Preventing HIV Transmission

Who is at risk of HIV infection?

Anyone can become infected with HIV. In the United States at large and in Washington State specifically, men who have sex with other men account for most people living with HIV and most new cases of HIV. Women who have sex with men, men who have sex with women only, and people who inject drugs make up smaller but significant proportions of the HIV epidemic. African-Americans are disproportionately affected by HIV; black men who have sex with men and transgender women have some of the highest rates of new HIV infections.

Very few infants are born with HIV in the U.S. today (about 100-150 infants acquired HIV from their mothers in 2014); however, there are many young adults living with HIV today who acquired HIV from their mothers, particularly before availability of HIV medications and widespread HIV testing during pregnancy helped to reduce rates of maternal-to-child transmission.

About 1.2 million people are living with HIV in the US; about 12,000 people are living with HIV in Washington State; and about 7,500 people are living with HIV in King County [2014 WA/King County HIV/AIDS Epidemiology Report].

Anyone who has condomless, receptive anal or vaginal intercourse or who injects drugs is at risk for acquiring HIV.

Factors that can increase a person’s risk for acquiring HIV include:

Via Sex:

  • STDs the presence of other sexually transmitted infections, such as Chlamydia, gonorrhea, syphilis, herpes, or HPV can greatly increase a person’s susceptibility to getting HIV. It is important to get tested for STDs regularly if you are sexually active, especially if either you or your partner have other sexual partners.
  • Drugs — injected or not — can also increase a person’s risk for acquiring HIV by impairing judgment, decision-making ability, and/or by enhancing sexual drive. People who are drunk or high often take more risks than if they were sober.
  • Multiple Sex Partners – a person who has more sexual partners is more likely to be exposed to STDs, including HIV.
  • Having receptive sex – women who have receptive anal or vaginal intercourse and men who have sex with men that sometimes or often “bottom” during anal sex are at higher risk than people who only have insertive sex with their partners.
  • Having a partner from a high prevalence group – rates of HIV are high in some regions of the U.S. and in certain populations (among men who have sex with men or among black men in the South, for example). If your partner(s) come from a place or a population that has a high background rate of HIV, safer sex practices may be particularly important for you even if you have few sexual partners.

Via Drug Injection:

  • Sharing needles or injecting with a used-needle – if you aren’t sure a needle is clean and new, you may be at high risk of being exposed to HIV and other infections spread by blood, such as Hepatitis.
  • Sharing other injection works – Any injecting equipment that touches blood can spread HIV, so sharing works such as cottons, cookers, water, or tourniquets can increase your risk of being exposed to HIV or other infections spread by blood, such as Hepatitis.

How can HIV transmission via injection drug use be prevented?

The surest way to completely avoid HIV infection from injection drug use is to abstain. The next surest way is to use a new needle/syringe and clean works (e.g. cottons, cookers, tourniquets, water) every time you inject. Though it may not be as effective as using new/clean needles, properly bleaching a used syringe and needle may help prevent HIV transmission.

Another way to reduce the risk of acquiring HIV is to reduce the amount and frequency that drugs are injected. If someone who injects drugs is able to inject less frequently, their chances of being exposed to HIV declines. For these reasons, programs that help treat drug addiction can be helpful. Opioid replacement therapies (such as methadone or buprenorphine) for people with dependence on heroin or other opioid medications have been found to be effective at reducing the risk of HIV.

Where can free, clean needles, syringes, and works be obtained?

There are multiple needle exchange programs within King County. For general information about needle exchange, call 206-263-2000 or visit this website for detailed schedules and locations.

How can sexual transmission of HIV be prevented?

The Basics:

  • The surest way to avoid the sexual transmission of HIV infection is to abstain from sexual activity with other people.
  • The next surest way is to have sex with only one partner who is known to be HIV-negative and who only has sex with you.
  • There are many sexual behaviors that pose no risk of transmission, such as skin-to-skin touching, kissing, body rubbing/massage, and mutual masturbation.
  • In addition, there are many highly effective ways to reduce the risk of HIV transmission via penetrative sex; however, no one method is 100% effective.

