Seven Ways to Prevent HIV

You likely know about tried and true methods to help you prevent getting HIV, such as using condoms when having sex and new equipment when using drugs. But did you know that there are also newer approaches like using HIV medications to prevent HIV? With so many choices, it’s not always easy to know which prevention method to use and when.

This resource can help you decide which HIV prevention method (or combination of methods) will work best for you.

 

What is HIV?

HIV is a virus that can weaken a person’s immune system, which is the body’s built-in defence against disease and illness. With lifelong treatment and care, people with HIV now can live long and healthy lives and avoid passing HIV to others.  In fact, people living with HIV who are on successful treatment do not pass HIV to the people they have sex with.

How is HIV passed?

HIV is only passed through five bodily fluids:

  • blood
  • semen (including pre-cum)
  • rectal fluid
  • vaginal fluid
  • breast milk (chestmilk)

HIV can be passed when the virus in one of these fluids containing HIV gets into another person’s body. The two main ways that HIV can be passed are:

  • through vaginal or anal sex
  • by sharing needles or other equipment to use drugs (including steroids and hormones)

There are many options to choose from to help prevent you from getting HIV through sex and when using drugs.

How do you know if you have HIV?

HIV often has no symptoms, so the only way to know whether or not you have HIV is to get tested.

If you don’t know your HIV status, get an HIV test. If your test is positive, you can begin taking HIV treatment that will help you stay healthy and prevent passing HIV to others. If your test is negative, you have lots of prevention strategies to choose from to help you stay negative.

When you get tested for HIV, you can also get tested for sexually transmitted infections (STIs) and other infections such as hepatitis C. Talk to a healthcare provider about how often you should test.

You can get an HIV test from your family doctor or find another place to get a test in your area by checking HIV411.ca.

How can you find out which HIV prevention method will work best for you?

Here are some questions to ask yourself as you read about the different HIV prevention options.

What is your chance of getting HIV?

While there is no perfect formula for knowing your exact chance of getting HIV, you can estimate your risk by thinking about:

  • the types of sex you are having
  • if you are sharing drug use equipment
  • the number of people you have sex or use drugs with
  • how often you are having sex or sharing drug use equipment
  • what prevention method (or methods) you and the people you have sex or take drugs with use and if they are used every time

The highest chance of getting HIV comes from having vaginal or anal sex or sharing injection drug use equipment when no prevention method is used by either partner.

You are most likely to get HIV from someone who has HIV but doesn’t know it. This is because when someone doesn’t know that they have HIV, they will not be taking treatment to stay healthy and prevent passing HIV to others. The only way for someone to know if they have HIV is to be tested.  

If you’re at risk of HIV, it’s important you are prepared to use a prevention method that is right for you!

If you’re not sure about your risk of getting HIV, talk to a healthcare worker or someone at your local HIV organization.

What is your chance of getting other infections?

There are other infections besides HIV that can be passed through sex or from sharing equipment for using drugs. Some of the most common sexually transmitted infections (STIs) are human papillomavirus (HPV), herpes, chlamydia, gonorrhea and syphilis. You can get hepatitis B through sex and by sharing drug equipment if you haven’t been vaccinated against it.  Hepatitis C can also be passed by sharing drug use equipment.  Sexual transmission of hepatitis C is not common, but it is possible under certain circumstances.

Some HIV prevention methods only help to prevent HIV, and some also help to prevent STIs and other infections. If you are concerned about getting an STI or other infection, you may want to use a method that helps to prevent both HIV and other infections.

STIs and other infections often do not have symptoms, so the only way to know if you have them is to get tested. Some infections, such as gonorrhea, chlamydia, syphilis and hepatitis C, can be cured, while others, such as hepatitis B and herpes, can’t be cured but they can be treated.

How much risk are you comfortable with?

Different people are comfortable with different levels of risk for HIV, STIs and other infections. You have the right to set your own boundaries for what you are comfortable with and decide what prevention method you use based on your boundaries. The people you have sex or use drugs with also have this right.

Think about your chance of getting HIV and other infections and how much risk you are comfortable with. If you are currently using a prevention strategy, think about how much it protects you against HIV and other infections. Consider whether you are comfortable with this level of protection. If you would like more protection, you might decide to make a change.

What prevention method are you most likely to use?

As you consider your options, think about which method you will be most likely to use. You can use different methods based on your needs in different situations. You should also consider whether or not you can use a prevention method the right way every time, because a prevention method will only work when you use it correctly.

The method you decide to use may also depend on the prevention methods your partners are using. If you are going to rely on a method your partner is using then you need to know that they are using it the right way every time.

What are the most effective ways to prevent HIV?

There are many ways to prevent HIV. Some of these options help to prevent HIV during sex and some help when using drugs. Some help in both situations.

Sometimes you might rely on just one strategy, and other times you might use more than one.  

Have a look through the options that are available and think about what methods might work best for you and in which situations.

