HIV Prevention Q&As

There are complex reasons why gay and bisexual men are at higher risk for HIV. Some of the reasons are listed below.

• The large percentage of gay and bisexual men with HIV means that, as a group, they have an increased chance of being exposed to HIV. And too many men are unaware of their HIV infection, which means they do not get medical care and are at increased risk of unknowingly transmitting the virus to sexual partners.
• Most gay and bisexual men acquire HIV through anal sex, which is the riskiest type of sex for getting or transmitting HIV. During anal sex, it’s possible for either partner—the insertive (top) or the receptive (bottom) to get HIV. However, if you are HIV-negative, receptive anal sex (bottoming) puts you at greater risk for getting HIV than insertive anal sex (topping). If you are positive, insertive anal sex (topping) is riskier for transmitting HIV to your partner.
• As a group, gay and bisexual men also have more sexual partners compared to other men. The more partners you have, the more likely you are to have sex with someone who can transmit HIV or has another sexually transmitted disease (STD), like syphilis, gonorrhea, and chlamydia. STDs, in turn, increase your chances of getting HIV or transmitting it to others.
• Homophobia, stigma, and fear of discrimination may affect whether gay and bisexual men seek and are able to obtain high-quality prevention and health services. Lack of insurance, concerns about confidentiality, and fear of talking about risky behavior or sexual orientation may prevent some men from seeking testing, prevention and treatment services, and support from friends and family.

HIV severely affects gay and bisexual men–more than any other group in the United States. Gay and bisexual men make up about 2% of the overall population, but account for approximately two-thirds of all new HIV infections each year. Data included in CDC’s 2013 National HIV Prevention Progress Report show that there was a 12% increase in new infections among gay and bisexual men overall between 2008 and 2010, and a 22% increase among young gay and bisexual men aged 13-24. Gay and bisexual men also account for over half of the 1.1 million people living with HIV in the United States. A 2011 study in 20 U.S. cities found that 18% of gay or bisexual men had HIV. That’s about 1 in 6 men. Of these men, 33% did not know they had HIV. Those who are unaware that they have HIV may infect others without knowing it. Also, those who do not know they are HIV-positive are not able to get HIV treatment that can protect their health and reduce the chance of transmitting HIV to their partners.

Learn more about HIV among gay and bisexual men.

Your life matters and staying healthy is important. It’s important for you, the people who care about you, and your community. Knowing your HIV status gives you powerful information to help you take steps to keep you and your partners healthy. You should get tested for HIV, and encourage your partners to get tested too. If you test positive, you can get on treatment to stay healthy for many years and reduce the chance of transmitting HIV to your sex partners. If you test negative and are sexually active, continue to get tested at least once a year—some men may benefit from more frequent testing (e.g., every 3-6 months). To find a testing site near you, call 1-800-CDC-INFO (232-4636), visit https://gettested.cdc.gov/, text your ZIP code to KNOW IT (566948), or use a home testing kit.

For people who are sexually active, there are more tools available today to prevent HIV than ever before. The list below provides a number of ways that you can lower your chances of getting HIV. The more of these actions you take, the safer you can be.

• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming). Sexual activities that do not involve the potential exchange of body fluids carry no risk for getting HIV (e.g., touching).
• Use condoms consistently and correctly.
• Reduce the number of people you have sex with. The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
• Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicine daily to prevent HIV infection. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you are HIV-negative and have had a sexually transmitted disease (STD) or any anal sex (receptive or insertive) with a male partner without condoms in the past 6 months and are not in an exclusive relationship with a recently tested, HIV-negative partner.
• Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable (see Q12. Can I transmit HIV if I have an undetectable viral load?). Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV.
• Get tested and treated for other STDs and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others. Find an STD testing site.

• If your partner is HIV-positive, encourage your partner to get and stay on treatment. ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.

Being with one partner and agreeing to be sexually active only with each other, decreases your chance of getting HIV and other sexually transmitted diseases (STDs). But being in a relationship doesn’t automatically protect you from HIV.

It is important that you and your partner get tested for HIV and other STDs and share your test results with one another or get tested together as a couple. The only way to know your HIV status for sure is to get tested, and do it at least once a year.

