Many people don’t realize that HIV prevention options have evolved considerably in recent years. While more than one million people in the U.S. are living with HIV, estimated infections decreased 12% overall from 2018 to 2022, according to the CDC. Ahead, doctors share what to know about HIV prevention and treatment options.
“The first tool is knowledge—know your status,” says Howard Grossman, M.D., medical director at Spectrum Medical and a former executive director of the American Academy of HIV Medicine. “The next is finding a knowledgeable provider who can provide up-to-date information and access to medication. And third is to understand one’s risk and, if at risk, get onto a form of PrEP that fits one’s lifestyle.”
Meet the Experts: Howard Grossman, M.D., medical director at Spectrum Medical and a former executive director of the American Academy of HIV Medicine and Ronald Collman, M.D., a professor at The Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for AIDS Research.
“People need to also know that HIV is not a death sentence anymore,” says Dr. Grossman. “If they do test positive and get on treatment, they will live a normal life. No one wants to have a disease, but we can control this now.”
Ahead, experts explain the research-backed HIV prevention strategies and explain what treatment can look like for people living with HIV.
1. Always use a condom
“HIV is transmitted through sexual activity: male to female, female to male, and particularly male to male,” says Ronald Collman, M.D., a professor at The Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for AIDS Research.
HIV.gov notes that anal sex is the highest-risk sexual behavior for HIV transmission, and vaginal sex has a lower, but still very substantial, risk. The person who’s the receptive anal sex partner (commonly known as the “bottom”) is actually at a higher risk for contracting HIV than the insertive partner (commonly known as the “top”). In fact, HIV.gov notes the bottom partner is 13 times more likely to get infected than the top, and that’s because the rectum has a very thin lining, which allows HIV to enter the body.
Keep yourself safe by using condoms correctly every time you have sex. Latex condoms are the most durable, so they’re your best line of defense. For people with latex allergies, polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are reliable options, even though they do break a little bit more often than latex ones. One important thing worth noting: Lambskin and other natural-membrane condoms have small holes in them, so they don’t block HIV and sexually transmitted infections (STIs).
It’s also key to use the right kind of lubricant. Water-based options (like KY) won’t weaken condoms, while oil-based lubes like massage oil or body lotion can.
2. Know the risks of oral sex
Oral sex carries “little to no risk” for getting or transmitting HIV, according to HIV.gov. However, certain factors, such as oral ulcers, bleeding gums, mouth sores, and the presence of other STIs—like syphilis, chlamydia, and gonorrhea—increase the likelihood of acquiring HIV through oral sex.
3. Never share needles or syringes
Sharing needles, whether you’re injecting hormones, steroids, or illegal drugs, can increase your risk for HIV. Needles, syringes, or other injection equipment that has already been used may have HIV-infected blood in them that can make you sick, according to the CDC. In addition to HIV, these needles often also carry the viruses that cause hepatitis, which can lead to liver failure, Dr. Collman says.
That’s why he says that needle-sharing programs, where injection drug users can obtain clean hypodermic needles and associated paraphernalia at no cost, are “very effective” in preventing the spread of HIV.
4. Ask your doctor about PrEP
There are currently four FDA-approved pre-exposure prophylaxis, or PrEP, drugs on the market. Two of them (Truvada and Descovy) are pills taken by mouth every day. The other two (Apretude and Yeztugo) are injections. Apretude is a shot taken every two months and Yeztugo is a shot taken every six months.
Add Prevention as a preferred source in your Google search results.
Use your Google account to add this to your settings.
“Which form of PrEP is best depends on personal choice,” says Dr. Grossman. “Some people cannot tolerate needles, so once-a-day pills are right for them. For others, they are already taking meds for other problems, so adding one more pill is easy. For many, though, the convenience of long-acting injectables outweighs everything.”
Grossman also notes that PrEP has largely been marketed to men, meaning many women are unaware that it’s an option. “One thing I’d like people to understand is what a powerful tool PrEP is for women. It puts prevention into their hands in much the way oral contraceptives put the decision on pregnancy under women’s control,” he says.
If you’re looking to get tested or find a provider of PrEP, Grossman suggests using the PrEP Locator website.
5. Learn about viral load
In 2017 the CDC declared that people with HIV who have an undetectable viral load—meaning levels of HIV in the blood is below the threshold of detection—are unable to transmit HIV to their partners. This is often summarized with the phrase Undetectable = Untransmittable or U = U.
The CDC made the declaration after analyzing the results of three studies that included thousands of couples engaging in sexual acts without condoms, where one partner was HIV-positive with an undetectable viral load, and the other was HIV-negative (and not on PrEP). Not one of the HIV-negative people in the three studies contracted the virus from a positive person when their viral load was suppressed, the CDC reported.
The way to obtain and maintain an undetectable viral load is through taking a combination of antiretroviral medications. This treatment is referred to as antiretroviral therapy or ART, according to HIV.gov. HIV researchers, doctors, and activists alike now view having an undetectable viral load as a means of HIV prevention, commonly referred to as Treatment as Prevention (TasP).
6. Avoid mother-to-child transmission
“HIV can be transmitted from mother to child during pregnancy, or more commonly at birth or through breastfeeding if the mother is not treated [for HIV],” Dr. Collman says. The good news is that advances in HIV research have made it possible for many women with HIV to give birth to babies who are free of infection. Taking HIV medicine (called antiretroviral therapy, or ART) to fully suppress the virus will help prevent transmission to your baby. According to HIV.gov, a C-section delivery may be recommended to reduce the risk of perinatal transmission, but it depends on the viral load.
7. Protect cuts and scrapes from exposure
Merely touching the blood or semen of an infected person isn’t enough to contract the virus. However, if these fluids come in contact with damaged tissue (such as a cut or scrape) or a mucous membrane, transmission can occur, Dr. Collman says. “Mucous membranes are found inside the rectum, vagina, penis, and mouth,” he notes.
8. Seek treatment if you think you’ve been exposed
If you believe you may have been exposed to HIV, talk to a health care provider as soon as possible—ideally within 72 hours. If you’re seen within this timespan, you may be able to take post-exposure prophylaxis (PEP) drugs that can reduce your risk of infection, according to the CDC.
As Dr. Grossman noted above, people who test positive for HIV and subsequently get on treatment “will live a normal life.”
“No one should fear knowing their status,” he says. “Knowledge is definitely power in this case.”
Read the full article here
