HIV 101
Transmission and Prevention
What is HIV?
HIV stands for Human Immunodeficiency Virus.
The virus attacks the body’s immune system.
The immune system is the body’s natural defense system against infections.
The virus reduces the number of CD4 cells in the body.
These cells are the infection-fighting cells that the human body produces.
If left untreated, over time HIV can destroy many of the CD4 cells and lead to an increasing number of other infections, known as opportunistic infections.
What is HIV?
When left without antiretroviral therapy (ART), HIV can later progress to AIDS (Acquired Immunodeficiency Syndrome), which can make the person more likely to get other infections or infection-related cancers.
A person is considered to have AIDS when CD4 cells fall below 200 cells per cubic millimeter of blood (200cells/mm3).
At present, there is no way to cure HIV or remove the virus from the body. However, drug therapy can slow down the virus and the damage that it does to the immune system.
HIV Replication Cycle
This infographic illustrates the HIV replication cycle, which begins when HIV fuses with the surface of the host cell.
(A capsid is the protein shell of a virus, enclosing its genetic material)
The capsid containing HIV’s genome and proteins enters the cell after the initial fusion. The shell of the capsid disintegrates and the HIV protein inside (called reverse transcriptase) transcribes the viral RNA into DNA.
RNA (Ribonucleic acid) is a nucleic acid present in all living cells. Its principal role is to act as a messenger carrying instructions from DNA for controlling the synthesis of proteins however, in some viruses (like HIV) RNA rather than DNA, carries the genetic information.
HIV Replication Cycle
The viral DNA is transported across the nucleus, where the HIV protein (integrase) integrates the HIV DNA into the host cell’s DNA.
The host cell’s normal transcription machinery then transcribes HIV DNA into multiple copies of new HIV RNA. Some of this RNA becomes the genome of a new virus, while the cell uses other copies of the RNA to make new HIV proteins.
The new viral RNA and HIV proteins then move to the surface of the cell, where a new, immature HIV forms.
Finally, the virus is released from the cell, and the HIV protein called protease cleaves newly synthesized polyproteins (which are the thing responsible for genome replication) to create a mature infectious virus.
How is HIV transmitted?
Only certain body fluids from a person living with HIV can transmit HIV. These fluids include:
Blood
Semen (cum)
Pre-seminal fluid (pre-cum)
Rectal fluids (mucus that lines the rectum)
Vaginal fluids
Breast milk
These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.
Mucous membranes are found inside the rectum, vagina, penis, and mouth.
How is HIV transmitted?
Mucous membranes throughout the body can contain a lot of HIV. This is because these membranes are rich in immune cells, which are the cells that HIV likes to infect and replicate within.
Since so much HIV replication can occur at the mucous membranes, the virus is able to enter the mucus that the membranes produce.
As a result, mucus produced by someone living with HIV, can contain HIV (although the virus can be present in varying amounts), which can potentially be transmitted to someone else.
How is HIV transmitted?
HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host. It is not transmitted:
By mosquitoes, ticks, or other insects
Through saliva, tears, or sweat
By hugging, shaking hands, sharing toilets, sharing dishes, or closed-mouth or “social” kissing with someone who has HIV
Through other sexual activities that don’t involve the exchange of body fluids (for example, touching)
Through the air
How is HIV transmitted?
Most people who acquire HIV do so through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers).
The next few slides will delve deeper into each behavior and the associated risks.
HIV transmission: Anal Sex
HIV transmission is possible during anal sex with someone living with HIV, without using protection (like condoms or medicine to treat or prevent HIV).
Anal sex is the riskiest type of sex for getting or transmitting HIV.
Being the receptive partner (bottom) is riskier for getting HIV than being the insertive partner (top).
The bottom’s risk of getting HIV is very high because the rectum’s lining is thin and may allow HIV to enter the body during anal sex.
The top is also at risk because HIV can enter the body through the opening at the tip of the penis (or urethra), the inner mucosal surface of the foreskin if the penis isn’t circumcised, or small cuts, scratches, or open sores anywhere on the penis.
