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Table of Contents
- What Is Safer Sex?
- Practicing Safer Sex
- No-Risk Safer Sex Activities
- Other Safer Sex Tips
- Thinking It Through
What Is Safer Sex?
Safer sex can be fun, exciting, and very pleasurable. It can make your sex more relaxed and satisfying, by decreasing your worry about getting or spreading sexually transmitted infections or diseases (STIs or STDs). It is also a great chance to add variety to your sex life, and to build trust and intimacy with your partner(s) by talking about each other’s desires.
If all partners are living with HIV, safer sex can reduce the chances of getting another strain of HIV that is resistant to the HIV drugs you are taking.
Some health conditions, which may become serious without treatment, can be passed from one person to another through sex. Safer sex is sex that reduces the chances of transmitting or getting STIs, including HIV. It involves certain actions (e.g., using a condom) that prevent person-to-person sharing of bodily fluids which can spread STIs. Choosing to have safer sex shows that you care about the pleasure and health of yourself and your sexual partner(s).
For people living with HIV, safer sex is important because it can prevent infection with other STIs that can weaken the immune system. If all partners are living with HIV, safer sex can also reduce the chances of getting another strain of HIV that is resistant to the HIV drugs you are taking. Taking HIV drugs is also a part of safer sex for people living with HIV. When a person's viral load has reached undetectable levels (not enough HIV in their bloodstream for a standard test to measure), they cannot transmit HIV to anyone through sex.
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Practicing Safer Sex
Practicing safer sex involves knowing what bodily fluids can spread sexually transmitted infections, what sexual activities are risky for each person, and how you can make that activity less risky. Bodily fluids that can spread STIs include blood (including menstrual blood), vaginal secretions, semen (cum and pre-cum), and anal fluids.
For people who are HIV-negative, taking HIV drugs can protect against acquiring HIV if they are exposed to the virus.
Researchers have also found that hepatitis C can be sexually transmitted through anal sex even when there is no blood.
One part of safer sex is using barriers to prevent passing fluids into another's body. Barriers include condoms (male or internal, also called female, condoms), dental dams (thin squares of latex), and latex or nitrile gloves. There are also several sexual activities that do not pass sexual fluids or blood between bodies and therefore pose virtually no risk of transmitting STIs.
Other than barrier methods, which some people or their partner(s) may not wish to use, there are now several other options to protect against acquiring or transmitting HIV during sex. Treatment as prevention, or TasP, refers to ways in which we can use HIV drugs, or HIV treatment, to lower the risk of transmitting HIV. After many years of research and evidence, we now know that a person living with HIV who is taking HIV drugs and is virally suppressed (has an undetectable viral load) is unable to transmit HIV to a sexual partner. For much more information on this exciting development, see our Undetectable Equals Untransmittable fact sheet.
For people who are HIV-negative, taking HIV drugs can protect against acquiring HIV if they are exposed to the virus. Such prevention includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP means taking HIV drugs before potentially being exposed to HIV. It involves taking a pill every day, much the same way you might take birth control pills, or getting a shot every two months. PrEP is a tool that women can use without their partners' knowledge or cooperation. Post-exposure prophylaxis (PEP) refers to taking HIV drugs for about a month starting within 72 hours (3 days) after possible exposure to HIV (e.g., unprotected sex, meaning sex without barriers or treatment-as-prevention methods), to prevent HIV acquisition.
Recent research shows that in any act of sex, a partner who is living with HIV and has an undetectable viral load will not transmit HIV. However, other STIs or unwanted pregnancies may also be a factor. HIV treatment as prevention cannot prevent STIs besides HIV and does not keep a person from getting pregnant. See our fact sheets on Birth Control and STIs for more information.
If you are unaware of your or your partner's viral load, or the viral load is detectable, it can be helpful to know which sexual acts are riskier than others for transmitting HIV. The risk for a specific sexual act is determined by what bodily fluids are exchanged and what part of the body is involved. Below is a list of common sexual activities, their risks, and tips for making them safer:
Receptive vaginal-penile sex, or heterosexual intercourse, refers to sex in which the penis goes into the vagina. It is considered a high-risk activity when barriers or treatment-as-prevention methods are not used. Worldwide, it is the most common way that HIV is spread worldwide. While it is high risk for both women and men, men living with HIV are much more likely to transmit HIV to women than women living with HIV are to transmit HIV to men.
One effective way to make vaginal-penile sex safer is to use a condom ("rubber"). There are two main types of condoms: male condoms and internal (female) condoms. Most male condoms are made of latex; some are made of polyurethane or polyisoprene (types of plastic) or lambskin. Lambskin condoms can prevent pregnancy; however, they do NOT prevent HIV transmission. Only latex and plastic condoms prevent the transmission of HIV.
