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Concerns with intimacy and dentists-not at the same time!
Jan 20, 2008

Dr. Bob, I was diagnosed HIV + in February 2007 with an initial CD4 count of 186 and an astronomical viral load...I am on HAART now and I'm undetectable. My CD4 count has increased to over 350. I'm not sure what my CD4 % is right now; my biggest concern is the lack of physical intimacy with my wife. She is afraid to kiss me, let alone engage in any other forms of intimacy. How can I reassure her that given my undetectable VL and the effective use of barrier protection, the odds of her becoming infected are extraordinarily low? Is there someone we can talk with about this? I'm sorry about the somewhat misleading title...that is another concern of mine..how do I find a dentist that will feel relatively comfortable treating me? We live in Portland, Maine. I have already looked on HIVdent and I can't find a list or the name of an organization where I can get a list of dentists willing to treat HIV + patients. Thank you so much for your help!

Response from Dr. Frascino

Hi,

Glad to hear you are responding well to your combination therapy, both virologically (HIV plasma viral load plummeting from "astronomical" to undetectable) and immunologically (CD4 counts rising from 186 to "over 350"). BRAVO!

Regarding your wife's fears, this is a common concern for all magnetic couples (one poz, one neggie). You are correct that driving your viral load to undetectable levels significantly decreases the potential risk for HIV transmission and also that when latex or polyurethane condoms are used properly and don't fail, the risk of HIV transmission is essentially nonexistent. As for how to reassure your wife, I'd suggest several tactics. First, have her accompany you to your visits to your HIV specialist. Ask her to address her concerns with the specialist. Next, have her read through the sections of the archives of this forum titled "Magnetic Couples," "HIV Sexual Transmission," "HIV Prevention (Sexual)," and "Safer Sexual Techniques." She should find the information there enlightening and reassuring. Communication is key. If she's having difficulty talking to you about her fears, consider couples counseling with an HIV-knowledgeable therapist. Your HIV specialist should be able to provide you with a recommendation for a counselor/therapist.

As for the dentist problem, again I'd start by asking your HIV specialist if he has any recommendations. If not, try calling your local AIDS service organizations. (Just Google AIDS service organizations and Portland and a list will pop up.) They often keep lists of HIV competent and friendly health care providers. If that is not helpful, check with the American Academy of HIV Medicine (www.aahivm.org). They have a list of certified HIV specialist physicians listed by locale. You can contact several offices and ask for a recommendation for an HIV-savvy and compassionate dentist in your area.

Good luck.

Dr. Bob



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