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HIV in Ontario > Prevention

Prevention

There are many ways to prevent HIV when it comes to sex. These include:

Treatment (Undetectable Viral Load)

Viral load refers to the amount of HIV virus present in the blood of a person living with HIV. If a person’s viral load is “undetectable,” it means that the virus is still present, but below the level that tests can detect.

In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable=Untransmittable ( U=U) concept as scientifically sound. U=U means that people living with  HIV who achieve and maintain an undetectable viral load by taking antiretroviral therapy (ART) daily as prescribed cannot sexually transmit the virus to others. HIV treatment is a powerful HIV prevention tool, however, people’s viral load can also increase without any clear symptoms.

If you are having sex with somebody who has a different HIV status than you, here are some things to keep in mind about undetectable viral load:

  • Viral load can and does fluctuate for some people – a single “undetectable” viral load test result does not mean that HIV will be undetectable in the future, so regular testing is important. An undetectable viral load sustained over six months greatly reduces the risk of HIV transmission.
  • Adherence to HIV medications (i.e., taking them as prescribed) is key to maintaining an undetectable viral load.
  • Having an undetectable viral load does not reduce the risk of transmitting other sexually transmitted infections (STIs), and it is possible that having STIs increases the risk of transmitting HIV. If you are having sex without a condom because you have a low viral load, it is important to test for other STIs regularly.
  • People living with HIV have to disclose their HIV status to partners before sexual activity that poses “a realistic possibility” of HIV transmission. Ontario has recognized that having a low enough viral load could, on its own, mean there is no realistic possibility of transmission. For more information on the criminalization of HIV non-disclosure, go to the DISCLOSURE AND CRIMINALIZATION For up-to-date and emerging information on viral load and other HIV prevention strategies, please visit CATIE.

Same HIV status sex

Having sex with people who are of the same HIV status as you, whether positive or negative, can help reduce the risk of HIV transmission. This is sometimes called “serosorting”.

The idea behind this strategy is that if people living with HIV are only having sex with other people living with HIV, and HIV-negative people are only having sex with HIV-negative people, then HIV-negative people are not going to be exposed to HIV. While it seems simple in concept, there are factors that can make it more complicated in real life. In fact, some organizations recommend serosorting for HIV-positive people and discourage it for HIV-negative people as it can be more difficult to be sure of an HIV-negative status. If you are considering serosorting as an HIV prevention strategy, there are some things to consider:

For HIV-negative people: You cannot be sure your partner is HIV-negative. They might not know their status: According to national HIV estimates, 8,300 people were living with HIV but didn’t know it (undiagnosed) at the end of 2018. They might have had sex without condoms or used another HIV prevention strategy (like PrEP) since their last HIV test, or they might have been infected within the window period before their last HIV test (up to 12 weeks). They might not understand how testing works, or assume they are HIV-negative because they have no symptoms. If you are going to have sex without a condom with other people you think are HIV-negative, here are some strategies to consider:

  • Get tested for HIV and other sexually transmitted infections (STIs) on a regular basis.
  • Talk to your sexual partner(s) about their HIV status, and do not make assumptions. If they are a regular partner, do not assume their status or sexual health has not changed since the last time you discussed this with them
  • If you cannot have an open and honest conversation, or cannot be sure of their HIV status, consider what information you do not know and whether you are comfortable with having sex without a condom in this situation.

For HIV-positive people: There is still the possibility of getting or passing on other STIs, like syphilis and hepatitis C. If you are going to have sex without a condom with other people living with HIV, here are some strategies to consider:

  • Get tested for STIs and hepatitis C on a regular basis.
  • Talk to your partner about their HIV status, STIs, and sexual health strategies. If they are a regular partner, do not assume their status or sexual health has not changed since the last time you discussed this with them. For tips and strategies, click here.

Condoms

Condoms are an important tool in preventing HIV. There are many types available in Ontario. You can buy these, or you can often get them at health care offices, AIDS service organizations, or other public health sites.

Condoms come in both internal (sometimes called female) or external (sometimes called male) forms. Condoms are best used in combination with a water-based or silicone-based lubricant during anal, vaginal or oral sex. For more information about condoms and preventing the sexual transmission of HIV, click here.

Safer Sex Practices

There are sexual activities that pose a lower risk of HIV transmission. For tips and strategies, talk to a worker at your local AIDS service organization (ASO). To find an ASO and other HIV/AIDS programs near you, call the Ontario AIDS & Sexual Health InfoLine. For information in English and many other languages call: 416-392-2437 or 1-800-668-2437 (toll-free in Ontario), and for French call: 1-800-267-7432 (toll-free in Ontario). The InfoLine is free and anonymous.

In Ontario, you can dial 211 on your phone or visit 211 Ontario to find an ASO and other HIV/AIDS programs in your city or town. Use your location to find services near you.

You can also visit HIV411.ca and search for an ASO using your postal code, or the name of your city or town.

PrEP

Pre-exposure prophylaxis, or PrEP, is a highly effective HIV prevention strategy that HIV-negative people can use to lower their chance of getting HIV.  PrEP may be useful for people who have sex with people who are HIV-positive, or who do not know their sexual partner(s) HIV status. PrEP is generally safe and well tolerated and is available by prescription in Canada. It is important to be informed about PrEP, including possible side effects. Talk to a doctor to learn more about PrEP. For more information on PrEP, click here.

Post-Exposure Prophylaxis (PEP) is a medication you can take if you think you have been exposed to HIV. If you think you were exposed, see a health care professional right away. There is a 72-hour window to take the medication after exposure however it is best to start PEP as soon as possible. When you are speaking to the health care professional, inquire about cost and coverage. There is coverage in some cases, but not all cases. For more information about PEP click here or call the Ontario AIDS & Sexual Health InfoLine for information in English and many other languages call: 416-392-2437 or 1-800-668-2437 (toll-free in Ontario), and for French call: 1-800-267-7432 (toll-free in Ontario). The InfoLine is free and anonymous.

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