The HIV virus is found in semen, blood, rectal fluids, vaginal fluids and breast milk.
When a person living with HIV is on treatment and the level of virus (viral load) in the body is so low that it cannot be detected (is ‘undetectable’), HIV cannot be transmitted to sexual partners. This is also known as ‘undetectable’ equals ‘untransmittable’ (U=U).
HIV infection can be hard to spot in its early stages. Left untreated, a person with HIV will become very unwell over time.
You cannot get HIV:
It is extremely unlikely that you will get HIV from oral sex although there is a theoretical risk if you have open sores in your mouth.
Viral load is the term used to describe the amount of HIV in the body at any one time. It is determined with a blood test.
A higher viral load is associated with a higher risk of HIV transmission. With successful HIV treatment, the viral load can become so low that it is considered ‘undetectable’ in the blood, and this reduces the risk of HIV transmission to zero.
The amount of virus in the blood is usually the same as the viral load in other bodily fluids – semen, vaginal fluid and rectal fluid (the fluids commonly associated with the sexual transmission of HIV). This means that when the viral load in the blood decreases, it generally also decreases in other fluids. However, the viral load in each of the bodily fluids can sometimes be different.
For many people on long term HIV treatment, with an undetectable viral load, with no other concurrent STIs, the risk of transmitting the virus to a partner(s) is zero.
A lot of people with HIV see becoming undetectable as a very important benefit of HIV treatment, which decreases anxiety about onward transmission to a sexual partner. People are now taking their viral load into consideration when thinking about safer sex.
If you want to stop using condoms, it is important to discuss this carefully with your partner(s) and ensure they are also comfortable with the decision. This information may be new to a lot of people who do not have HIV; it may take time for someone to understand and trust what you are saying. It is also important to remember that while using this approach will protect your partner(s) from HIV, it does not protect them or you from other STIs.
The following are some guidelines for men who may be thinking about using this approach to reduce the risk of HIV transmission:
If you use this approach without disclosing your HIV status, it is important to remember that in some countries, having sex without condoms without disclosing that you are HIV positive is a criminal offence, regardless of the likelihood of HIV transmission.
Travel, mobility and migration are increasingly part of our lives.
It’s important to be aware that in a number of countries, criminal law is being applied to people living with HIV who transmit or expose others to HIV infection. Different countries have different laws.
Currently, criminal prosecution for the sexual transmission of HIV remains untested in Ireland, in both the Republic and Northern Ireland.
The following is an example of how the law has been applied in England and Wales.
This is not legal advice. It is an example that you may wish to consider when making your choices about disclosure.
In England and Wales, people living with HIV may be prosecuted with ‘reckless HIV transmission’ under section 20 of the Offences Against the Person Act 1861. It’s worth noting that this guidance applies to England and Wales only, although the Offences Against the Person Act still applies in Northern Ireland.
In the UK, based on the criminal prosecutions to date, a person may be prosecuted for reckless transmission of HIV if:
Although UK law does not precisely define ‘safer sex’, from the cases brought to court so far in the UK, it seems that a person will not be prosecuted if condoms are used for anal sex – as long as they have been used 100% of the time.
The law in the UK is not explicit in relation to a situation where a condom splits or slips off. The advice given in the UK is to disclose HIV status immediately and advise your sexual partner to get PEP.
The UK law covers any serious infection that is passed on sexually, so a prosecution for the transmission of Hepatitis C is also possible.