Safe sex
Safe sex is sexual activity using protective methods or contraceptive devices to reduce the risk of transmitting or acquiring sexually transmitted infections, especially HIV. The terms safer sex and protected sex are sometimes preferred, to indicate that even highly effective prevention practices do not completely eliminate all possible risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.
The concept of safe sex emerged in the 1980s as a response to the global AIDS epidemic, and possibly more specifically to the AIDS crisis in the United States. Promoting safe sex is now one of the main aims of sex education and STI prevention, especially reducing new HIV infections. Safe sex is regarded as a harm reduction strategy aimed at reducing the risk of STI transmission.
Although some safe sex practices can also be used as birth control, most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior, might not be effective forms of contraception.
History
Although strategies for avoiding STIs like syphilis and gonorrhea have existed for centuries and the term safe sex existed in English as early as the 1930s, the use of the term to refer to STI-risk reduction dates to the mid-1980s in the United States. It emerged in response to the HIV/AIDS crisis.A year before the HIV virus was isolated and named, the San Francisco chapter of the Sisters of Perpetual Indulgence published a small pamphlet titled Play Fair! out of concern over widespread STIs among the city's gay male population. It specifically named illnesses that would later be understood as symptoms of advanced HIV disease. The pamphlet advocated a range of safe-sex practices, including abstinence, condoms, personal hygiene, use of personal lubricants, and STI testing/treatment. It took a casual, sex-positive approach while also emphasizing personal and social responsibility. In May 1983—the same month HIV was isolated and named in France—the New York City-based HIV/AIDS activists Richard Berkowitz and Michael Callen published similar advice in their booklet, How to Have Sex in an Epidemic: One Approach. Both publications included recommendations that are now standard advice for reducing STI risks.
Safe sex as a form of STI risk reduction appeared in journalism as early as 1984, in the British publication The Daily Intelligencer: "The goal is to reach about 50 million people with messages about safe sex and AIDS education."
Although safe sex is used by individuals to refer to protection against both pregnancy and HIV/AIDS or other STI transmissions, the term was born in response to the HIV/AIDS epidemic. It is believed that the term safe sex was used in the professional literature in 1984, in the content of a paper on the psychological effect that HIV/AIDS may have on gay and bisexual men.
A year later, the same term appeared in an article in The New York Times. This article emphasized that most specialists advised their AIDS patients to practice safe sex. The concept included limiting the number of sexual partners, using prophylactics, avoiding bodily fluid exchange, and resisting the use of drugs that reduced inhibitions for high-risk sexual behavior. Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'. According to these guidelines, safe sex was practiced by using condoms also when engaging in anal or oral sex.
Although the term safe sex was primarily used in reference to sexual activity between men, in 1986 the concept was spread to the general population. Various programs were developed with the aim of promoting safe sex practices among college students. These programs were focused on promoting the use of the condom, a better knowledge about the partner's sexual history and limiting the number of sexual partners. The first book on this subject, Safe Sex in the Age of AIDS, appeared in the same year. It had 88 pages that described both positive and negative approaches to sexual life. Sexual behavior was loosely sorted into safe ; possibly safe ; or unsafe.
In 1997, specialists in this matter promoted the use of condoms as the most accessible safe sex method and they called for TV commercials featuring condoms. During the same year, the Catholic Church in the United States issued their own safer sex guidelines on which condoms were listed, though two years later the Vatican urged chastity and heterosexual marriage, attacking the American Catholic bishops' guidelines.
A 2006 survey found that the most common definitions of safe sex are condom use, abstinence, monogamy, and safe partner.
The term safer sex in Canada and the United States has gained greater use by health workers, reflecting that risk of transmission of sexually transmitted infections in various sexual activities is a continuum. Safer sex is thought to make it more obvious to individuals that any type of sexual activity carries a certain degree of risk. The term safe sex is still in common use in the United Kingdom, Australia and New Zealand.
The term safe love has also been used, notably by the French Sidaction in the promotion of men's underpants incorporating a condom pocket and including the red ribbon symbol in the design, which were sold to support the charity.
Practices
A range of safe-sex practices are commonly recommended by Sexual Health Educators and Public Health Agencies. Many of these practices can reduce risk of transmitting or acquiring STIs.Phone sex/cybersex/sexting
Sexual activities, such as phone sex, cybersex, and sexting, that do not include direct contact with the skin or bodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex.Non-penetrative sex
A range of sex acts called non-penetrative sex or outercourse can significantly reduce STI risks. Non-penetrative sex includes practices such as kissing, mutual masturbation, circle jerks, manual sex, rubbing or stroking. According to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted via skin-to-skin contact, such as herpes and human papilloma virus. Mutual masturbation and manual sex carry some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners, although the risks are significantly lower than other sexual activities.Condoms, dental dams, gloves
Barriers, such as condoms, dental dams, and medical gloves can prevent contact with body fluids, and other means of transmitting STIs during sexual activity.- External condoms can be used to cover the penis, hands, fingers, or other body parts during sexual penetration or oral sex. They are most frequently made of latex, and can also be made out of synthetic materials including polyurethane and polyisoprene.
- Internal condoms are inserted into the vagina or anus prior to sexual penetration. These condoms are made of either latex, polyurethane or nitrile. External and internal condoms should not be used at the same time, they may break due to friction between the materials during sexual activity.
- A dental dam is a sheet of latex typically used for protection between the mouth and the vulva or anus when engaging in oral sex. Condoms or disposable gloves may be cut to act as a dental dam. Insufficient research has been conducted regarding whether or not plastic wrap can perform effectively as a dental dam, but authorities on sexual health cautiously recommend it due to its greater accessibility compared to dental dams.
- Medical gloves and finger cots made out of latex, vinyl, nitrile, or polyurethane can cover hands or fingers during manual sex or may be used as a makeshift dental dam during oral sex.
- Condoms, dental dams, and gloves can also be used to cover sex toys such as dildos during sexual stimulation or penetration. If a sex toy is to be used in more than one orifice or partner, a condom/dental dam/glove can be used over it and changed when the toy is moved.
While use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use. It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".p. 40.
Pre-exposure prophylaxis (PrEP)
is the use of prescription drugs by those who do not have HIV to prevent HIV infection. PrEP drugs are taken prior to HIV exposure to prevent the transmission of the virus, usually between sexual partners. PrEP drugs do not prevent other STI infections or pregnancy.As of 2018, the most-widely approved form of PrEP combines two drugs in one pill. That drug combination is sold under the brand name Truvada by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP.
Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug as PrEP. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners. AVAC has developed a tool to track trends in PrEP uptake across the globe. In 2025, Gilead announced approval for a PrEP shot that is effective for 6 months at a time, increasing the likelihood of adequate suppression.