Safer-Sex Methods

HIV InSite Knowledge Base Chapter
Published December 2003; Content reviewed January 2006
Tim Lane, PhD, MPH, University of California San Francisco
Herminia Palacio, MD, MPH, Harris County Health Department, Houston, Texas

Table 2: Specific Risk-Reduction Practices

Sexual practices and associated risks of HIV infection

No-risk practices. These sexual activities cannot transmit HIV:

  • Self-masturbation
  • Touching, massaging, hugging, caressing
  • Social (dry) kissing
  • Any type of sexual intercourse between partners who are certain that they are uninfected
Extremely low-risk practices. These activities carry a small (based on case reports) or theoretical risk of HIV transmission between partners of unlike or unknown HIV serostatus:
  • French (wet) kissing
  • Mutual masturbation (if no cuts on hands, and no ulcers or lesions on genitals of either partner)
  • Vaginal sex with a male or female condom (with proper use, including putting latex or polyurethane condom in place before any penetration)
  • Fellatio with condom (with latex condom placed on penis before oral contact)
  • Cunnilingus with dental dam (with latex dam placed over vaginal area before oral contact)
  • Anilingus (rimming) with dental dam (with latex dam placed over anus before oral contact)
  • Contact with urine (only with intact skin, avoiding contact with mouth)
  • Using one's own sex toys (without sharing of any toys that contact body fluids)
Low-risk practices. Epidemiologic studies have found these sexual activities to have a low probability of HIV transmission between partners of unlike or unknown HIV serostatus:
  • Fellatio without condom (Risk of HIV infection to insertive partner is extremely low, risk to receptive partner is increased if ejaculation occurs in mouth.)
  • Cunnilingus without a latex dam
  • Anilingus without a latex dam
  • Anal intercourse with condom (with proper use of condom, including placing latex condom on penis prior to any penetration, and using ample amounts of water-based or nonpetroleum-based lubrication with latex condoms)
  • Anal or vaginal penetration with the hand with latex gloves
High-risk practices. These sexual activities carry the highest risk, based on epidemiologic studies of transmitting HIV between partners of unlike or unknown HIV serostatus:
  • Vaginal intercourse without a male or female condom
  • Anal intercourse without a latex condom (highest risk is to the receptive partner)
  • Anal penetration with the hand (fisting) or other rectal trauma without a latex glove, or fisting followed by unprotected anal intercourse