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Risk factors
Jan 3, 2005

Dear Dr., My mate and I were together 3 years before his + diagnosis one year ago. During those 3 years we didn't use protection most of the time. I tested neg 2x before and 2x after his diagnosis. After just 1 1/2 months of HAART his VL is undetect and T Cells way up. We did use condoms for months after his diagnosis, but have had some serious condom failures. For a while now we have not used condoms, but are very careful about him being dry before insertion as well as not ejaculating either at all or not inside. I find I am less nervous this way than when we relied on the condoms and they either broke or came off. His Dr. has emphasized that it is entirely individual what couples do to feel safe, and that theoretically we have greatly lowered my risk, but I would like your opinion about our risk factor doing it the way we are now. Thanks, Not quite comfy

Response from Dr. Remien

I agree with your doctor when he says that couples really need to decide for themselves what level of risk and/or harm reduction they are comfortable with. You've been lucky up to know, but that it is not a guarantee that you will remain uninfected if there is continued unprotected sex.

The fact that you are "not quite comfy" is because there is a certain level of risk involved in what you are doing. You've taken some steps to reduce the level of risk, but have not eliminated it. You are right to be concerned about the frequent condom breakage you were experiencing. I wonder why that was happening? Good quality condoms are very strong and should not break often. When using them, make sure they have not expired (check the date on the wrapper), use the right size (so that they don't fall off) and use sufficient water-based lubricant. Many couples who use condoms still ejaculate outside of the body so that they don't have to worry about condom breakage or slippage.

What you decide to do is up to the two of you. My advice is to work towards using protection appropriately so that you can feel comfortable and enjoy yourselves. It's important that you be comfortable with the kind of risks you are taking so that you can both relax and enjoy the sex.


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