Heterosexual people

HIV PrEP is recommended for heterosexual people at risk of HIV infection, defined as having a history of any of the following HIV acquisition risks:

HIV acquisition risk in the previous 3 months that is expected to continue in the next 3 months:

  • at least one episode of condomless anal or vaginal sex (insertive or receptive) with a regular HIV-positive partner who is either not on treatment, or on treatment with a detectable viral load
  • at least one episode of receptive anal or vaginal condomless sex with any casual HIV-positive partner or a male homosexual or bisexual partner of unknown HIV status
  • planned episodes of condomless insertive or receptive vaginal sex with an HIV-positive partner in order to conceive, regardless of the viral load of the partner.

Expected HIV acquisition risk in the next 3 months, despite not having had HIV acquisition risk in the previous 3 months; examples include a person who:

  • plans to have episodes of condomless insertive or receptive vaginal sex with an HIV-positive partner in order to conceive, regardless of the viral load of the partner
  • plans to travel and anticipates they will have condomless sex with casual partners while away
  • reports recently leaving a monogamous relationship and plans to have condomless sex with a casual HIV-positive partner, or a male or female partner from a country with high HIV prevalence, or a male partner who is thought to have sex with men
  • presents with deteriorating mental health and a history of having increased their HIV acquisition risk behaviour in this setting
  • presents with a history of binge drinking of alcohol or recreational drug use and a history of having increased their HIV acquisition risk behaviour in this setting.

HIV PrEP should also be considered for heterosexual people if they:

  • have an HIV-positive partner, and the couple experience stress and anxiety about HIV transmission despite the HIV-positive partner being on treatment and not having a detectable viral load.

When assessing risk of HIV exposure, also ask whether the person shares intravenous drug equipment (see People who inject drugs).