A guide to HIV: What it is, how it’s passed on, and how to stay healthy

What is HIV? 

HIV stands for Human Immunodeficiency Virus. It’s a virus that weakens your immune system, and makes it much harder for your body to fight off infections, illnesses, and diseases. When HIV progresses without treatment, it can lead to Acquired Immune Deficiency Syndrome (AIDS), the most advanced form of HIV. At that stage, a person may experience worsened symptoms, serious infections, or develop certain cancers. If untreated, AIDS can become life-threatening.

Fortunately, many effective treatment options exist, meaning that people living with HIV can stay healthy and without any chance of passing on HIV to sex partners. Starting treatment early and remaining consistent with it turns HIV into a manageable, chronic condition. Many people living with HIV can expect to live long, full, and healthy lives.

Where to find HIV testing

In the U.S., you can find testing clinics on the CDC website, and self-testing via TakeMeHome, as well free HIV self-testing. In other locations, you can find testing resources in BHOC’s global directory.

Elsewhere, check with your local healthcare provider, sexual health organization, or public health authority for testing information specific to your region. You can find more information on STI testing here, and self-testing here.

What puts you at risk of HIV?

Today, there are more ways than ever to prevent HIV transmission. People who are HIV-negative can take PrEP (pre-exposure prophylaxis), a daily pill or on-demand medication that helps prevent contracting HIV, and use condoms. People living with HIV can take their medication and keep their viral load undetectable, meaning the virus can’t be passed on during sex.

Still, various kinds of sex carry different levels of risk for HIV transmission:

• No risk of HIV transmission: Kissing, touching each other or masturbating, rimming (oral play around the anus), grinding or body to body contact, massage, water sports (urine play), bondage, dirty talk and role play, spanking, wrestling.
• Little to no risk for HIV transmission: Oral sex.
• Medium risk for HIV transmission: Topping (being the penetrating partner) without using a condom.
• High risk for HIV transmission: Bottoming (being penetrated by a partner) without using a condom, or sharing needles.

Please bear in mind that these ranges apply only to HIV, not for other STIs such as syphilis, gonorrhea, chlamydia, or hepatitis. Infections such as mpox and COVID-19 also have their own ways of spreading. Some STIs like HPV, herpes, and syphilis can pass through skin-to-skin contact in areas a condom doesn’t cover.

While many kinds of play are low or no risk for HIV, the most common way it’s passed on is through sex without a condom unless the HIV-negative partner is on PrEP (pre-exposure prophylaxis) or the HIV-positive partner is taking medication and has an undetectable viral load.

What’s the likelihood of getting infected through oral sex?

The risk around oral sex varies depending on whether you’re giving or receiving. Still, using a condom or dental dam for oral sex can help to reduce that risk. 

Performing oral sex on people with vulvas: There have been very few reports of possible HIV transmission through cunnilingus (oral sex performed on a person with a vulva). It is biologically possible that HIV could be passed on through an HIV-negative person performing oral sex on a woman, or a person with a vulva, living with HIV, but this is considered to be low risk. 

The levels of HIV in vaginal fluid vary. They are likely to be highest around the time of menstruation (having your period), when HIV-bearing cells shed from the cervix are most likely to be found in vaginal fluid, along with blood. Oral sex will therefore be more risky around the time of menstruation.

From giving a blow job: Oral sex carries much less risk of HIV than anal or vaginal sex, but it’s not entirely risk-free. HIV can enter through minor cuts or sores in the mouth, though this is extremely rare. Researchers agree that getting HIV this way is very uncommon.

Once semen gets past the mouth, stomach acid and enzymes in the esophagus kill the virus. Because HIV needs a route into the bloodstream to cause infection, the risk of contracting HIV is lower when cum (or pre-cum) is swallowed or spat out soon after compared with letting it sit in your mouth.

To reduce your risk even more, make sure you keep your mouth healthy. You may want to avoid giving head right after brushing or flossing your teeth, which can irritate your gums anyway but especially if you have any oral cuts or sores. In which case, it’s best to wait until they have healed. While the risk of HIV from oral sex is very low, it’s still possible to get other STIs this way.

From receiving oral sex: The risk is considered effectively zero but the information above about healthy oral hygiene is still good to keep in mind. Other STIs can still be passed this way, which is why regular testing is a good idea if oral sex is part of your play.

Rimming: Rimming (oral play around the anus) carries little to no risk. Still, infections like hepatitis can be passed through oral–anal contact. Using a dental dam can help lower that risk while still keeping things intimate.

U = U: Treatment as Prevention

Treatment as Prevention (TasP) is a strategy people who are living with HIV can use to prevent the spread of HIV. When someone takes their HIV medication consistently, their viral load (the amount of HIV in their blood) can become so low that standard tests can’t detect it. 

It is impossible for people with an undetectable viral load to transmit HIV to their sex partners. This is known as U = U (Undetectable = Untransmittable). A simple, powerful message showing that effective HIV treatment not only keeps people healthy but it also means that HIV positive people can still enjoy sex without passing the virus on. 

How do we know it works? There are two big clinical trials that have provided definitive evidence that treatment as prevention is effective (HPTN 052 Study and PARTNER Study). However, we do not yet know if TasP is as effective in preventing HIV transmission through sharing needles or injection drug equipment. And keep in mind that when an HIV-positive person first starts treatment, it can take several months before their viral load is completely suppressed.

U=U has been adopted by HIV organizations around the world, and many people include it in their dating app bio or profile description to help raise awareness, normalize the conversation and challenge stigma. This could look like adding “U=U” or “HIV positive, undetectable.” For more information, check out the Prevention Access Campaign.

