HIV medicines every day to reduce the risk of getting infected with HIV.
These steps, promoted in prevention programs for substance users, have helped decrease the new cases of HIV resulting from injection drug use in recent years.
One additional prevention note: If you are likely to be in a situation where alcohol and other kinds of drugs will be used, have a condom with you in case you have sex.