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advice for my negative partner
Feb 10, 2008

I started seeing a great guy a couple months ago, and disclosed when things started getting serious. It was my first time having to do this, and I was extremely relieved and happy that his reaction was so supportive. We have continued to become closer and to have passionate -and safe- sex since then. We haven't talked much about my status or what it implies, but last weekend, after having had sex together, he expressed concern at the safety of our activities. As far as intercourse is concerned, he has so far been the active partner exclusively and uses condoms every time. He also doesn't perform oral sex on me. I told him that if we continued this way, and that my VL remained undetectable, he didn't have much to worry about, but I would like to back that up with more information and advice from a reliable source that will reassure him and perhaps even give us both some fresh ideas and guidance. The most recent and similar question I found in your database dates back to 2003. The answer given was that there still wasn't a publication available on the market that deals with these issues. To your knowledge would there be one out by now? Many thanks.

Response from Dr. Remien

It is good to hear that you are both being supportive with each other and are having satisfying and safe sex in the relationship. Also, talking about the issues is important - as you are doing; and your question is a good one.

The most important thing you are doing is using condoms consistently, which has been shown to be highly protective. Your partner is also at less risk, not being the receptive partner in anal sex (although condoms are also very protective for this behavior). And yes, having a well controlled viral load does significantly reduce the risk of HIV transmission.

There is some controversy as to whether there is risk and if so, how much risk when someone's viral load is "undetectable." Keep in mind, this only means that the level of viremia (viral load) is lower than the sensitivity of the test that was used; there is always some level of viral replication in the body, even when it is "undetectable." There are a number of articles in medical journals that speak to this issue. Very recently, a report was put out by experts from Switzerland and is the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in a recent Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system. You must know that there is considerable controversy about this statement, but thought you may want to read it for yourself - see website link below. Again, this is not an endorsement of this position, but wanted to share it with you. I suggest that you and your partner talk directly with a physician about the issue.

Report from Switzerland: http://www.aidsmap.com/en/news/4E9D555B-18FB-4D56-B912-2C28AFCCD36B.asp Report from Switzerland


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