The use of two of more prevention techniques to reduce the overall chances of transmitting (passing on) or acquiring (getting) HIV, during anal sex. These techniques and methods can include:
- condom use;
- undetectable viral load – obtained by taking effective HIV antiretroviral treatment which is known to significantly decrease the risk of transmission;
- PrEP – HIV-negative person taking HIV ARV treatment to prevent getting HIV;
- strategic positioning – being the ‘top’ [insertive partner] is less risky for getting HIV, and being the ‘bottom’ [receptive partner] is less risky for passing on HIV, during anal sex;
- negotiated safety – testing regularly and trusting sexual partners test serostatus results and making a range of agreements within the relationship about sexual risk taking outside of the relationship;
- serosorting – sex between confirmed same HIV-serostatus people; and
- withdrawal – before ejaculation. This is a weak risk reduction strategy since pre-ejaculate (pre-cum) can contain HIV virus. Having an undetectable blood viral load does not always mean seminal (semen) body fluid viral load will also be low, although some HIV ARV treatments (HIV drugs) penetrate the seminal tract more than some other HIV drugs.
The best prevention method against HIV transmission is condoms. Condoms are 100% effective for prevention if used properly (and with adequate water-based lubricant and without breakage). Other methods are often combined with condoms to enhance their protection benefits. When condoms are not used, other risk reduction strategies may be less effective in prevention against HIV infection. RRS reduce risk, not eliminate risk. Condoms PLUS risk reduction strategies may provide greater risk reduction against HIV infection. Condoms are also the best way to avoid passing on or getting other sexually transmitted infections (STIs).
If risk reduction strategies are not utilised this creates higher risk exposure to HIV. If a risk exposure occurs Post-Exposure Prophylaxis (PEP) treatment is available and should be taken within 72 hours of the risk exposure, preferably within 24 hours (see PEP for more information).