You can get or transmit HIV only through specific activities. Most commonly, people get or transmit HIV through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers). Babies can also get HIV during pregnancy, birth, or breastfeeding if their mother has HIV. However, not every exposure to HIV carries the same risk, and some sexual activities are riskier than others. Many factors can increase or decrease HIV risk. Also, there are many effective ways a person can reduce their risk of HIV getting or transmitting HIV.
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What is HIV?
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How can I prevent getting orSome sexual activities are riskier than others for getting or transmitting HIV. Anal sex is the riskiest type of sex for HIV transmission. If you don’t have HIV, being a receptive partner (or bottom ) for anal sex is the riskiest sexual activity for getting HIV. If you do have HIV, being the insertive partner (or top ) for anal sex is the riskiest sexual activity for transmitting HIV. There is extremely low to no risk of getting or transmitting HIV through activities like oral sex , touching , and kissing .
If the partner with HIV takes HIV medicine as prescribed and gets and keeps an undetectable viral load , they will not transmit HIV through sex.
What is anal sex? Anal sex is when a penis is inserted into an anus. The partner inserting the penis is called the insertive partner. The partner receiving the penis is called the receptive partner.
Anal sex is the riskiest type of sex for getting or transmitting HIV. Although receptive anal sex is much riskier for getting HIV than insertive anal sex, it’s possible for either partner—the insertive or receptive—to get HIV.
An HIV-negative receptive partner’s risk of getting HIV is very high because the lining of the rectum is thin. HIV can enter the body through this lining during anal sex from body fluids that carry HIV, including semen (cum) or pre-seminal fluid (pre-cum).
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On average, an HIV-negative receptive partner has about a 1 in 70 chance of getting HIV every time they have receptive anal sex with a partner who has HIV.
Being the receptive partner for anal sex is about 13 times more risky for getting HIV from a partner with HIV than being the insertive partner.
For women, anal sex is about 17 times more risky for getting HIV from a man with HIV than vaginal sex.
If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , you will not get HIV through sex with that partner.
An HIV-negative insertive partner is also at risk because HIV can enter the body through the opening at the tip of the penis (or urethra); the foreskin if the penis isn’t circumcised; or small cuts, scratches, or open sores anywhere on the penis. There is some evidence that circumcision decreases a man’s risk of getting HIV during sex.
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On average, an HIV-negative insertive partner has about a 1 in 900 chance of getting HIV every time they have insertive anal sex with a partner who has HIV.
Being the receptive partner for anal sex is about 13 times more risky for getting HIV from a partner with HIV than being the insertive partner.
For men, anal sex with a women with HIV is about 3 times more risky for getting HIV than vaginal sex.
If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , you will not get HIV through sex with that partner.
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An uncircumcised penis still has foreskin. The inner lining of the foreskin is different than other types of skin and has more of the cells that HIV infects. The foreskin may also be easier to tear during sex, providing another way for HIV to infect the body. Also, HIV may be able to survive for a longer time in the space between the foreskin and the penis. There is some evidence that circumcision may decrease the insertive partner’s risk of getting HIV during anal sex. And, being circumcised greatly reduces the risk of a man from getting HIV when having sex with a women who has HIV. Finally, a person with an uncircumcised penis may also have a higher risk of getting other sexually transmitted diseases (STDs), such as syphilis or herpes, which can increase the risk of getting HIV.
Keep in mind that HIV can be found in pre-seminal fluid (pre-cum), which means there’s a risk for either partner to get HIV even if the insertive partner withdraws before ejaculating. Withdrawal before ejaculating may, in theory, reduce the receptive partner’s risk of getting HIV. But it does not change the insertive partner’s risk of getting HIV.
Many things can increase someone’s risk of getting HIV from anal sex besides sexual position (insertive vs. receptive). For example, the HIV-negative partner is more likely to get HIV if either partner has another sexually transmitted disease (STD). Also, if you are HIV-negative and have anal sex with a partner who has HIV, your chance of getting HIV is very high if that partner is not on HIV treatment and does not have an undetectable or suppressed viral load. If your partner with HIV takes HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex.
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You can get other STDs from anal sex even if you use a condom because some STDs are transmitted through skin-to-skin contact. And you can get hepatitis A and B, parasites like Giardia, and other bacteria like Shigella, Salmonella, Campylobacter, and E. coli from anal sex because they’re transmitted through feces.
