We call these “basic” facts but they are still worth checking out and we hope things will be a bit clearer after you’ve gone through them. They are not meant to replace the advice of your doctor and there is obviously a limit to what we can cover. Please This e-mail address is being protected from spambots. You need JavaScript enabled to view it , send us links to your blog, or join our Facebook and Twitter pages to tell us more about your safer sex successes, your HIV journey or anything else you want to share.

 

Fluids which transmit HIV

 

There are only four body fluids that carry a sufficient amount of HIV to be infectious: blood, vaginal fluids, semen and breast milk. Breast milk has a lower amount of HIV than the others, but as babies are usually breast fed for months, this increases the risk.

How does infection with HIV take place?

 

For infection to occur we need to remember the acronym SAD:

 

S = sufficient quantity of the virus. This means only the four fluids above can transmit HIV. But even in these fluids, viral quantity can fluctuate. We know that a newly infected person (in the window period) or someone in the AIDS stage has a higher viral load (concentration of HIV) so this will affect risk of infection. Also, a person on treatment will have a lower viral load if the treatment is working and they are adhering to their medication, making their fluids less infectious.

 

A = access to the bloodstream, for example through a significant cut or sore on the outside of the body, an abrasion, cut or sore inside the body, or introduction into a vein through something like a shared needle when using drugs. Obviously a blood transfusion could be risky if there was HIV in the blood but all blood is tested for HIV before being donated.

 

D = duration of exposure. The longer the exposure, the greater the risk. So for example during sexual intercourse, semen left inside the vagina (or anus) has time to access the bloodstream through micro-abrasions, and there is a large surface area in the vagina (or anus) for the virus to access the bloodstream. On the other hand vaginal fluids (or blood from the anus) can only infect a man during sex, through the relatively small opening of the penis, or through cuts, abrasions or sores on the head of the penis. Remember too that the virus does not survive for long outside of the body – the longer it is outside, the less viable it is. Surprisingly, it’s quite a fragile virus.

 

If you have any doubts, go for an HIV test. In fact go regularly anyway, it’s always best to be on top of your HIV status.

If you have any worries about a sexual encounter, or an event or accident which brought you into contact with the body fluids of another person, and you now have questions about HIV, explore the SAD factors. You will find that a calm analysis will give you a clearer picture of your risk. If you have any doubts, go for an HIV test. In fact go regularly anyway, it’s always best to be on top of your HIV status.

 

Safer sex

 

So we’re calling this safer sex, not safe sex, because we accept that (a) very little, apart from complete abstinence or 100% faithfulness, is safe or even that common, and (b) humans always under-report the risky things they’ve done (they will swear they always used condoms and forget about the time they forgot to use one – thereby casting doubt on the safety of condoms). No, we accept that we are all human, not divine, and we need to be reminded all the time to take care, and to not give up after a slip up. HIV transmission, even where there has been risk, is not always inevitable and there is often a second chance (and sometimes a third one!). Also we know that safer sex cultures develop over time, with the support of other people in our social group.

 

"...a sex positive, harm reduction approach to human sexuality and HIV."

So what you will see reflected in this section, and we hope the whole site, is a sex positive, harm reduction approach to human sexuality and HIV. Humans generally like sex – that’s ok – and need to be encouraged to keep making it safer, even if they are not safe all the time.

 

One of our other human frailties is to imagine we have magical powers, and can tell if someone is living with HIV just by looking at them, or quizzing them about their sexual history, or using other hidden talents. The truth is, it’s almost impossible to guess a person’s HIV status just by looking at them. So the first step on the continuum of “safer” sex is to initiate a conversation about HIV and HIV testing. If you’ve tested too, then you have good grounds to ask someone about their HIV status. If you haven’t, then perhaps you’re just being cheeky and presumptuous.

 

But even if you ask, you may not always be in a better position. Here are some scenarios:

  • They have not tested, but may be HIV negative anyway (perhaps they have always been careful or abstinent or faithful to their previous HIV negative partner).
  • They have not tested and are HIV positive, but have no symptoms.
  • They have tested and they say they are negative: but how do you know they are still negative?
  • They have tested and are HIV positive, but say they are HIV negative because they are afraid of your reaction.
  • They have tested and they say they are HIV positive and healthy and committed to safer sex.
  • They say they have tested but will only tell you their result once they know they can trust you.

