HIV Transmission

Penetrative Sex

The primary mode of transmission for HIV in Australia is through sexual transmission. More specifically, HIV is spread through vagina or anal penetration.

For HIV to be transmitted, the virus must have an exit point from the person who is HIV-positive and be able to find an entry point for the person who is HIV-negative. HIV is present in seminal fluid and pre-cum, so penetrative sex of the vagina or anus by a penis presents an example of how HIV can be transmitted between one person and another.

Some people believe that being the insertive partner during sex means that they are not at risk of contracting HIV. This is not correct.

HIV exists in vaginal fluids, menstrual blood, and anal mucus (or the lining of the anus), and therefore HIV can be transmitted to the insertive partner as well.

With the introduction of biomedical prevention, such as PrEP, there are ways to engage in condomless sex that are safe in terms of preventing the transmission of HIV. However, the most common method of HIV prevention is the use of condoms and water based lube when engaging in penetrative sex.

Testing regularly for HIV is one of the best ways to prevent the spread of HIV.

Oral Sex

When it comes to oral sex, there are many myths around the transmission of HIV. Although it is biologically possible for HIV to be transmitted through oral sex, it is a physiological improbability, meaning it is basically impossible to do so.

Even under the most susceptible scenarios, there are no recorded, diagnosed cases of HIV being transmitted through oral sex.

However, the factors that can increase the possibility include:

• Cuts and/or abrasions in the receptive partner’s mouth can inflame the entry point, making it more vulnerable to allowing HIV into the bloodstream;
• The insertive partner is HIV-positive, has a very high viral load leave, and is not on treatment;
• Ejaculation occurs from the insertive to receptive person.

If you are worried about transmission through oral sex, these tips may make you feel more at ease:

• Using a condom;
• Avoiding brushing or flossing your teeth before oral sex;
• Rinsing or gargling salty water, mouthwash, or alcohol to see if you have any cuts in your mouth.

HIV can be transmitted through blood-to-blood contact, like sharing injecting or tattooing equipment.

It is important to remember that HIV does not live outside of the body for very long. Therefore, the blood-to-blood transmission routes would require HIV-positive blood to be directly inserted into the bloodstream of someone who is HIV-negative – such as through the use of a needle that someone has previously used or with tattooing equipment.

At the start of the epidemic, the most common method of blood-to-blood transmission was through blood transfusions. Since this was discovered, several significant steps have been implemented to reduce and eliminate the possibility of this occurring.

The best way to avoid blood-to-blood transmission if you are an injecting drug user is to have a new kit for every hit. When getting a tattoo, use registered tattoo establishments where you can see that the equipment has been sterilised.

For more information, see Safer Injecting.

When conceiving a child, there is a risk of HIV infection when one parent is HIV-positive.

However, there are many things that prospective parents can do to reduce the risk. If you or your partner have HIV, then it is best to discuss these options with your HIV specialist before you conceive.

Mother-to-Child

The main method of transmitting HIV from a parent to a child is through mother-to-child transmission during pregnancy, birth, or breastfeeding. However, in Australia, there are great options that mothers can choose to help prevent the onwards transmission of HIV from themselves to their child, including:

• Being on anti-retroviral treatments (HIV medication);
• Using anti-retroviral treatments for the child;
• Avoiding breastfeeding, as breast milk contains HIV;
• Opting for a caesarean section rather than a vaginal delivery as the possibility of something going wrong (i.e., and thus the risk of transmission occurring) is reduced.

Father-to-Child

For HIV-positive fathers, there are some different steps that can be taken to reduce the risk of transmission of HIV to the child.

For example, sperm washing is a treatment option when the father is HIV-positive and the mother is HIV-negative. Sperm washing concentrates and then separates sperm from the infectious seminal fluid. The sperm can then be safely injected into an egg and implanted in the women’s uterus. This prevents the women from HIV infection and passing it onto the child.

For more information, visit the Australian Federation of AIDS Organisations, and speak with an HIV specialist for best recommendations.