Sexual Health – Risk Reduction
Sexual health, HIV and condom use – a lot of work needs to be done among men having sex with women in our communities before the connection becomes part of everyday behaviour.
Women cannot use condoms regularly without the cooperation of male partners. Condoms are a necessary part of women’s sexual health when men are involved.
If you think a woman is in need of support or counselling about her sexual health needs, her relationship, or her safety, please refer to the Service Locator section link at the bottom of this page. We’ve designed this tool to be the most current and convenient way to connect to specialized sexual health services in Toronto.
This city is rich in AIDS service organizations and other women-serving agencies with expertise in these issues. They can support the work you are already doing with the women you serve.
In the meantime, here are some tips and strategies to help keep women safer when condom use is not an option. They are definitely not as effective at preventing HIV transmission as condoms. Some of them may be tricky to negotiate. Still, they have been shown to reduce the chances of HIV infection.
Many women have grown up with the idea that the inside of the vagina needs to be cleaned out with water or mixtures of other fluids (douching):
- during periods
- before or after sex
- with a vaginal infection
- to get rid of a feeling of not being fresh
Women might have seen their mothers, sisters or aunties do it. But medical professionals agree that women should not douche. Vaginas have a delicate balance of good and bad bacteria and yeast. Together, they secrete fluids that keep a healthy internal acidic balance. All of this acts to keep the vagina naturally clean.
Douching removes both the good and bad bacteria from a woman’s vagina. This can cause irritation and infection. In this way, douching increases the chances of HIV infection as well as other sexually transmitted infections (STIs).
Douching is dangerous for women.
Use water-based or silicone lubricant
Water-based or silicone lubricant lessens the chance of HIV infection. These kinds of lube also make sex feel better. Use the unscented and unflavoured type. (Same goes for condoms.) The sugars and perfumes in flavoured/scented lubricants and condoms can irritate a woman’s vagina – giving her an infection and increasing her chances of getting HIV.
How does an unscented, unflavoured water-based or silicone lubricant help protect women?
- Lubrication lessens friction during sex.
- Less friction means fewer abrasions (tiny tears) in the vagina or anus.
- Damage like this can happen because of sex when:
- – a woman isn’t turned on (wet) enough
- – sex is rough
- – sex goes on for a long time
- Abrasions to the inner surface lining of the anus or vagina can make it easier for HIV to enter the body.
More lube means fewer tiny tears. And this means greater protection from HIV.
It’s important to remember that using oil-based lubricants (like Vaseline or baby oil) is not recommended. They can be harder for the vagina to get rid of after sex. As a result, oil-based lubes increase the chance of vaginal infection.
Also, oil-based lubricants weaken latex. This can make latex condoms break. It can also damage some sex toys.
HIV infection is unlikely to occur through oral sex.
Most types of oral sex are negligible risk for HIV transmission. This means that there is a potential risk, but no confirmed reports of HIV transmission through oral sex have been reported in Canada through these routes.
Two kinds of oral sex run a low risk of HIV transmission:1
- fellatio without a barrier, taking semen/pre-ejaculate in the mouth
- cunnilingus without a barrier, either during or not during menses
Low risk means there is a potential for transmission because activities may involve exchange of semen, vaginal fluids, or blood. A few isolated reports of infection have been attributed to these activities in Canada, usually in individual case studies or anecdotal reports.
Oral sex is a safer alternative to vaginal or anal sex with respect to HIV. However, many other STIs (such as herpes, gonorrhoea, syphilis and genital warts) can be passed on through oral sex. Having another STI can increase the risk of HIV transmission.
Oral sex during a period (menstruation)
Performing oral sex on a woman who is HIV positive is not usually considered to be high risk for passing on HIV. However, if a woman who is HIV positive is having her period, it might make it easier to pass on HIV from her to her sexual partner through her menstrual blood.
Avoid flossing before oral sex
Although oral sex has much less chance of transmitting HIV, flossing can cause small cuts and temporary bleeding in the gums. Any damage like this increases the chance of HIV entering the body.
The same might be true soon after a visit to the dentist, for example.
Maintain good oral hygiene
Although we do not recommend flossing right before oral sex, we do recommend brushing, flossing and going to the dentist regularly for healthy teeth and gums. A mouth infection can increase the chances of HIV entering the body.
Hard sex and sex that lasts a long time
Having penetrative sex that is rough – or that goes on for a while – can cause irritation in the vagina or anus. Irritation in these areas makes it easier for HIV and other STIs to enter the body.
Apply as much water-based lubrication as you like when having sex. If intercourse starts to hurt, either pause and add more lubrication before continuing, or stop altogether.
Sexually Transmitted Infections (STIs)
Noticing visible STIs means watching out for unusual genital bumps, fluids or smells. They can occur inside or outside a vagina, penis or anus. It’s a good idea for partners to stop having sex if one – or both – has any of these signs. Both people should get tested and treated. Until tests confirm that neither partner has an STI, or after treatment is completed, penetrative and oral sex is not a good idea.
- If a person with other STIs is exposed to HIV, there is a greater chance of getting the disease.
- Some STIs can cause other serious complications – such as infertility – if they are left untreated.
- Many STIs have no symptoms. Someone who is worried about a possible infection is encouraged to contact a trusted health provider.
- Getting a test after noticing any of the changes listed above will mean that – if any STIs are found – they will be treated early, before they get serious.
Good places to go for testing or treatment include sexual health clinics or a doctor.
Please see the website’s SERVICE LOCATOR to find sexual health clinics or community health services in Toronto.
Tests for STIs and HIV – getting them regularly
Regular tests for STIs and HIV can:
- increase treatment options
- keep people healthier as a result of early STI treatment
- reduce the chances for HIV infection
Having an STI can increase the possibility of getting HIV. How? An STI triggers the immune response. This makes surface tissues more vulnerable to HIV.
If a woman tests HIV positive at an early stage, she has the choice to use medication right away, which is better for her health. She will also be informed about HIV and pregnancy, childbirth and breastfeeding.
Some STIs, including HIV, can seriously affect the health of a breastfeeding baby.
If a woman is unable to use condoms, talking regularly to her sexual health-care provider or case manager might help her consider some of her health options.
Sex after childbirth or trauma
Most doctors or midwives advise women to wait a period of time before having sex after giving birth or having surgery. Unhealed wounds can increase the chance of HIV entering the body.
PEP (Post Exposure Prophylaxis)
PEP is anti-HIV medication prescribed for a period of 28 days. It works by attacking the virus before it becomes established in the body. For this reason, the treatment must be started soon after the potential infection. PEP is usually only prescribed where there is evidence of high-risk exposure. There are side effects. It must be taken for the entire 28 days. And it can be expensive.
PEP treatment must begin within 72 hours after exposure. The earlier PEP is taken, the more effective it is.
When a woman has been recently sexually assaulted (raped) by an HIV-positive man using his penis, PEP might be an option for her. PEP is covered by OHIP for women who have been sexually assaulted.
To be prescribed PEP from sexual assault:
- a woman has to report the attack to a sexual assault centre or to the police
- a health care professional will assess whether the assault has lead to a high risk of exposure to HIV
- a woman at high risk is offered PEP as part of a sexual assault kit
PEP is also available for sexual exposure not from assault, however in this instance it is not covered by OHIP. The cost for the course of treatment is about $1,000. This cost can be too expensive for many women.
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1HIV Transmission: Guidelines for Assessing Risk,Canadian AIDS Society, 2005