Male condoms come in a variety of shapes, sizes, colors, textures, and even tastes. They are generally inexpensive and can be found at pharmacies, grocery stores, sex stores, and online. Sometimes they are available for free at certain health clinics and AIDS service organizations. They are also quite small and easy to carry with you, so that you can always be prepared to protect yourself.
Internal condoms are made of latex or polyurethane and can be put inside the vagina or the anus ("butt") before you begin sexual activity. They usually cost more than male condoms and are often available at pharmacies, grocery stores, and sex stores. They are also available for free at certain health clinics and AIDS service organizations.
To make vaginal-penile sex even safer, consider using lubricant (lube). Lube can prevent the condom from breaking and also helps prevent small cuts or tears in the vagina and on the penis during penetration. Lube is good for un-lubricated condoms as well as ones that come already lubricated; sometimes the lubrication on the condom is not enough. Condoms lubricated with the spermicide Nonoxynol-9 (N-9) are no longer recommended. They have a shorter shelf life, do not decrease pregnancy more than other lubricated condoms, and may cause irritation of the vagina or rectum (which increases HIV risk).
When using latex condoms, use only water- or silicone-based lube. Do not use oil-based lubes like Vaseline, Crisco, shea butter, coconut oil, or baby oil because these weaken the condom and make it more likely to break. Silicone-based lube will last longer than water-based lube. Lube can also make the condom feel better. There are several types and brands of lubes, with a variety of different feels and tastes. Some also contain substances that "warm" or enhance sensation. For more information on using condoms, see our fact sheet on Talking to Your Partner about Condoms.
If you are not using a condom, you can avoid getting semen in the vagina by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm or ejaculation. Therefore, having a man pull out before he comes does not guarantee that you will not acquire HIV or other STIs that are spread through male sexual fluids.
Receptive anal-penile sex refers to sex in which the penis enters the anus or butt-hole. It is a high-risk activity when barriers or treatment-as-prevention methods are not used. While the risk for the insertive partner is lower than for the receptive partner, it is still risky. As with vaginal-penile sex, a highly effective way to make anal-penile sex safer is to use a condom and lube.
When using latex condoms, use only water- or silicone-based lubricant to prevent the condom from breaking and help it feel better. Lube will also help prevent small cuts or tears to the rectum, anus, or penis during penetration. Do not use oil-based lubes like Vaseline, Crisco, shea butter, coconut oil, or baby oil with latex condoms because these weaken the condom and make it more likely to break. There are several types and brands of lubes, with a variety of different feels and tastes.
If you are not using a condom, you can avoid getting semen in the anus by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm. Therefore, having a man pull out before he comes does not guarantee that you will not get HIV or other STIs that are spread through male sexual fluids.
Oral sex involves contact between the mouth and the genitals. It includes giving or receiving licking, sucking, or biting of the vulva (vagina, clitoris, and labia, or "lips"), penis, or anus. A number of studies have demonstrated a low but definite level of risk associated with both giving and receiving oral-penile sex. For more information, see our fact sheet on Oral Sex and HIV: What's the Real Risk?
To make it safer, use an unlubricated latex condom (one that does not have lube on it). If you perform oral-penile sex without a condom, finish up with your hand (mutual masturbation), or spit semen out and rinse with mouthwash rather than swallowing.
There have been very rare, but documented cases of HIV being spread from female-to-male and female-to-female during oral-vaginal sex. To make oral-vaginal sex safer, use a dental dam or a condom that has been cut open. Dental dams are squares made from latex. Put some water- or silicone-based lube on one side of the dental dam or cut-open condom. Then stretch the dam or condom over the vulva with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the vulva. Some people use plastic food wrap instead of dental dams or cut-open condoms. Plastic food wrap may prevent the transmission of herpes infections, but there is no proof that it can prevent the transmission of HIV.
Oral-anal sex has been shown to transmit hepatitis A, hepatitis B, and hepatitis C, as well as other infections. To make oral-anal sex safer, use a dental dam or a condom that has been cut open. Put some water- or silicone-based lube on one side of the dental dam or cut-open condom. Then stretch the dam or condom over the anus with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the anus.
If you do not use a barrier during oral sex, avoid getting pre-cum, semen, menstrual blood, or vaginal fluids in your mouth. Avoid oral sex on a woman who is menstruating (having her period) to prevent contact with blood. Bleeding gums, ulcers, or gum disease can make oral sex much riskier. Also, do not floss or brush your teeth just before oral sex; use a breath mint instead.
Sex with Sex Toys
It is also possible to transmit or get sexually transmitted infections while sharing sex toys. Many people like to use vibrators, dildos, butt plugs, and strap-ons as part of sex play. Sex toys need to be kept clean, whether they are used alone or with partners. If they are not cleaned after each use, they can grow bacteria and cause an infection. Because sex toys are made of different materials – silicone, rubber, vinyl, metal, etc. – they must be cleaned in different ways. Be sure to read the instructions on the package insert to see how to clean your toy properly.
