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Anxious physician in a magnetic relatonship
Dec 29, 2008

Hi Dr. Bob,

I am a male HIV- resident physician who's in love with an HIV+ male partner. I am totally in love with my partner and would like to be intimate with him, but I can't seem to shake my concerns about becoming infected. I've looked through your forum and have read the literature, but it's still not clear to me exactly what the risk of transmission is. More importantly, I'm unsure how to apply these statistics to my own life. I typically engage in receptive anal intercourse which I believe places me at the highest risk. My partner's CD4 count is well above 600 and his viral load is ~4000. We consistently use condoms and lubricant and have never had an episode where the condom has broken. I love my partner, but my concerns have caused discord in our relationship and I know that I would be devastated if I were to seroconvert. I need to know just how risky this is if I am to continue in this relationship. Can you please provide me with some advice based on your experience advising HIV discordant couples?

Response from Dr. Frascino

Hi,

You and your Mr. Happily-Ever-After should read through the entire chapter on magnetic couples in the archives of this forum. It addresses many of your concerns. In addition there are entire chapters on HIV sexual prevention and safer sexual techniques.

Since you are a physician, if you want a more detailed scientific analysis on the safety of various sexual activities, check out the HIV InSite chapter at http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02.

Finally, I should mention there are some precautions you and your partner could take to decrease the risk of HIV transmission:

1. Your partner could consider beginning antiretroviral medications now to drive his HIV plasma viral load to undetectable levels. This would greatly decrease the chance of HIV transmission in case of an accidental exposure (condom break, etc.).

2. You could get a starter dose of PEP (post-exposure prophylaxis) to take immediately in case of an accidental exposure.

3. You could consider PrEP (pre-exposure prophylaxis). There are clinical trials enrolling to see how effective this harm-reduction strategy really is. If you can't locate a clinical trial, some HIV specialist physicians are willing to write prescription for this off-label use of antiretrovirals.

4. Review proper condom technique. Condoms very rarely fail when used properly.

My magnetic relationship with my husband (Dr. Steve, the expert in The Body's Tratamientos forum) is as hot and passionate as ever. And we've been together for over 15 years. Happily Ever After does indeed exist for magnetic couples. We're living it!

Good luck. Be well.

Dr. Bob



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