HIV transmission: Vaginal Sex
HIV transmission is possible during vaginal sex with someone living with HIV, without using protection (like condoms or medicine to treat or prevent HIV).
Vaginal sex is less risky for getting HIV than receptive anal sex.
Either partner can get HIV during vaginal sex.
Most people with a vagina who get HIV get it from vaginal sex. HIV can enter the body during vaginal sex through the mucous membranes that line the vagina and cervix.
Insertive partners can also get HIV during vaginal sex. This is because vaginal fluid and blood can carry HIV. HIV can be transmitted through the opening at the tip of the penis (or urethra), the inner mucosal surface of the foreskin if the penis isn’t circumcised, or small cuts, scratches, or open sores anywhere on the penis.
HIV transmission: Perinatal
HIV can be transmitted from a parent to their baby during pregnancy, birth, or breastfeeding. However, it is less common because of advances in HIV prevention and treatment.
This is called perinatal transmission or “mother-to-child” transmission.
Perinatal transmission is the most common way that children get HIV.
Recommendations to test all pregnant people for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.
If a parent with HIV takes HIV medicine daily as prescribed throughout pregnancy and childbirth, and gives HIV medicine to their baby for 4 to 6 weeks after giving birth, the risk of transmitting HIV to the baby can be less than 1%.
HIV transmission: Injection
HIV transmission is very high when sharing needles or syringes to inject drugs, hormones, steroids, or silicone or when sharing other drug injection equipment (for example, cookers) with someone living with HIV.
Used needles, syringes, and other injection equipment may have someone else’s blood on them, and blood can carry HIV.
People who inject drugs may also be at higher risk for getting HIV (and other sexually transmitted infections) because they may engage in riskier sexual behaviors like having sex without protection (such as condoms or medicine to prevent or treat HIV).
There is also high risk for getting hepatitis B and C, and other infections if you share needles, syringes, or other injection equipment.
HIV transmission: Oral Sex
Oral sex involves putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (anilingus/rimming).
Factors that may affect this risk include ejaculation in the mouth with oral ulcers, bleeding gums, or genital sores, and/or the presence of other sexually transmitted infections (STIs).
You can get other STIs from oral sex (gonorrhea, chlamydia, syphilis). And if you get feces in your mouth during anilingus, you can get hepatitis A and B, parasites like Giardia, and bacteria like Shigella, Salmonella, or E. coli.
Although very rare, transmission can occur during deep, open-mouth kissing ONLY if both partners have sores or bleeding gums and blood from the partner living with HIV gets into the bloodstream of the HIV-negative partner.
HIV is not transmitted through closed-mouth or “social” kissing with someone living with HIV because HIV is not transmitted through saliva.
HIV transmission: Occupational
HIV transmission is possible during occupational processes.
The most likely cause is being stuck with a contaminated needle or another sharp object.
Careful practice of standard precautions protects patients and health care personnel from possible occupational HIV transmission.
PEP (Post-exposure Prophylaxis) is a short course of HIV medication taken after an exposure to HIV to prevent the virus from taking hold in the body. It must be started within 72 hours (3 days) after a possible exposure to HIV.
PEP (post-exposure prophylaxis) means taking medicine to prevent HIV after a possible exposure (occupational or otherwise).
PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.
When taken within 72 hours, PEP is highly effective in preventing HIV. By stopping the virus from replicating any infected cells in the body, any infected cells will eventually die off and the virus is stopped.
It is a short course of medication taken for 28 days.
If you think you’ve been exposed to HIV at work, report your exposure to the appropriate person at work and seek medical attention immediately.
Careful practice of standard precautions can help reduce the risk of exposure while caring for patients with HIV.
Occupational exposures aren’t the only instances where PEP is a viable option. Other instances were a potential exposure could occur include:
PEP is for emergency situations and is not a substitute for regular use of other HIV prevention. If someone is at ongoing risk for HIV, such as through repeated exposures to HIV, PrEP (which we will discuss later) may be a more appropriate prevention tool.
PEP is safe but may cause side effects such as diarrhea, headaches, nausea/vomiting, and fatigue in some people. The side effects can be treated and are not life threatening.