It is estimated that between 30% to 70% of HIV infections among gay men are acquired from their main sexual partner. Many of these infections can happen early in a relationship, because men may not have accurate knowledge about their own or their partner’s HIV status and they stop using condoms or other prevention strategies as the relationship becomes more serious. In addition, while you and your partner may never have sex outside of your relationship, some men do. While you may know your partner’s status today, you may not always know if your partner is having sex outside of the relationship or doing other things to increase the chance for getting HIV, such as injecting drugs.

Some people choose to keep using condoms when they are in an exclusive relationship for further protection from HIV and other STDs. In fact, because many STDs show no symptoms, you or your partner could have an STD from an earlier relationship and not even know it.

It is important that you and your partner have ongoing conversations about these issues to stay healthy, and protect you both from HIV. 

There are more options available today than ever before to keep your partner healthy and to reduce your chance of getting HIV. But it is important to know that your overall chance of getting HIV increases the more times you have sex with someone who is living with HIV. So, while any of these actions alone can lower your chance of getting HIV, you can lower your chances even more by taking multiple actions. The more actions you take, the safer you can be.

The following actions can lower your chance of getting HIV:

• Encourage your partner to get and stay on treatment. Antiretroviral therapy (ART) reduces the amount of virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. During anal sex, it is less risky for you as the HIV-negative partner to be the insertive partner (top) than the receptive partner (bottom). Sexual activities that do not involve the potential exchange of body fluids carry no risk for getting HIV (e.g., touching).
• Use condoms consistently and correctly.
• Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicine daily to prevent HIV infection. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner.
• Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable (see Q12. Can I transmit HIV if I have an undetectable viral load?). Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV.
• Get tested and treated for sexually transmitted diseases (STDs) and encourage your partner to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase the chance of getting HIV or transmitting it to others. Find an STD testing site.

It is also important for you to get tested for HIV at least once a year, so you are sure about your HIV status. You may benefit from more frequent testing (e.g., every 3-6 months). Knowing your HIV status gives you powerful information to help you take steps to keep you and your partners healthy (see Q7. When should I get tested for HIV and other STDs?). To find a testing site near you, call 1-800-CDC-INFO (232-4636), visit https://gettested.cdc.gov/, text your ZIP code to KNOW IT (566948), or use a home testing kit.

Taking care of yourself and staying healthy is important. Your life matters.

Talk about your HIV status with all of your sexual partners and take steps to protect your health and your partners’ health.

The following actions can reduce your risk of transmitting HIV:

• Use antiretroviral therapy (ART). ART reduces the amount of virus (viral load) in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to sex partners if taken consistently and correctly.
• If you are taking ART, follow your health care provider’s advice. Visit your health care provider regularly and always take your medicine as directed.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. During anal sex, it is less risky for you as the HIV-positive partner to be the receptive partner (bottom) than the insertive partner (top). Sexual activities that do not involve the potential exchange of body fluids carry no risk for getting HIV (e.g., touching).
• Use condoms consistently and correctly.
• Talk to your partners about pre-exposure prophylaxis (PrEP), taking HIV medicine daily to prevent HIV infection. PrEP should be considered for HIV-negative partners who are in an ongoing sexual relationship with an HIV-positive partner. PrEP should also be considered for HIV-negative men who have had an STD or any anal sex (receptive or insertive) with a male partner without condoms in the past 6 months, and who are not in an exclusive relationship with a recently tested, HIV-negative partner.
• Talk to your partners about post-exposure prophylaxis (PEP) if you think they have had a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable (see Q12. Can I transmit HIV if I have an undetectable viral load?). Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV. 
• Get tested and treated for STDs and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase the chance of getting HIV or transmitting it to others. Find an STD testing site.

You should also encourage your partners who are HIV-negative to get tested for HIV at least once a year so they are sure about their HIV status and can take action to keep them healthy. They may benefit from more frequent testing (e.g., every 3-6 months). (see Q7. When should I get tested for HIV and other STDs?). To find a testing site near them, they can call 1-800-CDC-INFO (232-4636), visit https://gettested.cdc.gov/, text their ZIP code to KNOW IT (566948), or use a home testing kit.