Prevention method Helps prevent HIV through sex Helps prevent HIV when using drugs
PrEP for people who are HIV negative
PEP for people who are HIV negative
Treatment for people living with HIV ✔*
Condoms
Choosing types of sex with a lower risk for HIV
New equipment for using drugs
Using drugs in ways with a lower risk for HIV
*We don’t know exactly how much HIV treatment reduces the chance of passing HIV when using drugs.

Pre-exposure prophylaxis (PrEP)

PrEP is used by people who are HIV negative to help prevent them from getting HIV. PrEP is a medication that you take starting before and continuing after you might come into contact with HIV. It is important to take the pill as prescribed for it to work. For most people, this means taking it every day. It is very rare for someone who is taking PrEP as prescribed to get HIV. Besides taking pills, taking PrEP involves seeing a doctor or nurse every three months for HIV testing, screening for STIs and other infections, monitoring for possible side effects, and ongoing support. Most public and some private drug plans will help to cover the cost of PrEP. If you would like to learn more about PrEP, visit a PrEP clinic, talk to a healthcare provider or visit www.catie.ca/prep.

Post-exposure prophylaxis (PEP)

PEP consists of medications that a person can take after they might have come into contact with HIV, to help prevent them from getting HIV. For example, someone might choose to use PEP after a condom breaks during sex.  To be effective, PEP needs to be taken as soon as possible after the exposure, and certainly within 72 hours. PEP needs to be taken every day for 28 days. When PEP is taken as prescribed, the chance of getting HIV is very low. PEP can be expensive but it is covered by some public and private drug plans. Coverage for PEP varies across Canada. Since you need to take PEP as soon as possible after a potential exposure, a hospital emergency department is a good place to go for it.

Treatment for people living with HIV

HIV treatment helps people with HIV to stay healthy, and it also helps prevent passing HIV to others. If a person takes HIV treatment as prescribed, the amount of HIV in their blood can become so low that tests can’t detect it. This is called having an undetectable viral load. When someone is on treatment and maintaining an undetectable viral load, they will not pass HIV to you through sex. Successful HIV treatment also lowers the chance of passing HIV from sharing equipment for using drugs, but we don’t know exactly how much it reduces the risk.

Keep in mind that PrEP, PEP and HIV treatment do not reduce the chance of passing or getting any infections other than HIV.

Condoms

Condoms help to prevent HIV and other STIs. There are external (sometimes called male) and internal (sometimes called female) condoms. The chance of getting HIV is very low if you use condoms the right way each time you have sex. If you are having sex with more than one person at a time, use a new condom every time you change partners. If you are sharing a sex toy, make sure to use condoms on the toy and put a new condom on the toy for each partner. Store condoms at room temperature and check the expiry date before using them. Use a water-based or silicone-based lube with them. Oil-based lube can break condoms. You can talk to a local HIV organization or other community-based agency to see if you can get free condoms in your area.

Choosing types of sex with a lower risk for HIV

Some types of sex have a lower risk for HIV than others. Oral sex has little to no chance of passing HIV.  Fingering, handjobs, mutual masturbation and using unshared sex toys have no chance of passing HIV. However, STIs can be passed through some of these types of sex.  In some situations, you might choose to avoid having vaginal or anal sex and instead choose a type of sex with a lower chance of passing HIV.  

New equipment for using drugs

If you use new equipment each time you use drugs, there is no risk of getting HIV or hepatitis C through drug use.  When injecting drugs, it’s best to use new needles, syringes, filters, cookers, acidifiers, alcohol swabs, tourniquets and water each time. When smoking or snorting drugs, the pipe or straws should also be new each time. In many communities, there are places where you can get free needles and other equipment for using drugs.  These are often called needle and syringe programs. Some communities also have supervised consumption services, where you can bring your drugs to inject under the supervision of a healthcare worker or peer. Supervised consumption services give you all of the equipment you need to inject drugs and the healthcare worker or peer will help if you have an overdose. Visit an HIV or harm reduction organization to learn what services are available in your community.

Using drugs in ways with a lower risk for HIV

Taking drugs by swallowing, snorting or smoking them carries little to no risk of HIV. However, there may be a risk for hepatitis C, so make sure to use your own equipment (such as your straw or pipe). Talk to a harm reduction worker about how to swallow, snort or smoke drugs as safely as possible.

Find out more

This resource gives an overview of the most effective methods for preventing HIV. For more in-depth information on all of these prevention methods, speak to someone at your local HIV organization or talk with a healthcare worker.

To find HIV testing, prevention and treatment services near you, visit HIV411.ca.

CATIE thanks Edmonton Men's Health Collective, AIDS Saskatoon, Women and HIV/AIDS Initiative (WHAI) and Mobile Outreach Street Health Halifax (MOSH Halifax) for reviewing this resource. We also thank the Sex Information and Education Council of Canada (SIECCAN) and Dr. Paul MacPherson, University of Ottawa, for medical review.

Writer: Mallory Harrigan
Design: GravityInc.ca