As with other forms of sex, making sex toy play safer involves using a barrier to prevent each person’s bodily fluids from touching the other person. The best way to keep dildos, vibrators, and butt plugs clean is to use them with a latex condom. Be sure to use a fresh condom whenever the toy is used by a different person or in a different location (e.g., moves from vagina to anus or vice-versa). Having sex toys that are not shared and only used by one person can reduce the chances of passing STIs between partners. However, it is still important to clean the toy after each use and to use a fresh condom whenever the toy is used in a different location on the body.
It also helps to use lube with sex toys, both to enhance pleasure and to reduce damage to the tissues that line the vagina, mouth, anus, and rectum. Do not use oil-based lubes like Vaseline, Crisco, shea butter, coconut oil, or baby oil with latex condoms because these weaken condoms and make them more likely to break. Also, do not use silicone-based lube with silicone sex toys, because the lube will destroy the toy.
Fisting, Handballing, or Fingering
Paper cuts and other openings in the skin can make your hands vulnerable to infection. Wearing latex or nitrile gloves keeps you protected during hand-vagina, hand-penis, or hand-anus sex. Adding water- or silicone-based lube to the outside of the gloves can increase your partner’s pleasure.
No-Risk Safer Sex Activities
These activities do not spread STIs because there is no physical contact with another person's bodily fluids:
- Masturbation: touching your own genitals
- Phone sex, cybersex, talking dirty, and sharing sexual fantasies
- Intimacy without sex: hugging, touching, massage
Other Safer Sex Tips
Sometimes the safest thing you can do is have a clear head.
Repeated or rough vaginal, anal, and oral sex play can cause damage to the linings of these areas. Since these linings are the body’s protection against STIs, damaging or tearing them can increase the chance of being exposed to a bodily fluid that carries HIV or another STI. Seek medical attention for any infections or health problems in the genital area.
Sometimes the safest thing you can do is have a clear head. When you are under the influence of drugs or alcohol, you may be more likely to have sex that risks transmission of HIV. It is also a good idea to plan ahead: get your safer sex items (condoms, dental dams, gloves, lube, prescription for daily PrEP, etc.) before you find yourself in a sexual situation where you may need them.
Thinking It Through
It can be helpful to think through things that make it difficult for you to practice safer sex. Doing this can help you be safer when you find yourself in a sexual situation. Because our thoughts affect how we act, it can also be helpful to think about things in new ways. Here are some examples:
- "We slipped once and forgot to use a condom, so it is too late now."
- New idea: It is never too late. Yes, even one time can be dangerous, but it is not as dangerous as many more times! If you slipped once, it is time to get back on the wagon. Post-exposure prophylaxis, or PEP, may also be an option.
- "Safer sex is such a drag. It is no fun."
- New idea: Here is a great chance to spice up your sex life. Why not take one of the workshops offered on "Eroticizing Safer Sex?" How about getting a book or DVD about hot safer sex?
- "Even though I'm taking HIV drugs and my viral load is undetectable, I am still worried that my partner will get HIV from me."
- New idea: Undetectable Equals Untransmittable! Feel free to let go of the decades of fear-based messages about HIV risk. While HIV drugs do not prevent other STIs or pregnancy, you and your partner(s) can rest easy and enjoy each other knowing that HIV transmission is not an issue.
- "I cannot feel anything through condoms!"
- New idea: Time to change brands! Getting free condoms at the health clinic or buying them at a drugstore may be cheap, but you are probably not getting the best around. Try some of the variety packs offered by mail-order sex supply catalogs or hit the "adult love" stores in your area for a better selection. The best condoms are thin but tough and transmit heat and sensation well.
- "Condoms are the method I want to use, but my partner absolutely refuses to use one."
- New idea: How comfortable are you with someone who is willing to put your health and life at risk? This sounds like a serious issue, and it is probably not the only one in your relationship. Have you considered individual or couple counseling? You may want to see our fact sheet on Talking with Your Partner about Condoms and also consider taking PrEP if you are HIV-negative. Otherwise, how about inserting an internal condom before sex begins? Or perhaps you could offer to put a condom on his penis with your mouth to make the idea more enticing.
- "I’m afraid that my partner will hurt me if I suggest that he use a condom."
- New idea: If you feel threatened, please read our fact sheet on Violence Against Women. How comfortable are you being with someone who may hurt you? This sounds like a serious issue beyond just condom use. You may also want to consider taking PrEP if you are HIV-negative.
Most importantly: if you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)]. You can also search for a safe space online at Domestic Shelters.
- "I cannot suggest to my partner that we get an HIV test. He or she would take it as an insult."
- New idea: How about presenting it as an act of love? "You know, I really love you. We have been together for a while, but we never got tested for HIV. I hate the thought that I could be putting you at risk, because I could not stand to hurt you. Why don't we go get tested together for our peace of mind?" Taking PrEP is also an option if you are HIV-negative.