   Taking care of each other and keeping you both healthy is important.

You and your partner should take steps to protect your health—for yourselves, for each other, and for those who care about both of you.

• Visit your health care provider regularly. Be sure to talk about any questions or concerns you may have.
• Use antiretroviral therapy (ART). ART reduces the amount of virus (viral load) in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to sex partners if taken consistently and correctly. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are.
• If you are taking ART, follow your health care provider’s advice. Always take your medicine as directed.
• Get tested and treated for sexually transmitted diseases (STDs) and encourage your partner to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. Find an STD testing site.
• Use condoms if one of you has another STD. You should also use condoms with any other partners if either you have sex outside of your relationship, even if those partners are also HIV-positive. Using condoms will reduce your chance of getting an STD.
• Take care of yourself and each other. Nutrition, exercise, mental health and substance use, including smoking, all affect your health and well-being. HIV is just one part of your life . . . take care of all of you.

If either of you have other sex partners who are HIV-negative or whose status you don’t know, the following strategies can reduce your risk of transmitting HIV:

• Use condoms consistently and correctly.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. During anal sex, it is less risky for you as the HIV-positive partner to be the receptive partner (bottom) than the insertive partner (top). Sexual activities that do not involve the potential exchange of body fluids carry no risk for getting HIV (e.g., touching).
• Talk to your partners about pre-exposure prophylaxis (PrEP), taking HIV medicine consistently daily to prevent HIV infection. PrEP should be considered for HIV-negative partners who are in an ongoing sexual relationship with an HIV-positive partner. PrEP should also be considered for HIV-negative men who have had an STD or any anal sex (receptive or insertive) with a male partner without condoms in the past 6 months, and who are not in an exclusive relationship with a recently tested, HIV-negative partner.
• Talk to your partners about post-exposure prophylaxis (PEP) if you think they have had a possible exposure to HIV. An example of a possible exposure is you have anal or vaginal sex without a condom or the condom breaks and your partner is HIV-negative and not on PrEP. Your partners’ chance of exposure to HIV is lower if you are taking ART consistently and correctly, especially if your viral load is undetectable (see Q12. Can I transmit HIV if I have an undetectable viral load). Your partners should talk to their doctors right away (within 3 days) if they think they have had a possible exposure to HIV. Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it daily for 4 weeks reduces your partners’ chance of getting HIV.
• Get tested and treated for STDs and encourage your partner to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase the chance of getting HIV or transmitting it to others. Find an STD testing site.

You may also want to encourage your partners who are HIV-negative to get tested for HIV at least once a year, so they are sure about their HIV status.

Sexually active, gay and bisexual men should be tested for HIV at least once a year, and may benefit from more frequent testing (e.g., every 3-6 months). Regular testing for other STDs is also important. Having an STD can increase the chances of getting HIV or transmitting it to others. All sexually active gay and bisexual men should also be tested for STDs at least once a year.

To find a testing site near you, call 1-800-CDC-INFO (232-4636), visit https://gettested.cdc.gov/, text your ZIP code to KNOW IT (566948), or use a home testing kit.

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All sexually active gay and bisexual men should be regularly tested for STDs. The only way to know your STD status is to get tested (you can search for a testing site). Having an STD (like gonorrhea) makes it easier to get HIV, so it’s important to get tested to protect your health and the health of your partner. CDC recommends sexually active gay and bisexual men test for:

• HIV;
• Syphilis;
• Hepatitis B and C;
• Chlamydia and gonorrhea of the rectum if you’ve had receptive anal sex, or been a “bottom” in the past year;
• Chlamydia and gonorrhea of the penis (urethra) if you have had insertive anal or oral sex in the past year;
• Gonorrhea of the throat if you’ve performed oral sex (i.e., your mouth on your partner’s penis, vagina, or anus) in the past year;
• And sometimes your health care provider may suggest a herpes test.

Your health care provider can offer you the best care if you discuss your sexual history openly. Talk with your provider about getting vaccinations for hepatitis A and B, and HPV. You should have a provider you are comfortable with. CDC’s Lesbian, Gay, Bisexual and Transgender Health Services page has resources that can help you find health services that are gay-friendly.

