Nov 12, 2012
Hi Nelson, I'm positive since May '11 and undetectable for over a year; my partner is negative. I'm really concern we sometimes get so horny that have bareback sex for a few seconds... my partner is quite confident he's not at risk. I know a change of behavior is the best solution but weve tried and failed. What alternatives do we have? How can I better protect him? I'm in love and worry he might get infected one of these crazy nights.
Response from Mr. Vergel
This question if definitely one of those double edged swords. My first impulse was to forward it to other experts, but then I realized that it would be good to risk giving you a "non-textbook" answer that may be controversial in a hot topic that has exploded after new studies were presented this year. This is a topic that few want to deal with for fear of being demonized.
Most people would only have one answer for you, and you already know that answer: using a condom every time is the surest way to minimize risk. But it is not "not knowing" that prevents you guys from using a condom every time there is insertive sex. You equate raw sex with "horny crazy sex."
Admitting that you are having this inner conflict is something most people do not even share in support groups. Many people in our community only want to have a relationship with someone of the same HIV status because they cannot deal with a situation like yours. And some have no problem at all using a condom every single time. Many others are in denial about their "bareback slips" with long term or casual sex partners.
I am assuming that these briefs (but possibly frequent) bareback moments are not related to alcohol and drug use. Let me know if that is not the case. If drugs and alcohol are in the picture, then what I will say may not apply to your situation.
The good news reported this year is that someone can take pre-exposure prophylaxis with Truvada to improve their chances of not getting infected, although there is still conflicting data on gay men and women. We also have good evidence that someone with stable and sustained undetectable HIV viral load in the blood may be a lot less infectious to others, although some report 5-8 percent of semen samples still showing some detectable virus even in people with long term HIV control. These two sets of data working together, even with their limitations, now represent a two sided approach to harm reduction to people like you. However, as you well know, 100 percent safety cannot be ensured if condoms are not used.
In my 20+ years as an activist traveling around the country, I have known several HIV serodiscordant ("magnetic") gay couples that claim that the HIV negative top has remained uninfected even after years of unprotected sex with the HIV+ bottom. But I have met people who were not as lucky. Of course, they did not have an approved pre-exposure prophylaxis regimen or great viral control available to them. Two of the people I have known to have infected their partners were on a structured treatment interruption at that time, which may have increased their infectiousness. In almost all cases, the HIV+ person felt horrible and long lasting guilt about infecting his partner (in one case, the negative partner got transmitted HIV resistance to some of the meds to which his partner had been exposed). Some couples stay together and some do not after this situation.
I am looking forward to seeing data on gay and heterosexual couples in which the raw HIV negative top is on long term and stable pre-exposure prophylaxis while the HIV+ bottom has had long term HIV viral suppression.
As you can tell, I am no expert of this subject since I am only sharing with you what I have seen out there. The decision about proceeding with your sexual behavior is ultimately yours and his.
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