August 2019 Issue #32 August 2019 Issue #32 | Page 155

There are several key messages that can be given to
clients about the risk of HIV transmission through anal
sex (where the HIV-negative person inserts their penis
into an HIV-positive partner’s anus):
- Rectal fluid can contain a high concentration of HIV and, if it comes
into contact with a partner’s penis, can lead to HIV transmission.
- HIV transmission through this type of anal sex does not require
blood to be present in the HIV-positive partner’s rectum.
- Inflammation in the rectum, caused by STIs or tearing, may in-
crease the amount of virus in the rectal fluid and increase the risk of
HIV transmission. Minimizing rectal inflammation through the use of
lubricants (lubes) and management of STIs (regular STI testing and,
if needed, treatment for STIs) may prevent increases in rectal fluid
viral load.
- Lowering the viral load in the blood and rectal fluid through success-
ful antiretroviral treatment can substantially decrease the risk of HIV
transmission.
- Condoms, in combination with lube, are highly effective in prevent-
ing the risk of HIV transmission if used consistently and correctly.
Condoms can also significantly reduce the risk of STI transmission.
- Post-exposure prophylaxis and pre-exposure prophylaxis are both
highly effective options for HIV-negative people to reduce their risk
of HIV infection. PEP needs to be accessed as soon as possible, but
within 72 hours, after an exposure and taken daily for 28 days. PrEP
needs to be taken daily, on an ongoing basis. Adherence to daily
pill-taking is important for both to be effective.
- Penile circumcision may reduce the risk of HIV infection for
HIV-negative gay men who primarily engage in insertive anal sex,
but it is unclear how much it reduces HIV transmission risk.
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