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Mutually Poz Couple
Feb 21, 2004

Dear Dr. Bob,

Thank you so much for all the time and effort you put forth in your struggle to help those of us in need. I have been greatly frightened and helped by this site, and you always seem to be compassionate and gentle. My question is this...My husband (same sex) ans I are mutually infected with the same virus. I was sick with what Doctors thought to be mono when we met, and tested negative for hiv three consecutive times. We now know this was my seroconversion stage. As we thought ourselves negative we had unprotected sex (all the time). Years lateer, when I became sick, we both tested hiv poz. We are responding very well to treatment and are both undetectable for >6 months. We started on same drug therapies, but I was a little slower to respond so added Abacavir to my cocktail. We both had geno/pheno typing done, and show no drug resistance and no mutations. My husband is VERY not fond of condoms, and so instead of having "safe sex" we seem to be avoiding our "favorite activity" in the bedroom. I know I don't have to tell you how demoralizing this can be. Different experts seem to disagree to the risks of our having unprotected sex with eachother. We are definitely mutually infected with the same strain of non-mutated and non resistant virus, very monogamous, healthy and undetectable, and very much in love. What do you think the risk is in us having unprotected intercourse to our health? Thank you again for the time and care you take with your readers and patients. You are a Godsend to this malady and those afflicted. God Bless and be well!

Response from Dr. Frascino

Hi Poz-Guys,

You pose an interesting question, and I can understand why different experts may give you different advice. The truth is that we really don't know, and experts usually hate admitting they don't know anything. The reality of the situation is that you and your partner have to decide together how much risk (theoretical or proven) you are willing to mutually accept. For instance, he may be very fond of hang-gliding off mountain cliffs, but you might find this an unacceptable risk, so you shouldn't be coerced into doing it. Similarly, he may want to vote for Geedubya in November (now that's what I would call extremely risky behavior), but you might not think this is a good idea (and correct you would be); so again, you shouldn't be coerced into voting that way. So negotiated risk (or "negotiated safety") is of utmost importance, if you are both going to enjoy your sex life.

Next, what about being "mutually infected, same strain, non-mutated, non-resistant, monogamous, healthy, undetectable, . . . etc.?" It is possible you both became infected around the same time with identical or very similar viral strains. However, the virus unfortunately does not behave the same way in each of us. How and if a virus mutates is related to many, many factors, most of which are non-quantifiable. For instance, every person's immune system is a bit different, and consequently how their system responds to the virus is different. You can see this in your own situation, because you were "a little slower to respond," and now have an additional drug, Abacavir, added to your regimen. See what I mean? Identical isn't exactly identical. Consequently, by having unprotected sex, it is possible for one of you to transmit a more aggressive strain of the virus to the other person. Has this been shown to occur? Yes. How often does this occur? We don't know. It's very difficult to sort out scientifically. Most likely, it's not all that common, but it is indeed a possibility. Are you and your boyfriend both willing to accept that risk? Only the two of you can determine that. If one or the other of you is not, then commando sex shouldn't be part of your sexual rituals. We all agree condoms are a less-than-perfect solution. They are unnatural (latex), decrease sensitivity (despite what the advertisements say), are not always easy to navigate (ever get a hair caught while unrolling one?), taste bad (unless you get the flavored ones and then they taste like bad candy), are inconvenient (trying to open those damn packets with slippery fingers is nearly impossible, and it's hard to tell which way they unroll in the dark) . . . and the list goes on and on. But, no doubt they do work and allow penetrative sex that is much safer and guilt free.

I don't know if I answered your question or not, but hopefully now your options are clearer.

Good luck, guys. Please stay well and don't let HIV spoil your life or your sex life.

Dr. Bob



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