Women Living with HIV

Women Living with HIV: Undetectable=Untransmittable

Women are resilient. Women are the solution. Advances in HIV treatment have given people living with HIV the tools to live long, healthy lives. Improvements in HIV medications means having HIV can be a manageable condition. When a person living with HIV is diagnosed early and participates in their medical care, they can live about as long as someone not living with HIV.

Taking your HIV medications as prescribed helps keep you healthy by lowering the amount of HIV in your blood to levels that cannot be detected (seen) by standard laboratory tests. This is called this having an undetectable viral load. When you have a consistently undetectable viral load for six months or longer and have no other sexually transmitted infections, you cannot pass HIV to your sexual partner. In short, Undetectable = Untransmittable (#UequalsU).

It is important to know that, even if your viral load is undetectable, your viral load can become detectable again if you stop taking HIV medication.

Check out this great video from Positive Women’s Network USA with women living with HIV sharing what being undetectable means to them:

For more on U=U, visit the Prevention Access Campaign and The Well Project.

How is HIV Transmitted?

HIV is transmitted, or spread, through contact with these body fluids:

  • Blood (including blood from your period and any blood in saliva, urine, and feces).
  • Semen (“cum”) and other sexual fluids from the penis (“pre-cum”).
  • Vaginal fluids.
  • Breastmilk.

HIV is not spread through contact with these body fluids:

  • Sweat
  • Tears
  • Saliva (spit)
  • Feces (poop)
  • Urine (pee)

Methods of transmission:

  • Perinatal transmission: during pregnancy, labor, delivery, or breastfeeding.
  • Sex not protected by condoms or medications.
  • Re-using or sharing needles or other works/equipment for injecting drugs, tattoos, or other substances.

HIV is not spread by hugging, holding hands, kissing, drinking or eating from the same cups or utensils as a person living with HIV, or by using a toilet also used by someone living with HIV.

Taking your HIV medications and staying undetectable is not only good for your own health, it is the best defense against transmitting or passing HIV to another person.

For more on HIV transmission:

Preventing HIV Transmission

Treatment as Prevention (TasP):

One of the most effective ways to prevent passing HIV to a sexual partner is Treatment as Prevention (TasP), which means taking your HIV medications as prescribed by your medical provider and maintaining an undetectable viral load. TasP has been endorsed by many researchers and organizations.

An undetectable viral load/TasP works in preventing transmission of HIV and supporting you in having a healthy and an enjoyable sex life.

For real-life stories on TasP for sex, check out our blog.

Pre-Exposure Prophylaxis (PrEP)

PrEP is an HIV prevention medication that a person without HIV takes to keep from getting HIV. PrEP works if taken daily. PrEP takes 7 days to start working before anal sex, and 20 days to start working before vaginal sex. PrEP is safe and effective. Most people can tolerate PrEP well, but it may have some mild side effects like nausea and headaches when first starting.

Anyone taking PrEP should be seen by a medical provider for regular lab check-ups, including HIV/STI testing, Hepatitis B testing, and tests to make sure the kidneys are healthy. To find a PrEP provider, and for live chat about PrEP, visit PleasePrEPMe. For more on PrEP, check out this CDC resource.

Post-Exposure Prophylaxis (PEP)

PEP is an emergency medication available by prescription that can stop HIV if started within 72 hours of exposure. If a person without HIV has been exposed to HIV within the last 72 hours they can go to a clinic or emergency room and ask for PEP. For more on PEP, check out this CDC resource.

Condoms

Using a male or a female condom with lube when you have vaginal sex works to prevent HIV, pregnancy, and other sexually transmitted infections (STIs). For people living with HIV, using condoms can prevent other STIs.

Using a female condom may give you more control. Female condoms can also increase pleasure for both partners due to heat-transmitting material, stimulation from the ring, wider size, and looser fit. To learn more about female condoms, check out our friends at the National Female Condom Coalition.

For more on condoms as an HIV prevention method, check out this resource from our friends at The Well Project.

Disclosure: Telling People Your HIV Status

HIV disclosure is telling someone that you are living with HIV. Disclosure is a journey. It can be stressful. It can be freeing. Disclosing to a family member or friend might be part of your plan to get support for your treatment and wellbeing.  Disclosing to a sexual or intimate partner might be on your mind. Why disclose and why not disclose? The reasons are different for each person.

Having a support system can be helpful for disclosing your HIV status. If you’re not ready to tell close friends, family members, or other loved ones, consider joining an online support group or discussion forum. Your provider and/or social worker can help you make a plan, and they may ask you questions such as:

  • How do you feel about disclosing your status?
  • What are the benefits of disclosure?
  • Why are you think of disclosing now?
  • What are the worst things that could happen if you disclosed?
  • What do you think it would look like to disclose?
  • Have you ever imagined having a talk about disclosure? If so: how did you imagine doing it? How did you imagine it went?
  • Where is the best place for you to disclose?

Here is what it could look like to talk to your provider about disclosing to a sexual partner:

We believe that no matter who, where, when or if you choose to disclose, disclosure is a choice. Trust yourself to make the best decision for you.

Laws related to HIV disclosure and HIV exposure are different in each state. Local practices may also be different for each provider and hospital or clinic setting. Ask your provider or a trusted advocate about local disclosure and exposure laws and provider practices. Here are some questions you can ask about disclosure:

  • Who am I legally required to disclose my status to?
  • I had condomless sex with someone before knowing my HIV status – do I need to tell them I’m living with HIV?
  • If I’m pregnant, are you [my provider] legally required to tell my partner my status?
  • Once I’ve delivered a baby, can my partner find out my status by asking my baby’s medical provider?

