Peter and Harry

Peter and Harry

Read More
Joseph and Adam

Joseph and Adam

Read More
Anton and Richard

Anton and Richard

Read More
Nick and Brian

Nick and Brian

Read More
One of the biggest priorities for couples is ensuring that HIV is not passed on. This is both a practical and an emotional issue. Many couples talk about feeling anxious about sex because of the presence of HIV. This is entirely understandable. But couples also report that their confidence builds over time as they come to rely upon and trust particular approaches to safe sex.

Scientific advances in recent years mean that there are now a number of ways to reduce the risk of HIV transmission during sex. Taking a Look covers the basics of HIV prevention.

For mixed HIV status couples, three approaches are regarded as such low risk they can be called “safe sex”:

  • Condoms
  • Treatment as prevention
  • Pre-exposure prophylaxis (PrEP)


Correct use of condoms during sex prevents HIV transmission. Condoms also prevent transmission of most sexually transmissible infections, which is something to consider if your relationship is open.

Couples who regularly use condoms say that they like the fact they are a visible, physical barrier. If the condom slips off or breaks, it’s quickly fixed with a fresh one.

Couples who say they don’t like condoms say they reduce sensation for the insertive partner or the barrier aspect is unwelcome, getting in the way of sexual intimacy.

“Treatment as Prevention” or undetectable viral load

Effective HIV antiretroviral treatment can significantly reduce a person’s viral load until it is ‘undetectable’ and having an undetectable HIV viral load greatly reduces the risk of HIV transmission.

Treatment as Prevention is a reliable safe sex approach, in it’s own right, if three conditions are met. These are:

  1. Viral load must be undetectable and stable (for at least the previous 6 months).
  2. Medication must be taken as directed, very consistently.
  3. No other sexually transmissible infections (STIs) can be present. If you do have sex outside the relationship, then consider condoms as a way to reduce the risk of STIs with additional partners. Also, have a regular STI check up. For gay men with multiple sexual partners, screening every three months is recommended. Click here to read more.

Some couples have decided to stop using condoms and rely solely on this approach. Others feel reassured by Treatment as Prevention as a background measure but, for various reasons, including emotional ones, prefer to take additional measures such as using condoms.

Pre-Exposure Prophylaxis (PrEP)

PrEP is the use of HIV antiretroviral medication by the partner who is HIV negative to prevent HIV infection. If taken as directed, PrEP can be a highly effective way to prevent HIV.

Currently in Australia, PrEP is not subsidised by the Pharmaceutical Benefits Scheme. However, it is possible to import the medication from overseas pharmacies at reasonable prices. Advice about personal importation is available.

A script is still required from an Australian doctor. Sexual health or HIV doctors are well informed about PrEP and are a good source of information and advice.

PrEP maybe something couples wish to consider in certain instances, such as:

  • Some people with HIV are unable to achieve an undetectable viral load despite taking effective treatment. This may present a small risk of HIV transmission and PrEP maybe a good option in such cases.
  • Couples who have an open relationship where the HIV negative partner is exposed to risks outside the relationship, e.g. having condomless sex with partners whose HIV status is unclear or unknown, or with HIV positive partners whose viral load is unknown or detectable.

Possible exposure? GET PEP!

Post exposure prophylaxis (PEP) is a course of treatment available for the HIV negative partner if they believe they have been exposed to HIV. It works a little like a morning after pill and involves taking antiretroviral drugs for four weeks, immediately after the exposure. The HIV negative partner will need to visit a doctor or emergency department and commence PEP within 72 hours, although treatment is more likely to be effective the sooner it is started. A national list of PEP prescribers is available at

  • Peter and Harry

    Peter and Harry

    Harry and Peter are taking time to adjust to what they feel is safe sexual practice for them.

    Harry: When we first met, we would only have sex with condoms. But in a long-term relationship it gets to be a drag. Recently I’ve started taking PrEP, so we no longer have to use condoms. PrEP is like an invisible safety net. Although adjusting our idea of what’s safe has taken some time.

    Peter: I have never thought about not wearing condoms because I was so clear about what the diagnosis meant to my sexual practice. I didn’t realise I was afraid of not wearing condoms.

    Harry: Also, because his viral load is undetectable the risk of transmission is very low.

    Peter: We don’t think PrEP replaces condoms; it’s an addition. In our relationship it doesn’t change things.

    Harry: We’re still working it out, really.

    Peter: Before Harry was on PrEP there was fear and anxiety and a sense of wrongdoing about sex without condoms. That has changed. It’s made sex more enjoyable.

  • Joseph and Adam

    Joseph and Adam

    Joseph and Adam rely on undetectable viral load but also take certain sexual positions to further reduce risk.

    Joseph: We don’t use condoms. We didn’t from the outset. I am on treatment and undetectable. I was up-front with Adam the night we met and he did his own risk evaluation around the roles.

    Adam: I top; it’s my preference anyway but it plays a part in reducing risk.

    Joseph: I am not worried about sex or a relationship with someone who’s HIV negative because I know my undetectable status makes it very low risk.

    Adam: We have talked about PrEP but my understanding is that we don’t need it, as long as Joseph is undetectable.

  • Anton and Richard

    Anton and Richard

    Anton and Richard are interested in taking PrEP.

    Richard: Getting PrEP has been a bit of a mission.

    Anton: Meanwhile we use condoms if I’m the top but not if Richard is. We do feel more confident over time but PrEP will give us 100% assurance.

    Richard: PrEP also allows us to share the responsibility for safe sex. It’s not only Anton’s responsibility to maintain his treatment. I have to do the same thing. It’s fairer.

  • Nick and Brian

    Nick and Brian

    Brian and Nick rely solely on undetectable viral load.

    Brian: I’ve been undetectable for so long I’m confident I can’t pass on HIV, even without condoms, which we don’t use. We have discussed this a lot; it is a mutual thing.

    Nick: And I’ve talked with my doctor about it and he has assured me that a person who is HIV positive but undetectable has very slim chances of passing it on.

    We haven’t really considered PrEP because I trust Brian and we both trust this undetectable approach. It’s good enough for us.