HIV Risk


Know the risks

It’s a good idea to know how HIV is commonly transmitted and why.  There are many factors to keep in mind when it comes to HIV exposure. Do you know how easy it is to transmit HIV during oral sex, topping without a condom, or having sex with someone who’s HIV-positive with an undetectable viral load?   Or what about if you get semen in your eye?

If you're not 100% confident about what behaviors might put you at risk, it might be difficult for you to decide what you’re comfortable doing with people you have sex with. Don't wait until the morning after to wonder whether you might have been exposed to HIV.  

SAFER: Learn more about HIV and how it’s transmitted—and what you can do to decrease your risk. Check our page "Isn't everything sexual risky?"or a site like to make sure you really know how to keep yourself safer.

Establishing a regular testing schedule for yourself is a great way to take charge of your sexual health. Encouraging your regular sex partners to do the same is a great way of helping your partners and the community.

We recommend people who are sexually active get tested for HIV every six months. People who are very sexually active should get tested every three months. If you live in San Francisco or the Bay Area, you can come in to Strut, our health and wellness center for gay, bisexual and transgender men in the Castro, and a counselor will be able to recommend a testing schedule for you. Schedule your tests far in advance so they become routine.

Caution: Assuming you can tell if someone is HIV-positive

It’s not possible to know if someone is living with HIV just by looking at them. Someone who was recently infected might not show any visible signs at all but can have a lot of the virus active in their system, and therefore be highly infectious.  A surprising number of people who have HIV don't know they are infected and may unknowingly expose their partners.

SAFER: Focus on what you can do to protect your own health. Establish personal rules for what you're comfortable doing, and apply those rules to all your encounters. Make it clear to the person you're with that your desire to 'play safely' is not a judgment of them.

Caution: Over-tipping the elbow - drinking & partying

Drinking during a night out with friends, when you go dancing, or when you eat a meal is very common. When we're nervous, like on a first date, or when we're hoping to meet someone special, it's tempting to “cut loose” and drink enough to lower our inhibitions.

There's a downside to having your inhibitions lowered, however. You might not make the same decisions when you’re drinking that you would otherwise. It's not unusual to hear from our clients, "I had too much to drink and next thing I knew, we had sex without a condom," or "I'd been drinking all day at the street fair and I just wasn't thinking."  

We do things when we're drunk or high we wouldn't do under normal circumstances. If you're going into a situation where you'll be drinking a lot or doing drugs, and there's even a small possibility that you'll be having sex of any kind, you can still take steps to reduce your risk.

SAFER:  Be Prepared. Make a habit of carrying condoms with you when you go out to party, just in case. Remember that once you're at the party, you will be a lot less interested in trying to find a pharmacy. Consider starting PrEP, if you want extra protection against HIV that you can control ahead of time.

Have an accountabili-buddy. Make a plan with a friend you trust that will be with you. Agree on when you expect to leave the event, and touch base with each other periodically and before you leave with someone else. A quick check-in with your trusted friend before you go home with someone else gives you a chance to think—do you have condoms? Is this what you want? Would it be better to get their number and meet up another time?

Caution: Shooting up with shared equipment

By using clean and unshared injection drug equipment, you can prevent your risk for contracting infections such as HIV and hepatitis C. Injection drug use becomes a risk for HIV infection and hepatitis C  only when the user shares their equipment or uses previously used,  “dirty” needles. Blood from the first injector can stay in the needle and be transferred to the second user. Hepatitis C virus can live on the needle and on drug preparation equipment. People who use injection drugs should NOT reuse equipment and should NOT share injection drug equipment with anyone else.  

SAFER:  A healthier choice is to always use clean needles and equipment. San Francisco AIDS Foundation Syringe Access Services program makes it easy for people to access new needles and safer drug use equipment, and turn in used needles anonymously and without judgment. Find out where to get safer injection supplies in San Francisco.

If you're in the San Francisco Bay Area and would like help managing your substance use or reducing the harm that can come from using substances, get support from Strut, The Stonewall Project, The Speed Project and

Caution: Being too shy to talk

Have you ever just "gone along with it" when it comes to sexual activity that seemed a little risky because you just couldn't think of what to say?

Many of us have trouble putting on the brakes when we're in the moment. It may seem awkward to ask things like, "Do you have a condom?," or "What are you OK doing?" Sometimes the desire to just be with someone is stronger than asking them to put on a condom, talk about PrEP or ask if they’re on meds and undetectable. If you don't date much or are at a sex club or hooked up online, you might feel really uncomfortable asking personal questions at an intimate moment.

Those awkward moments can unfortunately lead to people taking risks when they don’t want to. If you clam up at the wrong moment, it might feel like it's too late to say no or to change what's going on.  Likewise, people who feel shy because of personal struggles, low self-esteem, mental health issues, or other issues may feel shy and be uncomfortable having these conversations with partners.

SAFER: Practice!  It sounds comical, but one approach is to practice having conversations about sex ahead of time. If you’re on PrEP and want to be able to talk to your partners about it, practice with a friend or in front of a mirror. You can do the same if you’re HIV-positive and want to be able to explain your status to your partners, or if you want to practice talking about how you’d like to use condoms.

Have a plan! If your partner can't think of anything fun to do that fits your definition of safe, have some suggestions prepared.

Read David Duran’s reflection about his experience not disclosing his HIV status to his partner, on BETA.  


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