Safer Sex

Safer sex is a good way to prevent the transmission of HIV. As long as you use condoms when having intercourse with your partner and keep to the other rules for safer sex, you do not need to worry.

In addition, if you are successfully on HIV treatment, only very low levels of the virus are present in your bodily fluids. The chance that you will pass on HIV is therefore much lower than if you are not on treatment.

Even if you know that your partner is also HIV-positive, there may be good reasons in some circumstances to use condoms. Condoms reduce the risk of contracting other sexually transmitted infections such as syphilis, gonorrhea and especially hepatitis C, which is difficult to treat.

Safer sex accidents

Even if you keep practice safer sex, things can go wrong. Condoms can tear or come off, for example.

This kind of "accident" doesn't automatically mean that HIV will be transmitted. Whether or not it is depends on many factors, such as the level of the virus in bodily fluids, especially in semen, vaginal fluids and rectal mucous membranes.

It is also possible to lower the risk of infection after the event. To do this, the HIV-negative partner takes a four-week course of HIV treatment, which can prevent the virus becoming established in the body and the person remains HIV-negative. This treatment is called post-exposure prophylaxis, or PEP for short.

It is important to begin PEP as soon as possible after exposure to HIV. You can find more information about it here.

Multiple infections/"Superinfection"

In some situations, if your partner is also HIV-positive, it is possible for you to infect each other with different types of HIV. An infection with several types or strains of virus is called a multiple infection.

It is not yet clear how often this happens and what long-term consequences multiple infection could have.

The risk of a multiple infection is probably higher in the first year after first becoming infected with HIV. Once the HIV infection has been established for longer, the risk appears to be lower.

With superinfection, types of virus that are resistant to certain drugs are also transmitted. This limits your options in HIV treatment. We recommend that you continue to protect yourself by using condoms.

If at least one partner is undergoing effective HIV therapy, a multiple infection is very unlikely (see also “viral load method”).

Responsibility

Responsibility is not an easy question. We are not only responsible for ourselves, but for others as well. At the same time, everyone is primarily responsible for protecting themselves during sex.

Legally, however, the situation can look quite different. You can find more information about HIV and criminal law here.

In practice, of course, the question of who is capable of assuming responsibility in a particular situation may also play a role. If your partner has had a lot to drink or is swept away in the heat of the moment, you may be able to maintain a cool head - and vice versa.

If something goes wrong, so-called PEP  can considerably reduce the risk of HIV transmission after the event. In this situation, behaving responsibly means telling your partner that they may have been exposed to HIV and telling them about the option of PEP.

"Viral load method"

HIV treatment considerably reduces the level of the virus in bodily fluids such as semen and vaginal fluid. This also strongly reduces the risk of HIV transmission.

Under the following conditions, it is almost impossible for HIV to be transmitted:

• You are taking a combination therapy that is working well and you take your treatment in the right way.

• Your viral load has been undetectable for at least six months. That means that a laboratory test can no longer detect the virus in your blood.

• You and your partner do not have any other sexually transmitted diseases.

If you, together with your doctor, can be sure these conditions are met, sex without condoms also counts as safer sex.

Some couples in which one partner is HIV-positive then stop using condoms. Before taking this decision, it's important that both partners they have discussed it carefully, that they feel comfortable and happy about it and that neither of them has any concerns about it.