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Worried :(

Apr 30, 2009

Doc, I'm in what you call a 'magnetic' relationship, and have been now for 8 months (and I've never been happier). My boyfriend became... positively charged a couple of years before I met him, and has maintained undetectable status (<75 copies/mL and cd4 over 1000) since 6 weeks after he first tested positive and started meds. Ever since we met, I've been reading your Q/A blog constantly. I can't find an answer to my exact question, but many similar. Since I don't have a vagina, and my boyfriend doesn't have full-blown AIDS, I'm forced to post my first question here. Last night we had crazy hot sex. I was on top, and usually am; and was wearing a condom, and always do. Intercourse lasted about fifteen minutes though, and it wasn't until after the horses were out of the barn I realized that the condom didn't make it. Never in my life... I (we) never felt it break. So I'm asking for your best advice. And, to your knowledge, the risk of transmission given the circumstances. Undetectable positive receptive male, insertive negative male. Thanks in advance.

Response from Dr. Frascino

Hi Happy Magnetic-guy,

Actually this question has been answered several times and those responses are posted in the archives! Consequently I'll be brief. First I should mention we don't use the term "full blown AIDS". It never really made any sense since because there is no such thin as "partially blown AIDS."

The estimated per-act risk of acquiring HIV from unprotected (or broken-condom) insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. Yes, driving the plasma HIV viral load to undetectable levels with combination antiretroviral therapy significantly decreases the risk of all types of HIV transmission; however, it doesn't completely eliminate it. In situations like yours a course of PEP (post-exposure prophylaxis) could be considered; however, this should be started as soon as possible (and no later than 72 hours) after the exposure. You can read much more about PEP and other potential harm-reduction measures, including PrEP (pre-exposure prophylaxis) in the archives. Your next step, if more than 72 hours have passed and thus PEP is no longer an option, is to get HIV tested at the three-month mark. If negative the CDC recommends one additional test at the six-month mark, as you had a significant exposure to someone confirmed to be HIV positive. The odds are in your favor that you did not get infected but testing is still warranted. Also, check the expiration date on your Magnum extra-large condoms and review proper condom technique (also in the archives). Latex and/or polyurethane condoms only seldom fail (break) when used properly.

Good luck to both you and your Mr. Happily-ever-after.

Dr. Bob

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