The symptoms of HIV

When someone goes from being HIV-negative to being HIV-positive, we say that they have “seroconverted.” Soon after contracting HIV, some people experience what is known as  “acute HIV infection,” which may feel like a bad flu that lasts for a couple of weeks. Symptoms may include a fever, rashes, a sore throat, or swollen glands. However, not everyone experiences them.

After experiencing seroconversion illness, the person will probably begin to test positive on HIV tests. Over time, some may notice ongoing symptoms like unexplained weight loss, diarrhea, rashes, or recurring fevers. If HIV is left untreated over a period of time, it can eventually weaken the immune system and lead to AIDS and/or AIDS-related illnesses like pneumonia, brain infections, skin cancers, and severe fungal infections.

About HIV treatment

There is currently no vaccine or cure for HIV, but it can be effectively managed with medication. People living with HIV take medications, called antiretrovirals (ART), that keep them healthy and, when taken consistently, can make their viral load undetectable. When someone is undetectable, they can’t pass HIV on to their sexual partners.

It is recommended that people start ART immediately after being diagnosed.   Research shows that beginning treatment early helps people living with HIV stay healthy and live just as long as those without HIV, especially when treatment starts soon after infection. That’s why regular HIV testing is so important: the earlier HIV is detected, the sooner treatment can begin.

Antiretroviral therapy can either be in the form of daily oral medications or regularly scheduled injections. For more on long-lasting injectable ART, see the following section. Staying on treatment keeps the virus under control, allowing people living with HIV to live long, full, and healthy lives. Without treatment, HIV can weaken the immune system over time and progress to AIDS, which can be life-threatening, so early detection and treatment are the best way to stay healthy.

Injectable ART

In addition to ART that is taken orally, it’s now possible to receive ART as a series of regularly scheduled injections.

Injectable ART has several advantages that may make it a good fit for some people. Injectables are more private and they’re long-lasting so it’s easier to stay consistent, taking one thing off a person’s daily to-do list. Plus, for some HIV-positive people, taking a daily pill is the only moment in their day that may still remind them of their status. So removing that can bring a sense of relief and freedom for some.

There’s a growing body of research showing that injectable ART can be just as effective, and for many people even easier to maintain, because it reduces the chance of missing doses and helps them stay undetectable.

On the other hand, injectable ART currently requires clinic visits either every month or two. For some, that schedule might not be practical when compared with the convenience of taking medication at home.

Because injectable ART has only been studied in people who were already undetectable, it isn’t currently an option for people who were recently diagnosed or whose viral load isn’t undetectable.

Key terms for understanding HIV prevention and treatment

Here are some key terms and concepts to help people living with HIV and HIV-negative folks understand more about prevention and treatment.

Viral load

Viral load refers to the amount of HIV in a small sample of the person's blood. A viral load test shows how much of the virus is present and helps monitor how well treatment is working. The lower your viral load, the better your immune system can function and protect you from infections.

Antiretroviral therapy (ART)

Antiretroviral therapy, or ART, is the medication used to treat HIV. It works by stopping the virus from multiplying in the body, which helps lower your viral load and keeps your immune system strong. Taking ART consistently is the best way to stay healthy and undetectable.

Undetectable viral load

When treatment works so well that HIV can no longer be found by standard tests, a person is said to have an undetectable viral load. For most modern tests, that means there are fewer than 50 copies of the virus in a milliliter of blood. Reaching and maintaining an undetectable viral load is one of the main goals of HIV treatment.

PrEP

Short for “pre-exposure prophylaxis," PrEP is a way for people who are HIV-negative to protect themselves by taking HIV medication before possible exposure. Most people take PrEP as a daily pill, but some use what’s known as the “2-1-1” method around times of anal sex if that suits their routine better.The 2-1-1 method means taking two pills 2–24 hours before sex, one pill 24 hours after the first dose, and another pill 24 hours later. PrEP is highly effective when taken correctly and is one of the best tools for preventing HIV transmission.

Just recently, a new method of PrEP was approved, that involves injections taken just a few times a year. You can find more information here.

H3: Being undetectableUsing ART to reach an undetectable viral load means that there is very little HIV in your body.  This keeps your immune system healthy, helps you live longer, and means you can’t pass the virus on to sexual partners.

Staying safe: treatment, testing, and transparency

Studies have shown that people with an undetectable viral load have effectively no risk of transmitting the virus to their HIV-negative partners. When more people are on treatment and keeping their viral load under control, fewer new infections occur, an approach called “treatment as prevention,” or TasP.

Being undetectable does not mean “cured.” It means that there’s so little HIV in the blood that today’s monitoring tests are unable to detect it. Even with an undetectable viral load, however, an HIV-positive person still has the virus. That’s why staying on medication and attending regular check-ups is so important.

Keep in mind that after starting treatment it can take several months before the viral load is completely suppressed. During that time, it’s a good idea to use condoms and/or make sure your partner is on PrEP.

While suppressing the virus to undetectable levels has clear benefits for both people living with HIV and HIV-negative people, it’s just one part of HIV prevention. Other essential ways to stay safe include using condoms, accessing sterile syringes for people who inject drugs or hormones, taking PrEP if you’re HIV-negative, regular HIV testing, self-education about HIV and sexual health, and open communication with sexual partners.

HIV testing providers

In the U.S., you can find testing clinics on the CDC website, and self-testing via TakeMeHome, as well specific HIV testing. In other locations, you can find testing resources in BHOC’s global directory.

Elsewhere, check with your local healthcare provider, sexual health organization, or public health authority for testing information specific to your region.  

For more information, take a look at our guide to prioritizing sexual health and safety. You can also access our resources on the different types of STI testing, and how to use self-tests.