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Low viral load and transmission
Oct 24, 2000

I wish to start out by saying thank you so very much for having this forum here. My partner is positive and I am negative. I never thought I would fall in love with a positive person as I have lost every friend I grew up with from AIDS. I always tried to avoid it. But love finds you, not you it so here I am. My question is this. My partner's viral load is undetectable (I believe below 400, I'm not sure which test his clinic uses) and has been for about five years. He tolerates his meds very well, except for occasional nausea. He is taking Crixivan (forgive my spelling) and another drug. I am the top in our relationship. How likely percentage-wise am I to contract the disease if I don't wear a condom during anal sex? He insists that I do, but I want the intimacy and closeness of nothing. Any help you can give us on accessing my risk so I can make a well informed decision would be greatly appreciated.

Response from Dr. Remien

Of course this is one of the "million dollar questions," and you are certainly not alone in asking it. And unfortunately, it is difficult for anyone to give you a "percent" risk that would apply to you individually. It seems to be true that reduced viral load leads to a reduction in HIV transmission in studies of large groups of people. However, for any individual, there are fluctuations in viral load (even at low levels), and there is not always a one-to-one correspondence between viral load of plasma and viral load of semen. And of course, even when the viral load is "undetectable," there is still active virus circulating. Further, while it is also true that it is easier to become HIV infected from receptive anal sex than from insertive anal sex, the virus can be transmitted in both scenarios.

Many people in your shoes do feel that there is a big loss in "closeness and intimacy" when there is a physical barrier between them and their partner. These are important personal feelings that people grapple with. Many couples find it useful to think of the use of protection as a way of expressing love and concern for the health of each other. It is common for the HIV+ partner in mixed status relationships to be the stronger advocate for the constant use of protection. It is often verbalized as their "worst nightmare" to think of their partner becoming infected. Keep in mind that it is very important for BOTH of you to be comfortable with the things you do with each other. Anxiety and sex do not go very well together. Have the discussions you need to have and make sure that you can both live with the kinds of risks you are willing to take.


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