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Sero discordance + risk
Jun 19, 2006

Dr. Bob, Thanks for the great work keeping people informed about the facts regarding HIV/AIDS. I am HIV+ for 20y and have an HIV- partner. My viral load has been under 50 for at least 4 y. Our sex is always where my partner is receptive and occasionally we get carried away and have anal insertion without a condom, never with ejaculation and for a very brief moment where I essentially don't move and he sits on me then quickly gets off. We have talked about how dumb this really is, but it still happens occasionally. Can you tell me the risks based on current scientific data. By the way, the frequency of this behavior is less than a few times a month and is decreasing due our discussions about this, so our goal is to stop it, so your repsonse will not encourage us to continue, regardless of what data you might quote. We have been together 6 months has tested negative once after 3 months. I feel ashamed even asking the question, as I know we should not engage in this behavior ever and our sex life with a condom is very satisfying, but we both are drawn to this occasional "unforbidden" act. Thanks again for the information and this site.

Response from Dr. Frascino

Hello,

Being drawn to the forbidden fruit, so to speak, is not uncommon, especially when the fruit is a firm upstanding banana. The estimated per-act risk for acquiring HIV from unprotected receptive anal sex with a partner confirmed to be HIV positive is 50 per 10,000 exposures. The risk is mitigated somewhat by your having an undetectable viral load, the very brief exposure and your not ejaculating. However, the risk is certainly not completely eliminated.

Since your sex life with condoms is "very satisfying" and you are both aware of the potential devastating consequences of going commando, if your goal is to no longer bareback, then you should indeed just stop. Decide together, away from your satin-sheeted love nest, that barebacking is off limits, despite the allure of latex-less sex. Since it takes two to do the commando mattress mambo, you can both agree to help the other adhere to your mutually agreed upon new and improved safer sex rituals. Your post-sex afterglow should consist of contentment, not easily avoidable worries.

Stay well.

Dr. Bob



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