I am an HIV+ male, diagnosed in Sept 05 at which time I immediately began treatment with Truvada and Sustiva (subsequently replacing both with Atripla). I have been undetectable since the first 6-months after initiating treatment. I have had no other sexually transmitted diseases since my initial diagnosis. My question is this: What is the risk to my negative insertive partner during oral sex given my undetectable status and ongoing successful HAART treatment? I've been doing considerable research of the literature regarding the associated risks and while acknowledged to be extremely low for the insertive partner (1 in 20,000 according to PEP Guidelines in 2005), how significantly are those risks further reduced particularly given recent claims regarding the non-infectious status of undetectable HIV+ individuals? Again, I am specifically relating the topic to the associated risks of insertive oral sex with an undetectable, HIV+ receptive partner.

I am well aware that the archives address similar topics in volumes too numerous to count, but none that I could find in this specific regard. Thank you for your time in addressing the topic.

Yours truly,

NORM (negative oral receptive male) ;-)

Hey NORM,

Oral sex as you determined from your research carries only a very slight risk for HIV transmission/acquisition. As with all forms of penetrative sex, the receptive partner is at higher risk than the insertive partner. You are also correct in pointing out that if the positive partner reduces his HIV plasma viral load to undetectable levels with antiretrovirals for a period of time and does not have concurrent STDs, the risk of HIV transmission is "significantly" reduced. I cannot give you a firm statistic as to exactly how much, as there are far too many variables to consider viral strain, host immune integrity, local trauma, etc.

You and your negative partner should read through the chapter on magnetic couples and the one on oral sex in the archives of this forum. I'm confident you'll find the information and testimonials there enlightening and reassuring.

Good luck.

Dr. Bob