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IsSafe sex with HIV+ boyfriend possible?
Jun 24, 2002

I am a female with a heterosexual HIV+ boyfriend and we would like to have safe - condom protected sex. How realistic is it for me to think I will be safe doing this? Are there any studies showing incidences of transmission this way? I guess I would feel better knowing what my odds are on being infected before I make a decision regarding this! I love this man very much!

Response from Mr. Kull

Your chances of being infected with HIV when having sex with an HIV infected person depends on several different factors:

1) Having mucous membrane (the lining of the vagina, rectum, urethra, or mouth) contact with your partner's semen or blood poses a risk for transmission.

2) Having unprotected receptive vaginal or anal sex with ejaculation inside your body poses the greatest risk for infection. Having receptive sex without ejaculation and unprotected insertive sex also poses a significant risk.

3) Performing oral sex on a man poses a lower risk for infection, but remeber, transmission is possible. For more information, see my response to Oral Sex.

4) You are not at any real risk for infection when he performs oral sex on you, kisses you, when you masturbate with him, etc. HIV is known to be transmitted through anal and vaginal sex, and to the person performing oral sex.

5) Condoms are very effective in preventing HIV transmission. Studies do show that when condoms are used all of the time and correctly that the infection rate in mixed-status couples remains extremely low. Studies show that many mixed-status couples don't use condoms all of the time. Many factors can contribute to these lapses: safe sex fatigue, false confidence in antiviral treatments, depression, drug/alcohol use, denial, wanting greater intimacy, and the in-the-heat-of-the-moment slip. Failure to use condoms consistently (or ever) probably explains the majority of seroconversions.

6) Your partner's viral load (the level of virus in blood) may have an effect on transmission. In many HIV infected people, the use of antiviral medications greatly reduces the viral load in blood. Recent reports out of the XIII International AIDS Conference in South Africa give some information on viral load and it's role in sexual transmission. Studies of mixed-status heterosexual couples (serodiscordant) in Uganda showed that when serum viral load was less than 3500 copies/mL, transmission rate was 0.9 per 1,000 episodes of intercourse. The rates increase when serum viral load was greater than 50,000 copies/mL (2.98 per 1,000 episodes of intercourse). Translation: viral load does affect likelihood of sexual transmission (heterosexual intercourse, not oral sex). More studies need to be conducted.

This is a lot of information, so the bottom line is this: you can stay HIV negative when having sex with an HIV positive partner. Using condoms for sex greatly reduces the risk of transmission, and negotiating boundaries around sex and the risks involved is important in maintaining a psychological sense of safety.

This is a difficult situation for anyone to be in. Take your time. You don't need to jump in the sack yet, and you especially don't need to end the relationship prematurely. Pay attention to your feelings and try having an open dialogue with your new love.

RMK



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