Human Immunodeficiency Virus
(HIV Management)
Medical Author (Revision): Eric S. Daar, MD
Medical Editor (Revision): Jay W. Marks, MD
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Unprotected Sex Between HIV-Infected Partners: What's the Harm?
Medical Author: Eric S. Daar, M.D.
Medical Editor: Jay W. Marks, M.D.
 At least once a week, I am asked by one of my HIV-infected patients whether they need to continue to practice safe sex if they are in a monogamous (one mate only) relationship with an HIV-infected partner. Put another way, since both partners already have HIV, what's the harm of unprotected sex? Actually, this is not an easy question to answer fully. My belief, however, is that the best approach is to provide as much information as possible; emphasizing what is known versus what is uncertain. Such a complete disclosure is the only way I can remain credible while allowing the patient to make a fully informed decision.
My response to this question generally begins by telling the patient what is known about the risks of unsafe (unprotected) sex between HIV-infected partners. First of all, we know that in this situation, the spread of other
sexually transmitted diseases (STDs), such as gonorrhea, chlamydia,
syphilis, and
herpes remains a risk, as usual. What's more, these so-called traditional STDs are well known to be associated with serious complications.
Both gonorrhea and chlamydia initially can cause infections of the urethra (urethritis) and anus, or rectum (proctitis). Subsequently, these infections can progress to serious complications in these areas and even spread to other parts of the body. In addition, in women,
gonorrhea and
chlamydia are associated with increased risks of infertility and ectopic pregnancy, which at times can be life-threatening. (An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus; for example, in the tubes.)
Top Searched STDs in Women Terms:
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When was HIV discovered and how is it diagnosed?
In 1981, homosexual men with
symptoms of a disease that now are considered typical of the acquired
immunodeficiency syndrome (AIDS) were first described in Los Angeles and New
York. The men had an unusual type of lung infection (pneumonia) called Pneumocystis carinii (now known as Pneumocystis jiroveci)
pneumonia (PCP) and rare skin tumors called Kaposi's sarcoma. The patients were
noted to have a severe reduction of a type of cell in the blood that is an
important part of the immune system, called CD4 cells. These cells, often referred to as T cells, help
the body fight infections. Shortly thereafter, this disease was recognized
throughout the United States, Western Europe, and Africa. In 1983, researchers
in the United States and France described the virus that causes AIDS, now known
as the human immunodeficiency virus (HIV) and belonging to the group of viruses
called retroviruses. In 1985, a blood test became available that measures
antibodies to HIV that are the body's immune response to the HIV. This blood
test remains the best method for diagnosing HIV infection. Recently, tests have
become available to look for these same antibodies in the saliva and urine, and some can provide results within 20 minutes of testing.
How is HIV spread (transmitted)?
HIV is present in the blood and genital secretions of
virtually all individuals infected with HIV, regardless of whether or not they
have symptoms. The spread of HIV can occur when these secretions come in contact
with tissues such as those lining the vagina, anal area, mouth, or eyes (the
mucus membranes), or with a break in the skin, such as from a cut or puncture by
a needle. The most common ways in which HIV is spreading throughout the world
include sexual contact, sharing needles, and by transmission from infected
mothers to their newborns during pregnancy, labor (the delivery process), or
breast-feeding. (See the section below on treatment during pregnancy for a
discussion on reducing the risk of transmission to the newborn.)
Sexual transmission of HIV has been described from men to men, men to women,
women to men, and women to women through vaginal, anal, and oral sex. The best
way to avoid sexual transmission is abstinence from sex
until it is certain that both partners in a monogamous relationship are not
HIV-infected. Because the HIV antibody test can take up to 6 months to turn
positive, both partners would need to test negative 6 months after their last
potential exposure to HIV. If abstinence is out of the question, the next best
method is the use of latex barriers. This involves placing a condom on the penis as soon as an erection is
achieved in order to avoid exposure to pre-ejaculatory and ejaculatory fluids
that contain infectious HIV. For oral sex, condoms should be used for fellatio
(oral contact with the penis) and latex barriers (dental dams) for cunnilingus
(oral contact with the vaginal area). A dental dam is any piece of latex that
prevents vaginal secretions from coming in direct contact with the mouth.
Although such dams occasionally can be purchased, they are most often created by
cutting a square piece of latex from a condom.
The spread of HIV by exposure to infected blood usually
results from sharing needles, as in those used for illicit drugs. HIV also can
be spread by sharing needles for anabolic steroids to increase muscle,
tattooing, and body piercing. To prevent the spread of HIV, as well as other
diseases including hepatitis, needles should never be shared. At the beginning
of the HIV epidemic, many individuals acquired HIV infection from blood
transfusions or blood products, such as those used for hemophiliacs. Currently,
however, because blood is tested for antibodies to HIV before transfusion, the risk of acquiring HIV from a blood
transfusion in the United States is extremely small and is considered
insignificant.
There is little evidence that HIV can be transferred by casual exposure, as
might occur in a household setting. For example, unless there are open sores or
blood in the mouth, kissing is generally considered not to be a risk factor for
transmitting HIV. This is because saliva, in contrast to genital secretions, has
been shown to contain very little HIV. Still, theoretical risks are associated
with the sharing of toothbrushes and shaving razors because they can cause
bleeding, and blood contains large amounts of HIV. Consequently, these items
should not be shared with infected persons. Similarly, without sexual exposure
or direct contact with blood, there is little if any risk of HIV contagion in
the workplace or classroom.
Next: What happens after an exposure to the blood or genital secretions of an
HIV-infected person? »
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