HIV transmission: Tattoos/Piercings
It is possible to get HIV from tattooing or body piercing if the equipment used for these procedures has someone else’s blood in it or if the ink is shared. This is more likely to happen when the person doing the procedure is unlicensed because of the potential for unsanitary practices such as sharing needles or ink.
When getting a tattoo or a body piercing, it is imperative that the person doing the procedure is properly licensed and that they use only new or sterilized needles, ink, and other supplies.
HIV transmission: Miscellaneous
Biting
Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. Transmission can occur when there is contact between broken skin, wounds, or mucous membranes and blood or body fluids mixed with the blood of a person living with HIV.
There is no risk of transmission if the skin is not broken.
Female-to-Female (or AFAB individuals)
Case reports of transmission of HIV between two AFAB individuals are rare.
Vaginal fluids and menstrual blood may carry the virus and exposure to these fluids through mucous membranes (in the vagina or mouth) could potentially lead to HIV infection.
HIV transmission: Miscellaneous
Medical Care
The US blood supply and donated organs and tissues are thoroughly tested, so it is very unlikely that you would get HIV from blood transfusions, blood products, or organ and tissue transplants.
You cannot get HIV from donating blood. Blood collection procedures are highly regulated and safe.
Pre-Chewed Food
The only known cases are among infants. Contamination occurs when blood from a caregiver’s mouth mixes with food that is pre-chewed before feeding to an infant.
You can’t get HIV from consuming food handled by someone living with HIV.
Viral Load
The higher someone’s viral load, the more likely that person is to transmit HIV.
Viral load is the amount of HIV in the blood of someone living with HIV.
Viral load is highest during the acute phase of HIV, and without HIV treatment.
Taking HIV medicine can make the viral load very low—so low that a test can’t detect it (called an undetectable viral load).
People living with HIV who keep an undetectable viral load (or stay virally suppressed) can live long, healthy lives. Having an undetectable viral load also helps prevent transmitting the virus to others through sex or sharing needles, syringes, or other injection equipment, and from mother to child during pregnancy, birth, and breastfeeding.
Other Sexually Transmitted Infections
The presence of sexually transmitted infections (STIs), can increase the opportunity for acquisition or transmission of HIV.
Getting tested and treated for STIs can lower your chances of getting or transmitting HIV and other STIs.
If you have HIV and get and keep an undetectable viral load, getting an STI does not appear to increase the risk of transmitting HIV. But STIs can cause other problems.
Using condoms are one way to reduce your chances of getting or transmitting STIs that can be transmitted through genital fluids, such as gonorrhea, chlamydia, and HIV.
Condoms are less effective at preventing STIs that can be transmitted through sores or cuts on the skin, like human papillomavirus (HPV), genital herpes (HSV), and syphilis.
Once sexually active, routine STI testing is recommended, even if there are no signs of symptoms.
Alcohol and Drug Use
When drunk or high, you might be more likely to engage in riskier sexual behaviors like having sex without protection (such as condoms or medicine to prevent or treat HIV).
Drinking alcohol, particularly binge drinking, and using “club drugs” can alter your judgment, lower your inhibitions, and impair your decisions about sex and/or drug use.
You may be more likely to have unplanned sex, have a harder time using a condom the right way every time you have sex, have more sexual partners, or use other drugs.
When going to a party or another place where drinking or drug use will occur, bringing a condom can be an effective method to reduce the risk of getting or transmitting HIV if you have vaginal or anal sex.
In people living with HIV, substance use can hasten disease progression, affect adherence to antiretroviral therapy (HIV medicine), and/ or worsen the overall consequences of HIV.
Commonly Used Substances and HIV Risk
Opioids: Opioids, a class of drugs that reduce pain, include both prescription drugs and heroin. They are associated with HIV risk behaviors such as needle sharing when infected and risky sex, and have been linked to a recent HIV outbreak.
Methamphetamine: “Meth” is linked to risky sexual behavior that places people at greater HIV risk. It can be smoked or injected, which also increases HIV risk if people share needles and other injection equipment.
