5.5. Sex life

HIV is transmitted through unprotected sexual contact. The virus enters the body through the mucous membranes, when there is inflammation or micro-traumas of skin, genitalia or anus. The virus cannot penetrate through healthy, intact skin.

In the absence of treatment — during any kind of sexual contact — the host sexual partner runs more risk of getting HIV than the transmitting partner. Regular sexual contact with a person who has HIV infection, significantly increases the risk of HIV transmission. Women have a higher probability of infection, as a large amount of sperm gets into the vagina, and has longer contact with a larger mucosal surface.

The risk of infection of the host partner through unprotected anal sex is higher regardless of sexual orientation, as the mucous membrane of the rectum is easily traumatized.

The risk of the host partner to get HIV through unprotected oral sex is minimal, and the risk for the active partner is practically equal to zero. However, the risk increases if the corners of the mouth have sores and ulcers.

People coming into an unprotected sexual relationship may not always know their partner's HIV status, and sometimes even their own. Many people find it hard to tell a partner about their HIV status, other sexual relationships and use of injectable drugs.

If you've had unprotected sex with an HIV-positive person who is taking the highly active antiretroviral therapy (HAART) and has an undetectable viral load, the risk of virus transmission is reduced to zero. This has been proven by large-scale international studies HPTN 052 (https://hptn.org/research/studies/33) and PARTNER (http://www.chip.dk/PARTNER).

However, it is not recommended to practice unprotected sex due to the possibility of exposure to other sexually transmitted diseases (STDs, syphilis, gonorrhea, chlamydia, herpes, etc.). Certainly, these infections are treatable, but every new infection puts an additional burden on the immune system, which should be avoided for people living with HIV. Therefore, we recommend that condoms are always used.

Healthy sexual relations are based on mutual responsibility of the parties. Therefore, both partners, regardless of infection status, should regularly undergo a medical examination and follow-up with a doctor. Condoms should always be used, particularly if you unsure whether you or your partner has HIV or other infections. This reduces the potential risks of exposure to HIV and other sexually transmitted diseases (STDs).