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How Risky is protected sex for a serodiscordant couple?
Apr 25, 2001

I am an HIV+ female, my boyfrined in HIV-. His personal boundaries dictate that we do not have intercourse at all. This was an easier boundary to deal with for me, before we started looking at our commitment as a life time thing. We are not monogamous and he does have protected intercourse with other people. My question is this, Are there any confirmed cases of transmission between an HIV+ female and HIV- male when condoms were consistently and correctly used? Is this considered a therorectical, low or high risk activity?

Response from Mr. Kull

Using condoms consistently and correctly during intercourse with your partner puts him at low risk for infection. If the condom is latex, does not break, tear, or slip off, and it is used correctly throughout sexual intercourse, it should be 99% effective in preventing HIV transmission and many STDs.

In a 1987-1991 study of mixed-HIV-status couples, all 123 couples who used condoms every time for four years prevented transmission of HIV. In another study, among 122 couples who DID NOT use condoms every time, 12 partners became infected. In yet another large study, among couples who used condoms consistently, there were 0, 1.1, and 1.0 seroconversions per 100-person years (CDC). These numbers speak to the decreased odds of transmission when condoms are used.

The majority of breaks in condoms among serodiscordant couples do not result in infection. Studies about the effectiveness (efficacy) of condoms have yielded different conclusions about why condoms fail. Condom breakage during intercourse is estimated to be anywhere form 1% to 18% (based on a survey of literature), and the CDC reports the overall average of condom failure (based on studies) to be about 3%. In some studies, a small percentage of couples accounted for the higher number of condom failures. Most studies show that higher rates of condom failure happen among a small percent of the general population. This statistic can be explained by traits in the condom users, like technical skill, experience using condoms, prior episodes of breakage, condom fit, and amount of lubrication. Condom failure is more often attributed to user behavior and not to flaws in the condom itself.

Your situation illustrates the difficulties serodiscordant couples can face when negotiating their sexual relationship and boundaries with one another. It sounds like giving up intercourse in order to be with your boyfriend is causing you some conflict; understandably so. Make sure you and your partner introduce the concept of compromise into the decision-making process. You are not required to sacrifice an enjoyable sex life because you are HIV positive. If you guys aren't able to meet in the middle, you may want to pursue some sort of couple or group counseling.

Visit Dr. Remien's Forum for Mixed-HIV-Status Couples at The Body for more information on this topic.

RMK



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