What Your Doctor Wants To Tell You, But Can't (From A Medical Physician)
8 Things Your Doctor Wants You to Do to Protect Against HIV
People who are at high risk of HIV — for example, men who have sex with men, and couples who are in mixed-status relationships (in which one person is HIV positive and the other is HIV negative) — should know how to protect themselves from the virus. What’s important to note, though, is that you can have a healthy relationship (and sex life) with someone with HIV without exposing yourself to the virus.
A growing body of evidence is finding that when people take certain steps, the risk that they will transmit the virus to someone else can be extremely low. But because you can get HIV from even a single encounter, prevention requires an ongoing commitment by everyone involved. Here's what you should know.
Ask Any Partners Whether They Have HIV
Communication is crucial. Before having sex with someone for the first time, make sure that both of you have been tested recently for sexually transmitted infections (STIs), including HIV and other viruses. If your sexual partner is HIV positive, medications are available that can lower the risk that the virus will be transmitted.
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Make Sure Your HIV-Positive Partner Is Taking Antiretroviral Therapy, or ART
These medications can reduce the amount of HIV in a person’s blood to undetectable levels — that is, an amount (less than 200 copies of the virus per milliliter of blood) that can’t be detected by modern technology. If your partner is taking ART and maintaining undetectable levels, the risk that the partner will pass the virus to you during sex may be virtually nonexistent.
This conclusion was demonstrated by the 2019 results of the ongoing PARTNER study: When researchers from Europe recruited more than 1,000 HIV-positive people with undetectable viral loads, they found that during an average of a two-year period,noneof the participants passed the virus to their HIV-negative partners. (Eleven of the formerly HIV-negative people contracted the virus, but researchers determined that they didn’t get it from their partners.)
Know Your Partner’s Viral Load Count
For ART to be effective, your partner has to take the medication consistently — every day, at the same time each day. Skipping doses can cause the virus to replicate unchecked and possibly mutate into a form that’s resistant to your partner’s medication. If that occurs, your partner’s viral load count may increase, which means there is a greater likelihood that the virus can be transmitted to you.
It’s a good idea to encourage your partner to get his or her viral load tested regularly — at least twice a year, if not more often. If the results demonstrate undetectable levels of HIV, then “it’s pretty safe [to have sex]," says Monica Gandhi, MD, MPH, associate division chief of the division of HIV, infectious diseases, and global medicine at UCSF San Francisco General Hospital.
Get a Prescription for PrEP (or PEP)
Short for “pre-exposure prophylaxis,” PrEP is a daily pill that can reduce a person’s risk of getting HIV by up to 92 percent, according to the Centers for Disease Control and Prevention (CDC). If you (or your partner) regularly have sex with someone who is HIV positive, have sex without using condoms, or share needles with others, PrEP can be a powerful tool for preventing the spread of HIV.
If you believe that you were exposed to HIV during sex — for example, if a sexual partner was recently diagnosed with HIV — you can take emergency pills called PEP, or “post-exposure prophylaxis.” A 28-day course of medication, PEP needs to be taken within three days after a potential infection to help “block” the virus from taking root in your body.
Condoms continue to be a recommended method to prevent HIV infection. When used consistently and correctly, they may be 95 to 98 percent effective, according to the CDC. Even if your HIV-positive partner’s viral load count is undetectable, there are plenty of additional reasons to use condoms. Not only do they help prevent an unwanted pregnancy but they protect against other STIs, some of which can increase inflammation and raise your risk of getting HIV. "If you [or your partner] have a genital sore and you're going to have sex that day,” says Gandhi, “use a condom.”
Don't Inject Drugs — But If You Do, Don't Share Equipment
Any time you share a needle with someone — whether you’re injecting steroids, hormones, or drugs — you’re at risk for HIV and other blood infections. And it's not just the needle and syringe that can transmit the virus; a person can also get HIV by sharing the water that’s used to clean the equipment or by reusing filters and other containers. That’s because the equipment or water could contain blood and therefore the virus itself.
The best thing you can do if you use drugs is to seek treatment. For example, if you use heroin, joining a methadone program could help you to manage your addiction without the use of needles, lowering your risk of HIV.
Get Tested for HIV Regularly
If you’re currently HIV negative, it’s important to be tested for any change in your status. If a test shows that you’ve contracted the virus, your risk of spreading it to someone else is greatest in the acute phase, or the first three to four weeks after being infected. During that period, the viral load (a measurement of how “much” HIV is in your blood) spikes, increasing the likelihood of transmitting the virus by as much as 26 times, according to a study published in 2011 in the journalCurrent Opinion in HIV and AIDS.
If You’re Taking Steps to Be Safe, Try to Relax and Enjoy Yourself
The virus is only transmitted in specific ways — mainly through anal or vaginal sex or by sharing needles. There are plenty of ways HIVisn’tspread: for example, by kissing, hugging, or sharing eating utensils, all of which you can do with a loved one who has HIV without worrying about contracting the virus.
And if you know that your HIV-positive partner is on ART and is undetectable, try to forget about HIV during sex, Gandhi says.
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