Safer sex with someone who is HIV positive

Hello Alice,

I am very grateful for your website forum. I am a twenty-something gay professional male. I have recently fallen head-over-heals for a guy who has disclosed his HIV-positive status which he contracted three years ago. The virus has not progressed into AIDS.

I would like to know how I might practice safer-sex with him. We have had intercourse using traditional safe-sex measures (i.e. condom) and I have received oral sex from him as well. How safe, if at all, is it for me to return the favour? What things should I avoid besides the obvious not having unprotected sex?

Thank you,
In love with the man, not the virus.

Dear Reader,

Glad you find the website useful! And congrats on falling head-over-heels for your beau. In terms of HIV transmission, it is relatively safe for you to return the fellatio favor if he wears a condom. The risk of him transmitting the virus to you would be quite low in this case. If you have scrapes or cuts (even tiny ones) on your gums or in your mouth, but he still wears a condom, the risk for transmission only goes up slightly. Scrapes or cuts provide an entry point for the virus to enter the bloodstream, but a condom provides a reliable barrier. Returning the oral sex favor without condoms is more risky, since precum and semen can pass the virus through mucus membranes in the mouth and throat. One thing to consider is that other STIs (such as herpes or gonorrhea) are transmitted more easily via oral sex. However, there is zero risk of you contracting HIV from him giving you oral sex, unless his gums or mouth are bleeding. While HIV is present in saliva, its trace amounts and not enough to transmit the virus to you (this is also why kissing is safe, assuming no mouth bleeding). So, what activities are safe and what is to be avoided? Here’s the rundown:

 Safer activities include:

  • Manual sex (masturbation). This can be done without condoms, as long as your hands are free of any cuts, even tiny ones. To be certain, wash your hands in lemon juice. Any sting from the juice indicates a cut. If this happens, have him wear a condom or wear latex gloves. And use lots of lube!
  • Oral sex with condoms or dental dams.
  • Anal or vaginal sex with condoms. Use lots of lube and never "double bag" (use two condoms at once).
  • Rimming (oral sex via the anus) with dental dams.
  • Using toys (don’t share them — the virus can survive on surfaces, but only for a short period of time).
  • BDSM activities that don’t involve blood.
  • Kissing, watching porn together, and rubbing each other through clothes are also safe activities.

To maintain your HIV negative status, avoid:

  • As you noted, anal or vaginal sex without condoms and lots of lube.
  • Oral sex or rimming without condoms, unless you are certain you have no cuts or scrapes in your mouth or on your lips.
  • Mutual masturbation without a barrier, if you have any cuts or scrapes on your hands.
  • Sharing toys.
  • BDSM activities such as blood sports, piercings, or anything that involves bleeding.

Whatever activities you both fancy, know that there are many ways to maintain a happy, healthy, and active sex life when one of you is HIV positive and the other is not. Communication is the key: It’s great that your boyfriend has been honest in disclosing his status. Continue to communicate regularly about your safer sex practices. Remember that being very tired, very horny, or using drugs or alcohol, can impair one’s judgment, making it more likely to stray from safer sex practices. Make protection part of your routine together so it becomes habit.

Here’s to getting off safely,

Originally published May 14, 2015

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