If you’ve never had hepatitis A or B, there are vaccines to prevent these infections. Talk to a health care provider about your chances of getting hepatitis A or B and whether vaccination is right for you.
Not having sex is a 100% effective way to make sure you don’t get or transmit HIV through sex. If you’re sexually active, you can lower your risk by choosing sexual activities that carry a lower risk for HIV than anal sex. You can also do other things to reduce your risk, including taking medicine to prevent or treat HIV and using condoms the right way, every time. Condoms and medicine to prevent or treat HIV are highly effective at preventing HIV if used correctly. But the medicines are much less effective if you don’t take them as prescribed, and condoms can sometimes break or come off during anal sex. Using a water-based or silicone lubricant can help prevent condoms from breaking or slipping.
Talking openly and frequently with your partner about sex can help you make decisions that decrease your risk of getting or transmitting HIV. Learn more about how to get the conversation started.
Conversation Starters
Certain things about your sex and injection partners can put you at increased risk for getting or transmitting HIV. Explore Estimate the HIV Risk to learn more.
Explore other resources from CDC:
Learn about the Centers for Disease Control and Prevention’s HIV prevention campaigns:
What is vaginal sex? Vaginal sex is when a penis is inserted into a vagina.
When a woman has vaginal sex with a partner who has HIV, HIV can enter her body through the mucous membranes that line the vagina and cervix. Most women who get HIV get it from vaginal sex. Even if a woman’s male partner withdraws or pulls out before ejaculating, she can still get infected because pre-seminal fluid (pre-cum) can carry HIV.
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On average, an HIV-negative woman has about a 1 in 1,250 chance of getting HIV every time she has vaginal sex with a man who has HIV.
On average, a woman with HIV has about a 1 in 2,500 chance of transmitting HIV every time she has vaginal sex with an HIV-negative man.
For an HIV-negative woman, anal sex is about 17 times more risky than vaginal sex for getting HIV from a partner with HIV.
For a woman with HIV, anal sex is about 3 times more risky than vaginal sex for transmitting HIV to an HIV-negative partner.
If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , their partner will not get HIV through sex. See how receptive vaginal sex compares to other sexual activities here.
Men can also get HIV from having vaginal sex with a woman who has HIV. This is because vaginal fluid and blood can carry HIV. Men get HIV through the opening at the tip of the penis (or urethra); the foreskin if they’re not circumcised ; or small cuts, scratches, or open sores anywhere on the penis. There is strong evidence that circumcision greatly reduces the man’s risk of getting HIV during vaginal sex. There is no evidence that circumcision benefits the woman, though more studies are underway.
On average, an HIV-negative man has about a 1 in 2,500 chance of getting HIV every time he has vaginal sex with a woman who has HIV.
On average, a man with HIV has about a 1 in 1,250 chance of transmitting HIV every time he has vaginal sex with an HIV-negative woman.
For an HIV-negative man, anal sex with a woman with HIV is about 3 times more risky for getting HIV than vaginal sex.
For a man with HIV, anal sex with a woman with HIV is about 17 times more risky for transmitting HIV than vaginal sex.
If the partner with HIV takes HIV medicine as prescribed, and gets and keeps an undetectable viral load , they will not transmit HIV through sex.
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Men who aren’t circumcised are more likely to get HIV through vaginal sex than men who are circumcised. When a man isn’t circumcised, he still has the foreskin on his penis. The inner lining of the foreskin is different than other types of skin on the body and has more of the cells that HIV infects. The foreskin may also be easier to tear during intercourse, providing another way for HIV to infect the body. In addition, HIV may be able to survive for a longer time in the space between the foreskin and the penis. Finally, uncircumcised men also have a higher risk of getting sexually transmitted diseases, such as syphilis or herpes, which can increase the risk of getting HIV.
Keep in mind that HIV can be found in pre-seminal fluid (pre-cum), which means there’s a risk for either the man or the woman to get HIV even if the man withdraws before ejaculating. Withdrawal before ejaculating may, in theory, reduce the woman’s risk of getting HIV. But it does not change the man’s risk of getting HIV.