Crack cocaine: Crack cocaine is a stimulant that can create a cycle in which people quickly exhaust their resources and turn to other ways to get the drug, including trading sex for drugs or money, which increases HIV risk.
Inhalants: Use of amyl nitrite (“poppers”) has been linked to riskier sexual behaviors, illegal drug use, and sexually transmitted infections among men who have sex with men.
Risk of HIV
The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone living with HIV has used. This is because the needles, syringes, or other injection equipment may have blood in them, and blood can carry HIV. HIV can survive in a used syringe for up to 42 days, depending on temperature and other factors.
Substance use disorder can also increase the risk of getting HIV through sex. When people are under the influence of substances, they might be more likely to engage in riskier sexual behaviors, such as having anal or vaginal sex without protection (like a condom or medicine to prevent or treat HIV), having sex with multiple partners, and/ or trading sex for money and/ or drugs.
Risk of Other Infections and Overdose
Sharing needles, syringes, or other injection equipment also puts people at risk for getting viral hepatitis. People who inject drugs should talk to a health care provider about getting a blood test for hepatitis B and C and getting vaccinated for hepatitis A and B.
In addition to being at risk for HIV and viral hepatitis, people who inject drugs can have other serious health problems, like skin infections and heart infections. People can also overdose and get very sick or even die from having too many drugs or too much of one drug in their body or from products that may be mixed with the drugs without their knowledge (for example, fentanyl).
If I already have HIV, can I get another kind of HIV?
There are two main types of HIV: HIV-1 and HIV-2. Both types can develop into AIDS however, they're very different from each other.
HIV-1 is the most common type. When you hear the term "HIV," it's probably HIV-1.
HIV-2 occurs in a much smaller number of people, mostly in West Africa. In the U.S., it makes up only 0.01% of all HIV cases, and those are primarily people from West Africa. It's harder to transmit HIV-2 from person to person, and it takes longer for the infection to turn into AIDS.
When a person living with HIV gets another type, or strain, (often a subtype) of the virus it is called HIV superinfection. If a person is infected with a second virus before seroconversion to the first virus has taken place, it is called a dual infection.
The new strain of HIV can replace the original strain or remain along with the original strain and can cause some people to get sicker faster because the new strain of the virus is resistant to the antiretroviral therapy they’re taking to treat the original strain, in which case they’d need a new treatment.
Superinfection is rare – it happens in less than 4% of people. Moreover, hard-to-treat superinfection is also rare. Research from The Journal of Infectious Diseases indicates that there have been 16 documented cases of superinfection since 2002.
People living with HIV are at risk for superinfection by the same actions that would place an HIV-negative person at risk of acquiring HIV. These actions include sharing needles and/ or forgoing condoms with HIV-positive sexual partners.
Taking medicine to treat HIV can help protect someone from getting a superinfection because HIV is untransmittable when virally suppressed or undetectable.
Both HIV-1 and HIV-2 have multiple groups within them. Those groups branch out even further into subtypes, or strains. HIV-1 has four groups -- one large one and three much smaller ones.
Group M (Major)
This group is responsible for the HIV epidemic. Nearly 90% of all HIV-1 cases stem from this group.
The group has nine named subtypes or strains: A, B, C, D, F, G, H, J, and K. Some of these have sub-strains. Researchers find new strains all the time as they learn more about HIV-1 group M.
The B strain is the most common in the U.S. Worldwide, the most common HIV strain is C, accounting for 46.6% of all HIV-1 cases and is most common in southern Africa, east Africa, and India.
Scientists haven't done much research on strains other than B, so information on the rest is limited. The drugs that treat the B strain (antiretroviral drugs) also work on most others.
Groups N, O, and P
The smaller HIV-1 groups are rare outside of west central Africa, specifically Cameroon. They are:
N (New, Not-M, or Not O group): This form of the virus has only been seen in a small group of people in Cameroon. Researchers haven't named any strains for this group because there are so few cases of it.
O (Outlier group): This group has almost as many variations as the M group. However, researchers haven't identified its separate strains yet because it's so rare.
