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FAQ: Risks of Late Condom Use

for Veterans and the Public

Frequently Asked Questions

Q: What are the risks of getting HIV if you put on a condom after you've already started having sex?

Condoms work well to prevent HIV infection when one partner is HIV infected and the other isn't. Studies show that HIV-uninfected partners are 80% less likely to become infected, if they use condoms properly and consistently, compared with those who do not. Consistent condom use means using a condom for every act of vaginal (penis in vagina) or anal (penis in butt) sex.

But sometimes sex gets going before the condom goes on. What are the risks to an HIV-negative person if they start having condomless sex with an HIV positive man, but he puts on a condom before he ejaculates?

For an HIV-negative woman, some studies have suggested that the risk of HIV infection is lower if a male partner withdraws before ejaculating than if he doesn't, but the risk is still higher than it is among those who use condoms properly and consistently. Why? Well, we know that pre-ejaculate, the sticky-yet-slippery clear fluid that a man produces after being sexually aroused but before he ejaculates, can have the virus in it, and in enough amounts to be infectious.

For an HIV-negative man who has sex with men (MSM), at least one study has shown that the odds of becoming infected with HIV as a result of having receptive anal sex with delayed condom use were about the same as the odds of becoming infected from having anal sex without condoms (or PrEP).

It's important to mention that PrEP (or pre-exposure prophylaxis), a pill, is very effective at preventing HIV if it is taken every day. This may be a good option for you if you are having trouble using condoms consistently.

Having condomless sex increases the risk of contracting other sexually transmitted diseases (STDs), such as syphilis, gonorrhea, chlamydia, and genital herpes. Although these infections are treatable and (with the exception of herpes) curable, they often produce no symptoms and can increase the risk of becoming infected with HIV. Hepatitis B and C also can be transmitted through unprotected sex. Using condoms properly and consistently can decrease your risk of contracting these infections as well. And, proper condom use can prevent pregnancy.

So the bottom line is this: Putting on a condom after you already have started having vaginal or anal sex is more risky than using a condom from the start. If it is difficult to talk about condom use with your partner, then it's time to find someone who can talk with both of you. Many cities have STD clinics and HIV counseling and testing sites that can help partners have these discussions. This also may be a good moment to consider PrEP--discuss this with your VA clinician or your local sexual health clinic.