 

In all of these scenarios, you could choose from:

  • Waiting to get know them better so that when you do have sex some trust and honesty has developed (bearing in mind that some people are frank and honest straight off)
  • Sticking to non-penetrative sex until you feel ready to have penetrative sex with a condom (or penetrative sex without a condom once you’ve both tested negative and sat out the window period, if appropriate)
  • Having penetrative sex as soon as you both want it, but always using a condom, or some other barrier for oral-genital or oral-anal contact.

I guess we’re also saying that sex in this century, apart from those who completely faithful to their partners, is pretty much going to involve condoms, barriers, latex and lubrication.

Why not make peace with this and make this kind of sex natural and normal? It means less second guessing, fewer awkward questions and more comfort with the mechanics, and voila! You have good sex which is considerate, consensual and safe.

 

Safer sex is not supposed to be boring. If it is, perhaps you need to practice some more! Why not try putting on a condom as part of foreplay? If you are in a heterosexual relationship, have you ever considered using female condoms? Have you tried flavoured male condoms? Have you tried using dental damns during oral-vaginal sex or oral-anal sex? Have you tried sex toys (safely)?

 

Make condoms your friend. Remember too that condoms prevent many STIs and are useful to prevent pregnancy (but an oral or injectable contraceptive should be part of this package).

 

Some condom tips

 

  • It is not “bad” to carry condoms with you to be prepared for spontaneous (or planned!) sex – it’s responsible.
  • Make sure condoms are not expired, that is, become dusty with disuse. Like underwear and milk, condoms should be fresh!
  • Though it is very easy to use a condom, it can become challenging if you are under the influence of alcohol or drugs. Putting the condom onto the lubrication bottle, as cute as that is, is going to protect no one.
  • You can only use a condom once. More than one round (lucky you!) = more than one condom.

 

So whatever safer sex method you use, non-penetrative sex, sex with one faithful person, sex with a closed group of faithful persons (the traditional option is polygamy but there are modern variations on this theme too), or sex with a protective barrier, make sure that you are informed and open-minded. Talk to your partner(s) – being shy or conservative is ok, but the more you talk the easier it gets. And have that darned HIV test, and keep having it.

 

Some symptoms related to HIV

 

So we’ve been talking about testing as part of the package of safe sex. But what if you’ve never tested and you think you’ve got symptoms? A useful way of looking at symptoms is in terms of stages of HIV, but remember that real live humans don’t fit into these neat categories. If you have any doubts, have a test and then you can get the treatment you need, when you need it.

 

The take-home message around symptoms: take them seriously, get them investigated, test for HIV and get on to treatment sooner rather than later.

 

In STAGE ONE the person is HIV positive but has no symptoms, except for some short-term flu-like symptoms which may occur within a few weeks of infection (during the sero-conversion illness when HIV provokes an initial immune response). Stage one may last several years during which the person might have no HIV-related illnesses. But – and this is important – HIV is not dormant. It is replicating in the body and the basics of good nutrition and exercise and general self care (physical, emotional and spiritual) still apply.

 

In STAGE TWO the person begins to develop minor illnesses. Ear infections, frequent flu and skin problems are common at this stage. Always get these treated and keep working on diet, exercise and stress management. While it’s difficult to generalise, this may be the time to start thinking about ARV treatment, with a well informed doctor. Based on CD4 count and viral load, the decision to start treatment at the right time can make an enormous difference.

In STAGE THREE the person may lose a lot of weight and have longer term illnesses. These may include thrush in the mouth, pneumonia, a fever which lasts more than a month and tuberculosis (TB) of the lungs. By now it’s extremely important to start treatment – some ground may have been lost, but better late then never.

 

In STAGE FOUR the person has illnesses due to a very weak immune system. These may include PCP, chronic diarrhoea, toxoplasmosis, meningitis and TB in other parts of the body. It is at this stage that a person is said to “have AIDS.” A person is also said to “have AIDS” if their CD4 count goes under 200. It is preferable for people never to reach this stage – but even here treatment can make a huge difference.

 

The take-home message around symptoms: take them seriously, get them investigated, test for HIV and get on to treatment sooner rather than later.

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