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Unprotected sex
   Last updated: 21.12.05
 
Unprotected sex is any form of anal, oral or vaginal sexual contact which does not involve the use of a male or female condom or similar barrier. HIV and sexually transmitted diseases infections (STIs) can be passed on via by unprotected sex. Unprotected penetrative (the insertion of the penis into the body of another person) anal and vaginal sex carries the greatest risk of STIs, however, infections can also be transmitted through oral sex (mouth to genitals), and oral-anal sex (mouth to anus), also called 'rimming.' For oral sex, some people choose flavoured condoms. For anal sex, it is very important that condoms are used with plenty of water-based lubricant, you should never use oil based lubricants as these weaken the rubber in condoms. Spermicides with nonoxynol-9 should be avoided as these cause irritation making it more likely that HIV or an STI can be passed on.

Unprotected sex with HIV-negative and untested people
If you are HIV-positive, using condoms during sex with people who know that they are HIV-negative or are unsure of their HIV status will protect them against HIV and protect both of you from STIs. Even if you are taking anti-HIV drugs and have an undetectable viral load in your blood, you may still have enough virus in your semen or vaginal fluids to pass on HIV. You should also be aware that in some countries including certain states of the USA you are legally required to disclose your HIV status to sexual partners. In the UK people have been recently been sent to prison after infecting their sexual partners with HIV after failing to disclose their HIV status.

Sex with other HIV-positive people
If you are HIV-positive and having sex with another person who is also HIV-positive, many health promotion experts and HIV and sexual health doctors will recommend that you still continue to use condoms because:

  • There is a risk of pregnancy as a consequence of unprotected vaginal sex between men and women. There is a risk of transmission to the baby, when an HIV positive man has unprotected sex with an HIV negative woman who is pregnant or breast-feeding. See Fact Sheet 31, 'Mother to Baby Transmission' and 54, 'Pregnancy and Contraception' for more information.


  • There is growing evidence that it is possible to be super-infected with a new strain or strains of HIV, which may either be more aggressive than or resistant to anti-HIV drugs. This could lead to the failure of treatments that might otherwise have been effective. This applies to both men and women.


  • Unprotected sex puts you at risk of other sexually transmitted infections. This applies to both men and women.


Sexually transmitted infections (See Fact Sheets 25, 'Herpes,' 57, 'Chlamydia,' 58, 'Gonorrhoea,' 59, 'Syphilis,' and 60, 'Genital Warts' and Fact Sheets 37, 'Hepatitis B,' and 38, 'Hepatitis C' for more information).

Bacterial STIs, such as gonorrhoea, and chlamydia can be treated just as easily and successfully in most people with HIV as in people who are HIV-negative, provided that they are diagnosed and treated. Failure to get prompt treatment can lead to infertility and in some cases damage to the internal organs. Syphilis, particularly in people with severely damaged immune systems can be harder to diagnose and cure and can be more aggressive when the immune system is damaged. There have been syphilis outbreaks, particularly amongst gay men, across western Europe and north America in the past few years and gay men with HIV have been disproportionately affected. In eastern Europe, and much of the rest of the world, syphilis predominately affects heterosexuals and is also linked to increased risk of HIV infection, along with other treatable ulcerating diseases such as chancroid and donovanosis.

There are also viral STIs. Genital herpes and genital warts are not curable, even in people who are HIV-negative. Although both these infections will respond to treatment, they can reoccur and can be harder to control if you have a severely damaged immune system. Genital herpes is linked to an increased risk of HIV transmission, especially when ulcers are present. Some strains of the virus which cause genital warts have been linked with the development of genital cervical and anal cancers.

The liver viruses hepatitis A and B and (less easily) C, can also be passed on sexually and can be more complicated in people with HIV. Hepatitis can cause liver damage which can limit HIV treatment options and make you very unwell in its own right. There are vaccines for hepatitis A and B (but not C), which should be available at your HIV treatment centre. Gay men in particular are advised to be vaccinated against hepatitis A and B. After you have been vaccinated it is important to have your immunity to hepatitis A and B checked regularly, as the vaccines do not offer permanent protection.

Some of the opportunistic infections which affect people with HIV can be passed on through sex. Karposi's sarcoma is thought to be passed on sexually through a form of herpes virus. Both HIV-positive and negative people can be affected by gut infections such as Giardia, amoebas (small parasites which live in the gut and cause diarrhoea), cryptosporidium and microsporidium which can be passed on through oral-anal contact or any sexual activity which leads to contaminated faeces getting into the mouth. These infections can cause very severe diarrhoea which is particularly in people with badly damaged immune systems.

Having an active, untreated STI increases the amount of HIV in the genital fluids, making HIV easier to pass on if you have unprotected sex. It is recommended that all sexually active people have regular sexual health check-ups. Many HIV treatment centres have sexual health clinics attached, which in the UK offer free and confidential testing and treatment.