Prevention of Infection through Sexual Contact

A variety of strategies can be promoted by HIV/STI prevention programs and used by individuals to reduce risk for infection. The major strategies include:

• Reducing the number of sexual partners
• Delaying onset of sexual activity in young people
• Safer sex, including using condoms

While these strategies can be highly effective, they are not always easy to implement, particularly for women who often have little control over the terms of sexual relations or the behavior of their partners. Gender issues, such as power imbalances in sexual relationships, may interfere with condom use and may prevent women from protecting themselves, even if they are aware that their partner’s behavior may be putting them at risk. It is often difficult if not impossible for many women to negotiate safer sex with their partners. Moreover, because of their social and economic dependency on men, women frequently have little power to refuse sex or to insist that condoms be used during intercourse.

Safer Sex

Safer sex includes practices that reduce the risk of contracting STIs, including HIV (the virus that causes AIDS). These practices reduce contact with the partner’s body fluids, including semen, vaginal fluids, blood, and other types of discharge from open sores.

Safer sex reduces but does not completely eliminate risk. For example, using a condom correctly and every time for anal, oral, or vaginal sex greatly reduces but does not totally eliminate the risk for transmission. For some STIs that produce lesions outside of the area covered by the condom, such as chancroid or herpes, exposure can still occur with condom use. Although condoms are highly effective, breakage and slippage can occur, particularly if the condoms are used incorrectly.

What is the most risky kind of sex?

Unprotected anal and vaginal sex with an infected person carry a high risk for disease transmission. Anal sex is especially risky because it can result in tiny tears or cuts in the rectum. Viruses can enter the body more easily through these open sores than through healthy skin. Unprotected oral sex carries a lower risk but is not risk-free. The use of drugs or alcohol can increase the risk of getting an STI or HIV/AIDS because people under the influence may be less careful about practicing safer sex.

What are some forms of safer sex?

Very low or no risk:

• Kissing
• Massage
• Masturbation
• Sexual stimulation using your hand on another person
• Oral sex on a man who is wearing a condom
• Oral sex on a woman using a sheet of latex or plastic wrap

Low risk:

• Anal and vaginal sex using a latex or polyurethane male or female condom

Aside from abstinence or having sex with only one, uninfected partner, using condoms is the most effective way of preventing sexual transmission of HIV or other STIs. 

Remember, it is necessary to have an HIV test three months after engaging in risky sexual behaviors to be sure that you are HIV-negative. In addition, some STIs do not have symptoms for a long time, so it is impossible to know for sure if you are infected unless you are tested. It is important to learn about partners’ sexual history and risk for infection as well. However, getting a partner’s sexual history can be difficult and unreliable. People may not be honest because of fear or shame. Sometimes a partner may have an STI or HIV but is unaware of it because he or she does not have any symptoms.

Negotiating safer sex

Negotiation is a process in which two or more people with different perspectives or interests interact in order to arrive at a common goal or course of action. This usually entails compromise on the part of one or both partners. Because of the sensitive nature of sexuality, negotiating safer sex can be a difficult process for partners. Women in particular, due to gender inequalities and lack of power within sexual relationships, may find it difficult, if not impossible, to negotiate safer sex with their partners. Partners may equate a request for safer sex with an indication of unfaithfulness and may react negatively, even violently, or may react by withdrawing financial support or terminating the relationship.

Providers can help clients to gain skills in negotiating safer sex. It is important for providers to encourage partner communication, but to also be sensitive to the potential consequences for their clients of demanding condom use, or even raising the subject. Providers can help clients:

• Consider ways to broach the topic with their partner(s) in a nonthreatening manner
• Identify and practice arguments for condom use and responses to partners’ excuses for not using condoms
• Practice assertiveness
• Identify ways of communicating with partners indirectly by, for example, sharing information or literature from the clinic, leaving condoms in strategic places, or discussing the situation of others
• Consider ways to seek support from outside parties in communicating with partners
• Learn how to demonstrate that requests for safer sex are inspired by caring rather than accusation

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