P group: This is the newest group of HIV-1. It was given its own name because of how different it is from the M, N, and O strains.
HIV-2 viruses can also be divided into nine different groups, which are designated by the letters A through I and do not contain subtypes. Groups A and D appear to be the only ones that are currently circulating in humans.
HIV Testing
The only way to surely know someone’s HIV status, is to get tested. Knowing their HIV status can help them make healthy decisions to prevent getting or transmitting HIV.
Some people have flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection). These symptoms may last for a few days or several weeks.
Possible symptoms include: Fever, Chills, Rash, Night sweats, Muscle aches, Sore throat, Fatigue, and/ or Swollen lymph nodes.
But some people may not feel sick during acute HIV infection. These symptoms don’t mean you have HIV. Other illnesses can cause these same symptoms.
HIV Testing
Generally, there are only 3 possible results for an HIV test: Positive, Negative, or Inconclusive/Invalid
Positive result: The test detected the presence of HIV
Negative result: The test did not detect the presence of HIV
Inconclusive/Invalid: The test was not able to be run and/ or further testing or re-testing is needed
HIV Testing
I tested positive. What’s next?
Establish a care and treatment plan
While there is no cure, HIV is a manageable health condition
With treatment, it is possible to reduce the amount of HIV to very low levels and prevents someone from getting sick and/ or passing the virus to others
Antiretroviral Therapy
There are many different classes of antiretroviral drugs used to treat HIV. The healthcare provider for a person living with HIV will decide on the best medications for that individual.
This decision will depend on:
-the person’s viral load
-their T cell count
-their strain of HIV
-the severity of their case
-how far the HIV has spread
-other chronic health conditions (comorbidities)
-contraindications to other medications
Antiretroviral Therapy
HIV is usually treated with at least two different medications, although those medications can sometimes be combined into one pill. This is because attacking HIV from multiple directions reduces the viral load more quickly, which has been shown to control HIV the best.
Taking more than one antiretroviral drug also helps prevent resistance to the drugs being used. This means a person’s medications may work better to treat HIV.
A person may be prescribed two to four individual antiretroviral drugs, or they may be prescribed a single combination drug in what’s sometimes known as a single-tablet regimen.
Antiretroviral Therapy
When taken as prescribed, HIV medications can decrease the amount of HIV present in a person's blood (viral load). When someone’s viral load is too low to be measured by laboratory tests it is called being undetectable. Being undetectable prevents HIV from progressing and allows people to live long and healthy lives. It also protects the health of their sex partners.
People cannot pass HIV through sex when they have undetectable levels of HIV. This prevention method is estimated to be 100% effective as long as the person living with HIV takes their medication as prescribed and gets and stays undetectable. This concept is known as Undetectable = Untransmittable (U=U).
HIV Testing
I tested negative. What’s next?
One option: Find out if PrEP is right for you
PrEP is a pill for people who are HIV negative and want added protection
It is taken everyday – like birth control, but for HIV prevention. When taken as prescribed, PrEP is more than 99% effective.
It does not protect against other STIs. Condoms offer effective prevention against most STIs, including HIV, as well as pregnancy
PrEP, as well as condoms, are not an option for everyone but they are powerful prevention tools which will we be exploring more in depth in the next few slides (as well as other methods of prevention)
PrEP
PrEP stands for Pre-Exposure Prophylaxis
PrEP is a once-daily pill for prevention of acquisition of HIV.
Two pills are currently approved by FDA for PrEP: Truvada & Descovy
Both pills are nucleoside reverse transcriptase inhibitors.
Truvada is for all people at risk through sex or injection drug use.
Descovy is for people at risk through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex.
PrEP
PrEP is a once-daily pill for prevention of acquisition of HIV.
However, people who feel they may not be at an ongoing risk for getting HIV, can employ “PrEP on demand” use.
The type of “on-demand” PrEP that has been studied is the “2-1-1” schedule. This means taking 2 pills 2-24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose.
There is scientific evidence that the “2-1-1” schedule provides effective protection for men who sex with men when having anal sex without a condom.