Ways to reduce the risk HIV Transmission via oral, anal, or vaginal intercourse:

  • Use condoms consistently.Condoms, and other barrier methods such as dental dams for oral sex (including oral-anal sex), are effective at preventing HIV transmission if used consistently and correctly. Condoms have the added benefit of preventing transmission of other STDs, which is important because concurrent STDs can greatly increase your susceptibility to acquiring HIV.
  • Get tested for HIV regularly and help ensure sexual partners do as well. In the U.S. as many as one in seven people living with HIV don’t know it yet.
    • How often should you get tested? That depends on your level of risk for HIV. You can always ask your provider or the Madison Clinic Health Educator for advice about how often to test. Here are some basic guidelines:
      • Everyone ages 13-64 should be tested for HIV at least once.
      • Anyone who has had sex with a new partner in the past year or who injects drugs should get tested at least once per year.
      • Sexually active gay and bisexual men may need testing every 3-6 months depending on their sexual practices.
    • This website lists places a person can get tested for HIV in King County.
    • Schedule a free HIV testing appointment at Madison Clinic by walking-in to the front desk, calling 206-744-5100 and asking for “rapid HIV testing,” or calling the Madison Health Educator (206-744-5564)
  • Learn about Pre-Exposure Prophylaxis (PrEP)and consider talking to a provider. PrEP is a daily medication that can help protect someone from HIV. PrEP is most effective if a person taking it can take it every day as prescribed without missing doses. Some groups of people who could consider PrEP include:
    • Anyone in an ongoing sexual relationship with an HIV+ partner.
    • Anyone man or trans person who has sex with men who has had a bacterial STD (such as syphilis or gonorrhea) in the past 6 months.
    • Anyone who has condomless intercourse with partners who are HIV+ or whose HIV status is not certain.
    • People who inject drugs who meet any ONE of these critieria:
      • Shared any needles, syringes, or works in past 6 months.
      • Been in a methadone or suboxone program in the past 6 months.

Learn more about PrEP at the websites listed here: HIV – Sexual Transmission and Prevention.

  • Talk to your partners. Someone who is HIV-positive is not necessarily a high-risk partner if they are taking anti-HIV therapy (Treatment as Prevention).People who are HIV-positive can reduce the risk of transmitting HIV to their partners by taking medications to treat HIV. Someone who is on these medications, is being followed by a provider, is taking their medications as prescribed, and is getting bloodwork regularly to make sure the medications are safe and effective is very unlikely to transmit HIV to others via sex. This prevention method is often called Treatment as Prevention because the same medications that help an HIV-positive person stay healthy also help to prevent the spread of HIV to others. Learn more about the efficacy of Treatment as Prevention at the websites listed here: HIV – Sexual Transmission and Prevention.
  • Someone who has been exposed to HIV via sex or contact with blood can seek out Post-Exposure Prophylaxis (PEP). PEP is a month-long course of HIV medications that, if started within 72 hours of an exposure (the sooner the better), can help decrease the likelihood that the exposure will lead to an HIV infection. The Harborview Emergency Department and Madison Clinicwork closely together to provide PEP to people who have been exposed to HIV. It is important that a person receiving PEP be followed by a provider during the course of medications and afterward for HIV-testing.
    • Learn more about PEP here.
    • How to access PEP: Someone who has had an exposure to HIV within the last 72 hours can go to the Harborview Emergency Department at any time of day to be evaluated and started on PEP if it is indicated. That person will have to follow-up with an appointment at Madison Clinic within a few days.
  • There are other methods that can reduce the risk of HIV somewhat, but are not known to be as effective as the methods listed above. The following methods may reduce the likelihood of HIV transmission somewhat via oral, vaginal, or anal sex but are best used in combination other methods:
    • Use plenty of lubrication during anal and vaginal sex.
    • Get tested regularly for other STDs and encourage partners to do so as well. STDs can make HIV transmission a lot more likely.
    • Evidence is mixed about whether “sero-sorting” or “sero-adaptive behaviors” are effective. Sero-adaptation/sero-sorting means making decisions about condom use and positioning (being the insertive or receptive partner) based on whether your partner says they are HIV-positive or HIV-negative. Some studies suggest this practice may not help protect someone from HIV at all, while others indicate that it might offer some protection. It is always important to keep in mind that someone whose last HIV test was negative may still have an early HIV-infection that hasn’t been detected yet. Nevertheless, talking with all sex partners about their HIV-status and testing history is an excellent practice and can help you make the most informed decisions about how to protect yourself.