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HIV+, Doing Coke, & Having Unprotected Oral Sex
Apr 5, 2004

My partner & I were both diagnosed HIV+ a few months ago. I haven't been put on meds yet, but my partner has begun therapy. He dosen't have insurance and could not get further testing done to determine his viral again. They played it safe and put him on meds.

My partner has been a coke addict for quite some time. I haven't been able to get the courage to leave him and now I have been doing coke along with him. He insists that he can only have sex while under the influence. I can't get him to stop. He is now unemployed and I told him that I was not going to supply him with drugs.

We would normally buy coke he would perform oral sex on me all weekend long for 4-8 hours straight. It's hard for me to leave him with that kind of attention.

Questions:

1. Does coke make make the HIV progress any faster?

2. Am I giving him more HIV since he's the one going down on me (no ejaculation, but plenty of precum)?

3. Am I at risk of contracting a different strand that is used to the meds he is on?

4. Am I able to receive oral sex from others if I choose to finally leave him?

5. Is it safe for me to go down on him or others if I should decide to leave him?

I feel trapped in a relationship of drugs and sex. I guess sex has become an important role in my life. Please answer my questions above.

Response from Dr. Frascino

Hello Poz-Guy,

As you can probably guess, well controlled clinical studies using coke in pozitoids have not been done (ethical and legal reasons). However we did tweak out some mice transplanted with human immune cells to try to definitively answer this question. The experiments showed cocaine increased the production and spread of HIV. Mice that got high on coke (cocaine given by injection) had a greater decline in their T-cells and an increase in viral load compared to control mice injected with salt water. Also, many of us have seen patients whose CD4's dropped and viral loads increased when they began abusing coke.

Your next several questions concern the possibility of reinfection (superinfection) and the risks of HIV transmission via oral sex. I've written about both of these topics extensively (and recently). So I'll just refer you to the archives for that information, and not reiterate it all again here. Nothing has changed!

Last, if you're feeling trapped in a relationship of drugs and sex that is unhealthy, consider getting some counseling. You're not doing either you or your partner any favors by continuing to party all weekend. Giving up unhealthy activities does not mean giving up sex. Since you've only recently been diagnosed with HIV, there will undoubtedly be a period of adjustment as you learn to live with your new reality as an HIV-positive guy, cohabitating with this unwanted and dangerous intruder virus. Work closely with your HIV/AIDS specialist. Now is the time to focus on staying healthy. Don't feel trapped or discouraged. I've been positive since January 1991, and I can assure you sex is still an important part of my life too!

Good luck. I know you'll make the right decisions.

Dr. Bob



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