Reducing Risk

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

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

Those STIs that are also transmitted through blood exposure, such as human immunodeficiency virus (HIV), hepatitis B, and hepatitis C, can also be prevented through infection prevention precautions and safe injection practices.

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 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 acquired immunodeficiency syndrome (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 of 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 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 of 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. These include broaching the topic with a partner in a nonthreatening manner, seeking support from other outside parties, practicing assertiveness, and providing arguments that demonstrate the caring impetus behind the request for safer sex.

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