We don’t know how “on-demand” PrEP works for heterosexual men and women, people who inject drugs, and transgender persons.
Some health departments are offering guidance for “on-demand” PrEP as an alternative to daily PrEP However, this type of use is not currently part of CDC’s guidelines for PrEP use, which still recommends daily use for those at risk for HIV.
Taking PrEP once a day is currently the only FDA-approved schedule for taking PrEP to prevent HIV.
PrEP
Truvada is for all people at risk through sex or injection drug use.
It takes 7 days for people who are AMAB and 21 days for people who are AFAB to reach a steady state in the blood plasma.
When taken 7 days a week it is about 99% effective. When taken 5-6 days a week it is about 95% effective. And when taken 2-3 days per week it is about 70% effective.
PrEP
Are there side effects?
Many people who take Truvada for PrEP say they haven't had any side effects, but like with any drug, there are some reported side effects to consider.
Short term: approximately 10% of people taking Truvada for PrEP initially experience mild side effects such as nausea, diarrhea, and headaches. These tend to go away quickly.
Long term: A small number of people taking Truvada for PrEP may experience changes in their kidney function and in the bone density. These side effects are not common.
Since Truvada is filtered through the kidneys, patients receive labwork every 3 months for kidney function.
PrEP
Descovy is for people at risk through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex.
It takes 3 days for Descovy to reach a steady state in the blood plasma.
When taken 7 days a week, it is 99.7% effective.
PrEP
Are there side effects?
Many people who take Descovy for PrEP say they haven’t had any side effects. But like with any drug, there are some reported side effects to consider.
Short term: Less than 10% of people taking Descovy for PrEP initially experience mild side effects such as nausea, diarrhea, headaches, or fatigue. These tend to go away soon.
Long term: Current data does not support any negative effects to kidney function or bone density when taking Descovy for PrEP.
However, since Descovy is still minimally filtered through the kidneys, patients receive labwork periodically for kidney function.
PrEP
PrEP is about self-determination. It’s a tool one can choose to make to make their sex life safer and take control of their sexual health and wellness.
One might consider PrEP if…
PrEP
What about condoms?
A person may be drawn to PrEP because of a desire for intimacy and connection they may or may not feel when wearing condoms. For the prevention of HIV, PrEP taken consistently and correctly is actually more effective than condom use.
Condoms
A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection.
There are both “male” (external) and “female” (internal) condoms.
Condoms can greatly decrease the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV when used correctly and at every act of intercourse.
To a lesser extent, they also protect against genital herpes, human papillomavirus (HPV), and syphilis, again when used correctly and at every act of intercourse.
Condoms
External condoms are typically rolled onto an erect penis (or sex toy) before intercourse and work by forming a physical barrier which blocks semen from entering the body of a sexual partner (and vice versa by blocking vaginal or rectal fluid from coming in contact with the penis)
External condoms are typically made from latex and, less commonly, from polyurethane, polyisoprene, or lamb intestine*
External condoms have the advantages of ease of use, easy to access, and few side effects
People with a latex allergy should use condoms made from a material other than latex, such as polyurethane or nitrile
According to a 2000 report by the National Institutes of Health (NIH), consistent use of latex condoms reduces the risk of HIV transmission by approximately 85% relative to risk when unprotected
Condoms
Condoms may slip off the penis after ejaculation, break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils)
Standard condoms will fit almost any penis, with varying degrees of comfort or risk of slippage. Many condom manufacturers offer "snug" or large/extra-large sizes.
Condom size plays an important role in appropriate condom usage because smaller condoms used with larger penis have an increased risk of breakage and decreased slippage rates (and vice versa with using a larger condom with a smaller penis – the risk of breakage is decrease but the risk slippage is increased)
Lubrication also plays an important role in appropriate condom usage due to friction during intercourse
Condoms
There are many different types of condoms. Different types include, but are not limited to:
Condoms should only be used with water-based or silicone-based lubricants, not oil based lubricants.