More resources on disclosing your HIV status:

Videos:

HIV Criminalization

HIV criminalization refers to criminal laws that punish people for not disclosing their HIV status before having sex, or for any potential HIV exposure. These laws are generally outdated, and many were passed before we had effective HIV prevention methods. Advocates are working to update the outdated laws.

For more resources on laws that protect you, job discrimination, housing discrimination, and other forms of discrimination:

The Sero Project: Protect Yourself

TheBody.Com | Learn Your Rights: Discrimination, HIV/AIDS, Addiction and Criminal Records

TheBody.Com | What to Do If Discrimination Happens to You

Family Planning

As a woman, you have the right to decide if, when, and how to have children.

There are many birth control (also called contraception or contraceptive) options available to you, depending on when and if you want to have a baby. Your doctor can support you in finding the best option for you. Check out this article by Dr. Lealah Pollock.

For more on each method of contraception, visit Bedsider’s Method Explorer.

For more info on HIV & contraception, visit The Well Project’s page on birth control and HIV.

Safer Conception

Thinking of having a baby? Advances in HIV treatment and prevention make starting a family an exciting and safe option for women living with HIV. Having a consistently undetectable viral load prevents HIV transmission to your partner when you have sex to conceive and also protects your baby. Here are some steps to take to prepare for a healthy pregnancy.

There are several safer conception options available to you, depending on whom you plan to have a baby with:

Check out our blogs on safer conception.

HIV and Pregnancy

Here’s what we know: taking your HIV medications, maintaining an undetectable viral load before conception and throughout pregnancy, avoiding breastfeeding, and giving your infant medications (as prescribed by the doctor), nearly eliminates the risk of HIV transmission.

Almost all HIV medications are safe during pregnancy (AIDSinfo). Your healthcare provider will help you choose the right medications for your health. Here is what to expect from prenatal care visits. For more information on HIV and pregnancy, visit The Well Project’s page on Pregnancy and HIV.

If you live in the U.S., your provider can call the 24/7 Perinatal HIV Hotline for free, expert advice on all aspects of caring for pregnant women living with HIV: (888) 448-8765. Your provider can also download our perinatal HIV provider resources.

Check out this blog by a woman living with HIV who gave birth to a healthy baby.

Infant Feeding

Now that we know undetectable = untransmittable for sexual partners, women living with HIV may wonder if it is safe to breastfeed with an undetectable viral load. In the United States, the American Academy of Pediatrics and the Centers for Disease Control advise women living with HIV not to breastfeed to prevent passing HIV through breast milk*.

If you live in the U.S. and are thinking about breastfeeding, talk to your medical provider for support with making an informed decision for you, your baby, and your family. We put together this infant feeding basics tool  to support your decision making and to share alternatives to breastfeeding. Read this blog written by a woman living with HIV who considers breastfeeding.

If you choose to bottle feed, there are many techniques you can use to develop a strong bond with your baby. Here are some tips.

Another option is getting milk from a human milk bank. Click here to find a milk bank closest to you. Talk to your medical provider if you are interested in donor human milk. Your medical provider can write you a prescription and help you find out if your insurance covers it.

*Note: recommendations on breastfeeding are different in countries without access to clean water, and the ability to pay for, prepare and store infant formula safely. For more on global breastfeeding guidelines for women living with HIV, check out the WHO guidelines.

Resources

More Resources

No Baby Should Be Born With HIV. What Will It Take to Save Them All?

In the fall of 2010, Masonia Traylor’s life changed overnight. Then 23, she was living with her new boyfriend in Atlanta and working as a pharmacy technician at a nearby drugstore. She took good care of herself, always went for an annual checkup, and ever since she graduated from high school, she had made it a practice to get tested for HIV and other sexually transmitted diseases. Every year, her tests would come back negative. Until one didn’t.

Asserting Our #BodilyAutonomy on #NWGHAAD!

Friday, March 10, Positive Women’s Network USA teamed up with partners at HIVE, SisterSong, Desiree Alliance, The Well Project, Prevention Access Campaign, Arianna’s Center & Positively Trans to continue our National Women & Girls HIV/AIDS Awareness Day (#NWGHAAD) convo on the theme of #BodilyAutonomy. Check it out!

On Life’s Terms: Mothers in Recovery

Film description: “Driven by the desire for custody of their children, five mothers struggle to overcome substance use disorders in a gender-responsive treatment program. Their intimate story reveals experiences with domestic violence, [sex work], incarceration and complex intergenerational relations. On Life’s Terms: Mothers in Recovery interweaves the women’s three-year journey to self-sufficiency and newfound pride with drug laws that impact mother and child, and will inspire hope for recovery.”

Angela’s Story

Angela McGill is a woman living with HIV. She tells her story of discovering she had HIV and going on to have an HIV-free baby with the help of BAPAC (Bay Area Perinatal AIDS Center), now known as HIVE. Dr. Deb Cohan explains how it’s possible for women living with HIV to have natural births and not pass HIV on to their babies.

Caring for Survivors: Reducing Anxiety & Pain during Gynecological Exams and Procedures

“Many times the patients that are most ‘difficult’ are those who’ve had sexual trauma. She isn’t hard, she’s had a hard life…the body of a survivor remembers those traumatic experiences…she knows that other providers have found her to be a hard patient, so if you change the way you see her, then maybe she’ll change the way she sees herself in that dynamic.”