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What's the Risk?
Apr 9, 2004

Hi, Dr. Bob, Thank you, first off all!

Scenario: An HIV+ guy (positive for two years with a viral load of 21,000--no meds) recieves anal sex from an HIV- guy approximately once every couple weeks. (The neg guy "doesn't like to use condoms" and thinks the risk of transmission is "low"--even over a period of time-- since he's on top.

Question: Would you say the top guy is at great risk, moderate risk, or low risk for acquiring HIV? I know the question is abstract and difficult to answer, and I know there are other concerns that this scenario introduces. But from your expertise and experience, I'd appreciate any feedback on the question of transmission.

Thank you!

Response from Dr. Frascino

Hi,

"Great, moderate, or low" are all relative terms and therefore not much help in this "abstract" situation. Scientifically what's important to know is that there is a "significant risk" for this activity unprotected anal insertive sex. That one partner is confirmed to be HIV-positive increases this risk.

There are, in fact, two significant risks here:

1. The risk of HIV transmission to the "negative-guy." The risk is increased for several reasons, including the repeated episodes of exposure, the confirmed HIV-positive status of the receptive partner, and the detectable viral load of the poz partner.

2. The risk of STD's to the receptive (bottom) poz guy. The "negative" top "doesn't like to use condoms." Going commando greatly increases his risk for acquiring many types of STD's from various partners. These STD's can be transmitted to the poz-bottom-guy and have significant negative consequences on his health. Even reinfection (superinfection) should be a concern, because "negative top-guy" may not really be negative, since he participates in "commando" play and wrongly assumes his risk is "low."

Hope that helps. Bottom line -- no matter if you are "tab A" or "slot B," latex is the required dress code for staying healthy.

Dr. Bob



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