There are also many types of brands of condoms. Some common types of brands and sub-brands are: Trojan(Magnum), Lifestyles(Skyn), One, Atlas, FC2, Kimono, Durex…
Condoms
How to use an external condom correctly:
Condoms
There are safer sex items that are not condoms but usually are considered within the same category of a condom or are a condom but are very different from most condoms and we will explore each item in detail in the next few slides.
The items include insertive condoms, dental dams, and lambskin condoms.
Insertive Condoms
An internal condom (as known as a female condom) is a barrier device that is used during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a sexually transmitted infection (STI).
Meant as an alternative to the condom for external condoms, it is designed to be worn internally by the receptive partner during vaginal or anal sex to prevent exposure to ejaculated semen or other body fluids.
The FC2 brand condom comes pre-lubricated with a non-spermicidal, silicone based lubricant. The FC2 is made of nitrile so water-based (or oil-based) lubricants can be added on the inside and outside of the FC2 or on the penis.
Advantages to FC2 condoms are that they are latex free, can be inserted in advance of the sex act so there is no interruption during sex, can be used with multiple partners, reduced some skin-to-skin contact.
Insertive Condoms
How to use the FC2 for vaginal sex:
Insertive Condoms
How to use the FC2 for anal sex:
Dental Dams
Dental dams are latex or polyurethane sheets used between the mouth and vagina or anus during oral sex.
A new dental dam should be used for every new sex act.
Lubrication can be used to add more sensation but it should be water-based or silicone-based, not oil-based.
Condoms can be cut up and used as alternative if a dental dam is not present.
Alternatively, saran wrap can also be used (non-microwavable saran wrap only). Advantages to saran wrap are that it is larger, see through, has more supply, and is non-latex.
Dental Dams
How to use a dental dam:
Dental Dams
Natural Condoms
Lambskin condoms (also known as natural condoms) are a type of non-latex external condom. They are made from the intestinal membrane of a lamb, so these condoms are truly a natural animal product.
Lambskin condoms seem to have a more natural feel and a thinner texture than other condom types, so they transmit body heat better than latex condoms which can offer greater sensation and more of an intimate sensation, close to not wearing a condom.
Natural lambskin condoms are approved by the U.S. Food and Drug Administration (FDA) as an effective means of preventing pregnancy.
Unlike other condoms, lambskin condoms are not effective in preventing sexually transmitted infections as the natural pores in them are large enough for bacteria (like gonorrhea) and viruses (like HIV) to pass through. But even though lambskin condoms have tiny pores, they are too small for sperm to pass through.
Unlike other condoms that can only be used with water-based or silicone-based lubricants, lambskin condoms can also be used with oil-based lubricants.
Some other disadvantages are that they are more expensive, are not as stretchy as other condoms, are not as “attractive” or are odd looking, and smell different.
Risk Reduction
We’ve discussed PrEP, PEP, ART and condoms, but what are some other options for HIV prevention?
Medication and safer sex supplies are not an option for everyone but there are still plenty of things people can do before, during, and after sex to reduce the risk of getting or transmitting HIV.
Risk Reduction Strategies
Stigma
HIV stigma is negative attitudes and beliefs about people with HIV. It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable.
Here are a few examples:
While stigma refers to an attitude or belief, discrimination is the behaviors that result from those attitudes or beliefs. HIV discrimination is the act of treating people living with HIV differently than those without HIV.
Here are a few examples:
Stigma
HIV stigma and discrimination can affect the emotional well-being and mental health of people living with HIV. Someone living with HIV may internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if they disclose their HIV status.
“Internalized stigma” or “self-stigma” happens when a person takes in the negative ideas and stereotypes about people living with HIV and starts to apply those ideas or seterotypes to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and despair. These feelings can keep people from getting tested and treated for HIV.
HIV stigma is rooted in a fear of HIV. Many of our ideas about HIV come from the HIV images that first appeared in the early 1980s. There are still misconceptions about how HIV is transmitted and what it means to live with HIV today.
The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people who are living with HIV.
Talking openly about HIV can help normalize the subject. It also provides opportunities to correct misconceptions and help others learn more about HIV. We can all help end HIV stigma through our words and actions in our everyday lives.
Questions?