Oral sex involves giving or receiving oral stimulation to the penis (fellatio), the vagina (cunnilingus), or the anus (anilingus or rimming). Most types of oral sex carry little to no risk of HIV. Your highest oral sex risk is performing oral sex (fellatio) with ejaculation in your mouth. However, the risk is still low, and much lower than anal or vaginal sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs) (which may or may not be visible).

The following things can reduce your risk of getting HIV through oral sex:

• Avoid having your partner ejaculate in your mouth.
• Use barriers such as condoms, natural rubber latex sheets, dental dams, or cut-open non-lubricated condoms. 

In addition, your chance of getting HIV from oral sex is lower if you are already taking pre-exposure prophylaxis (PrEP) consistently and correctly or if your partner is living with HIV and is taking antiretroviral therapy (ART) consistently and correctly.

Keep in mind that barrier methods are the only way to protect you from some STDs, including gonorrhea of the throat. And although the chance of getting or transmitting HIV from anilingus (rimming) is small, there is a big chance of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming. There are effective vaccines that protect against hepatitis A and B and human papillomavirus infections. Talk to your health care provider to see if these are right for you, if you have not already been vaccinated.

• When used correctly and consistently, condoms are highly effective in preventing HIV infection. 
• Condoms are also effective at preventing sexually transmitted diseases (STDs) transmitted through body fluids, like gonorrhea, chlamydia, and HIV. However, they provide less protection against STDs spread through skin-to-skin contact like human papillomavirus (genital warts), genital herpes, and syphilis.
• There are two types of condoms: male and female.

Male Condoms

• Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies. Natural membrane (such as lambskin) condoms are porous, meaning that infections can pass through them, and therefore do not protect as well against HIV and certain other STDs.
• Lubricants can help prevent condoms from breaking. Water-based and silicon-based lubricants are safe to use with latex condoms. Oil-based lubricants and products containing oil, such as hand lotion, Vaseline, or Crisco should not be used with latex condoms.

Female Condoms

• Female condoms are thin pouches made of a synthetic latex product called nitrile.
• When worn in the vagina, female condoms are just as effective as male condoms at preventing STDs, HIV and pregnancy. Some people use female condoms for anal sex. However, we do not know how well female condoms prevent HIV and other STDs when used for anal sex. But we do know that HIV cannot travel through the nitrile barrier.
• It is safe to use any kind of lubricant with nitrile female condoms.

Although highly effective when used consistently and correctly, there is still a chance of getting HIV if you only use condoms, so adding other prevention methods can further reduce your risk (see Q2. I’m HIV-negative. How can I avoid getting HIV? and Q5. I am living with HIV, what should I do to keep my partners from getting HIV?)

Yes. If you are HIV-negative there are two different ways you can take medicines to prevent HIV: pre-exposure prophylaxis (PrEP) pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis (PEP).

You should consider PREP if you’re in an ongoing sexual relationship with an HIV-positive partner. PrEP should also be considered if you have had a sexually transmitted disease (STD) or any anal sex (receptive or insertive) with a male partner without condoms in the past 6 months, and are not in an exclusive relationship with a recently tested, HIV-negative partner.

PrEP involves taking a pill (brand name Truvada) every day. You and your health care provider should consider the following factors in deciding whether PrEP is right for you:

• Only people who are HIV-negative should use PrEP. HIV testing is required before starting PrEP and every 3 months while taking PrEP.
• PrEP involves taking HIV medicine every day and regular visits to a health care provider.
• PrEP can cause side effects like an upset stomach or loss of appetite but these are mild and usually go away within the first month.

Even when you use PrEP consistently and correctly, there still may be a chance that you can get HIV. Taking other actions, like using condoms consistently and correctly, can lower your chances of getting HIV even more.

PEP is medicine that is used to prevent HIV after a possible exposure. An example of a possible exposure is if you have anal sex without a condom with someone who is HIV-positive or whose HIV status you don’t know. You take PEP for 4 weeks if you may have been recently exposed to HIV and are not on PrEP. PEP keeps HIV from making copies of itself and turning into infection. To be effective, PEP must begin as soon as possible, but always within 72 hours (3 days) of a possible exposure. Keep in mind that PEP should only be used in situations right after a potential exposure. PEP is not intended for long-term use. It is not a substitute for other proven HIV prevention methods, such as correct and consistent condom use.