Many things can increase someone’s risk of getting HIV from vaginal sex . For example, the HIV-negative partner is more likely to get HIV if either partner has another sexually transmitted disease (STD). Also, if you are HIV-negative and have vaginal sex with a partner who has HIV, your chance of getting HIV is very high if that partner is not on HIV treatment and does not have an undetectable or suppressed viral load. If your partner with HIV takes HIV medicine as prescribed and keeps an undetectable viral load , they will not transmit HIV through sex.
Taking medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP ) can reduce your risk of getting HIV, and using condoms the right way every time you have sex can reduce your risk of getting both HIV and other STDs like gonorrhea and chlamydia that are transmitted through body fluids.
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Condoms provide less protection against STDs that spread through skin-to-skin contact like human papillomavirus or HPV (genital warts), genital herpes, and syphilis.
Not having sex is a 100% effective way to make sure you don’t get or transmit HIV through sex. If you’re sexually active, you can lower your risk for HIV by choosing sexual activities that carry a lower risk for HIV than vaginal sex. You can also do other things to reduce your risk, including taking medicine to prevent or treat HIV and using condoms the right way, every time. Condoms and medicine to prevent or treat HIV are highly effective at preventing HIV if used correctly. But the medicines are much less effective if you don’t take them as prescribed, and condoms can sometimes break or come off during vaginal sex. Using a water-based lubricant can help prevent condoms from breaking or slipping.
Talking openly and frequently with your partner about sex can help you make decisions that may decrease your risk of getting or transmitting HIV. Learn more about how to get the conversation started.
Conversation Starters:
The only way to know for sure if you have HIV is to get tested . Before having sex for the first time, you and your partner may want to get tested for HIV and learn the results. Be aware that there’s a window period , which is the time between when a person gets HIV and when most HIV tests will show that a person has it. If you have sex before you learn your test results, using a condom the right way every time you have sex can lower your risk for getting or transmitting HIV.
If you learn that you have HIV, the most important thing you can do is to take antiretroviral therapy (ART) as prescribed. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. ART can reduce the amount of HIV (viral load) in your body. Taking ART as prescribed can make your viral load so low that a test can’t detect it. This is called an undetectable viral load. If you keep an undetectable viral load , you can stay healthy for many years and will not transmit HIV through sex.
If you have HIV, the most important thing you can do is be on treatment. If you take ART as prescribed and keep an undetectable viral load, you can stay healthy and will not transmit HIV through sex. If you’re taking ART, follow your health care provider’s advice. Visit your health care provider regularly and take your medicine as prescribed. This will give you the greatest chance of having an undetectable viral load. Even if you have undetectable viral load, you or your sex partner may want to use additional prevention options. Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or having your partner take medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP ) can provide added peace of mind. Also consider using additional prevention methods if you
• Are unsure, for any reason, that you have an undetectable viral load
• Have a higher viral load (200 copies/ml of blood or greater)
• Have trouble taking HIV medicine regularly
• Missed some doses since your last viral load test
• Have stopped taking HIV medicine or may do so in the future
If your partner has HIV, encourage your partner to take ART too.
If you’re HIV-negative and have a partner with HIV who is taking ART as prescribed, they will not transmit HIV to you through sex as long as they keep an undetectable viral load. Even if your partner has an undetectable viral load, you or your sex partner may want to use additional prevention options. Using a condom the right way every time you have sex can protect you from other STDs. Using condoms or taking medicine as prescribed to prevent HIV (called pre-exposure prophylaxis or PrEP ) can provide added peace of mind. Also consider using additional prevention methods if you are unsure, for any reason, that your partner has an undetectable viral load.
You and your partner should learn about all the available prevention options and make the decisions that are right for both of you.
If you’re not taking PrEP , you can take post-exposure prophylaxis (PEP) if you have a recent possible exposure to HIV. For PEP to work, you must start it as soon as possible, and always within 72 hours of a recent possible exposure.
Having multiple sexual partners increases your risk for HIV. The more sexual partners you have in your lifetime, the more likely you are to have a sex partner with HIV who does not know their status, is not taking medicine to treat HIV, and/or does not have an undetectable viral load. It also increases the chances that you have a partner who has another STD.
Having other STDs increases your risk for getting or transmitting HIV.
Sharing needles, syringes, or other drug injection equipment (for example, cookers) increases your risk for getting or transmitting HIV.
