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Risk to inserting partner in gay couple.
Jun 8, 2009

Hi Dr. Franscino, We are a male couple, new together, and are serodiscordant. Sean is HIV positive and is the receptive partner during anal sex, exclusively. His viral load has been undetectable since starting HAART immediately after converting 5 years ago. His Tcell count is usually around 1100. Lit is the inserting partner, exclusively, and is negative. We do not care for condoms. In practical reality, what is the risk for transmission to Lit? Thanks, Sean and Lit, Omaha, NB.

Response from Dr. Frascino

Hi Sean and Lit,

"We do not care for condoms." Well, you're certainly not alone there. I don't know of anyone who particularly enjoys using them. Sean, you are HIV positive and have had to take HIV medications for the past five years. In addition you've had to have blood tests and take trips to your HIV specialist every three months to monitor the status of your immune system (CD4 counts) and activity of your virus (HIV plasma viral load) and to check for drug toxicities/side effects. Lit, you may not care for condoms, but I'm quite certain you'd dislike being HIV infected even more. Sean, is the inconvenience of using condoms worth the risk Lit might have to live with HIV for the rest of his life, take HIV medications everyday, be monitored as closely as you for complications, etc.?

The estimated per-act risk for acquiring HIV from unprotected insertive anal sex with a partner documented to be HIV positive is 6.5 per 10,000 exposures. That Sean is on combination antiretrovirals therapy, which has driven his viral load to undetectable levels, significantly decreases the HIV-transmission risk. However, it does not completely eliminate the risk. In other words every time you have unprotected sex Lit is playing sexual Russian roulette with his life. Remember, HIV is not curable, but it is 100% preventable. I do understand the difficulties of being in a magnetic relationship (one positive, one negative), because I'm part of a magnetic couple as well. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is HIV negative. I'm "virally enhanced." Personally I could never place the person I love most in the world at risk for acquiring a virus that could kill him. Whether the two of you choose to take such a risk is a personal decision. However, please note the "practical reality" is that HIV transmission remains a very real possibility for Lit should you choose to have unsafe sex.

Take a read through the archives of this forum for additional information. We have whole chapters devoted to magnetic couples, HIV sexual prevention, HIV sexual transmission, safer sexual practices, etc.

Good luck to you both. I do hope you'll choose wisely. The old adage about better to be safe than sorry definitely applies!

Dr. Bob



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