You should continue to use condoms with sex partners while taking PEP. If you have repeated exposures to HIV, you should consider PrEP.

Yes, it is possible that you could still transmit HIV. However, having an undetectable viral load greatly lowers the chance of transmitting the virus to your sexual partners who are HIV-negative. Having an undetectable viral load is also good for your overall health.

Viral load refers to the amount of HIV in the blood. An undetectable viral load is when the amount of HIV in the blood is so low that it can’t be measured. Antiretroviral therapy (ART) reduces viral load, ideally to an undetectable level, when taken consistently and correctly. If a person’s viral load goes down after starting ART, then the treatment is working. However, people with an undetectable viral load still have HIV in their body, which means there is a chance that they can transmit HIV through sex. An HIV-positive person can still potentially infect a partner even if they have an undetectable viral load, because of the reasons listed below.

• HIV may still be found in genital fluids (e.g., semen, vaginal fluids). The viral load test only measures virus in blood. Although ART also lowers viral load in genital fluids, HIV can sometimes be present in genital fluids even when it is undetectable in the blood.
• Your viral load may go up between tests. When this happens, you may be more likely to transmit HIV to sexual partners. Your viral load may go up without you knowing it because you may not feel any different.
• Sexually transmitted diseases (STDs) increase viral load in genital fluids. This means that an HIV-positive person with an STD may be able to transmit HIV to sexual partners even if the blood viral load is undetectable.

Researchers are studying how much you can lower your chances of transmitting HIV when your viral load is undetectable, and we should know more when these studies are complete. 

If you are taking ART, follow your health care provider’s advice. Visit your health care provider regularly and always take your medicine as directed. This will give you the greatest chance of having an undetectable viral load. Taking other actions, like using a condom consistently and correctly, can lower your chances of transmitting HIV even more.

You could start with a general conversation about sexual health. Ask about the last time your partner got tested for HIV and other sexually transmitted diseases (STDs) and ask about the results of those tests. Get other tips on how to start the conversation.

Listen. Talk. Support.

• Listen. Sometimes, having someone listen to the challenges people living with HIV face is just what is needed.
• Talk. Have open, honest conversations about staying safe, healthy, and the importance of getting and staying on HIV treatment. Remind him that treatment will allow him to stay healthy and have healthy relationships. Be sure not to judge or blame your friend for the actions that led to HIV infection.
• Support. Let them know you care and that you will be there for them. Don’t blame or judge. Listen and be a friend. Discuss any special needs and help provide support to meet those needs.

Feeling uncertain about disclosing your HIV status is very common, especially if you’re still adjusting to being HIV-positive and feeling anxious about your health and your future. Even if you’ve been living with HIV for some time, you may continue to find yourself in situations where it’s hard to disclose your status because of how people might react.

You will find that plenty of men will be accepting of your status–and you may even find out that your partner(s) is positive, as well.

But the reality is, there may be times when a partner is less accepting of your HIV status. When disclosing to your partner(s), encourage them to learn more about HIV to help dispel some of the myths and any potential fears that they might have. Try explaining that your status is just one part of who you are and that you are doing all you can to take care of your health and theirs. Discuss how you can work together to keep them safe and you healthy. Even if the conversation doesn't go the way you'd hoped and you’re unable to change how they feel immediately, it may help them be better informed.

If a partner cannot accept you, or chooses not to be with you, that can be difficult. Many people living with HIV have dealt with this situation and have found their way through it though—you will get through it, too. Disclosing your status is the right thing to do, and you should feel good about having taken a major step in keeping you and your partner(s) safe and healthy. You have to know that there are others out there who will respect and accept you.

It’s important to keep in mind that many states have laws that require you to tell your sexual partners if you are HIV-positive before you have sex (anal, vaginal, or oral) or share drugs or needles to inject drugs. In some states, you can be charged with a crime if you don’t tell your partner your HIV status, even if your partner doesn’t become infected. So again, telling your partner is the right thing to do. Learn more about state HIV-specific criminal laws.