When your viral load is low, so is your risk of transmitting HIV to others.
Living with HIV has changed drastically over the past couple of decades, and this is especially true when it comes to sex. Thanks to today’s HIV treatments, many people now have viral loads that are “undetectable.” This means there is so little HIV in the blood that standard blood tests don’t pick it up.
What does that have to do with sex? Undetectable viral loads are also untransmissable—meaning you’re unlikely to transmit HIV to your partner during sex.
Safe Sex with HIV
In the past, safe sex with HIV had a lot of guidelines. Condoms were a must. Public health campaigns encouraged tips like withdrawing before ejaculation and using hand stimulation instead of intercourse.
Thanks to antiretroviral therapy (the HIV treatment that prevents the virus from replicating), safe sex with HIV is no longer this prohibitive. People who take their medicines consistently as prescribed by their doctor can achieve low viral loads. That’s the amount of virus in the bloodstream. People with low viral loads have a very low risk of transmitting the virus to a partner who is HIV negative, so sex for them is not much different than for couples without HIV.
Even though people with HIV don’t need to wear condoms to protect their HIV-negative partners, they should still use condoms to protect from other sexually transmitted infections. An exception is when they are with a long-term, monogamous partner. Experts recommend that everyone wear condoms when they have a new partner or multiple partners. This is true whether you have HIV or not.
What to Know About the Risk
As long as the person with HIV is taking their medicine as prescribed and having regular blood tests with their doctor, they should feel confident that their HIV is undetectable and untransmissable.
However, if the person takes their medicine inconsistently or misses a dose, their viral load may go up. This may increase the risk of transmitting HIV to their partner during sex. If this is the case, it’s a good idea to wear condoms or delay sex until a doctor can confirm that they’re undetectable.
Finally, HIV-negative individuals who are dating people with HIV may benefit from taking PrEP. This is a medication that you take daily to prevent HIV infection. You must have it in your system before HIV exposure in order for it to work (similar to how you have to take a birth control pill every day at the same time to prevent pregnancy). Learn more about PrEP to prevent HIV here.
Stella A. Safo, MD, is an HIV primary care physician and assistant professor of Medicine at the Icahn School of Medicine at Mount Sinai Hospital.