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to leave him or Not....sex or not..confused
Aug 14, 2009

I have been reading many comments on this forum and I hope I can get some answers. at the beginning of June 2009 I had unprotected sex with my boyfriend who I had met on line. We chatted for almost a month and when we met in June, we really clicked and both fell in love, he is 48 and am 42. His kids are 16 and 23 but they live with their mother. My kids are much younger and live with me since my husband passed away 2 years ago. I have a great job and I believed he was negative becuase he said so online.He was the first guy i decided to date since my husband passed away and I found him to be the most comforing and understanding person. The last thing on my mind was to have a test or protetetd sex! However 2 weeks after meeting him and having sex, I met his family for lunch and his father who gets along with me very well warned me not to "spoil" my boyfriend and most importantly not to have sex with him because he was "sick". too late. The next day we went for a rapid test. mine was negative his inconlclusive. I have always been negative and faithful to my late husband. A later test confirmed him HIV positive.I immediately started the post exposure treatment which I did not think would work but it gave me some peace of mind.I only completed the PEP on 28th July. I have had 2 more tests and both have negative between june 17th and July. While taking PEP we continued to have protected sex but I would feel very bad afterwards and sometimes could not even do it. I love him so much and want to be there for him but lately I am finding it very hard, I do not want to have even protected sex . I am very angry because I feel that he lied to me.I am only learning now that he had a reckless sex life and lifestyle including crack cocaine.I have started counselling because I am so confused. I am not sure that I am really negative until after 3 months(?).He has started counselling but not ARVs (he cannot afford them, part time job, no medical insurance etc)his cd4 count is 250.In the past 2 weeks he has this flu and am worried that he has developed AIDS. I had to take him to hospital and pay his hospital bill because he could not afford it! I am so confused because a part of me wants to really be with him and another part says run. I have told him I dont want to see him for a while so that I can sort out my mind but I feel so bad because deep down I care about him. His family knows about his status but I do not want to share with anyone else. sometimes I hear about magnetic couples being together for years.Can I continue to have protected sex with him and will I be safe? could I still test postive after the 3 negatives and taking PEPS so late? Are condoms really 100% safe? what if it breaks will when we have sex will I have to go on PEPs again and for ever? how are other magnetic cuoples coping with safe sex? please help. confused Dominique

Response from Dr. Frascino

Hello Dominique,

Questions and concerns about your feelings toward your boyfriend (anger, distrust, fear, etc.) and whether you should continue the relationship are best discussed with your therapist. Should you decide to continue the relationship, couples counseling may be helpful in addressing trust, honesty and intimacy issues.

I will address the medical aspects of your post.

Your lapse in judgment is summed up by your statement: "The last thing on my mind was to have a test or protected sex!" This needs to be the first thing on everyone's mind with each and every sex partner!

Your boyfriend not only did not disclose his HIV status, he also willingly put you at great risk by having unprotected sex. For that alone he is indeed a scumbag. It's difficult to believe he truly loves you if he has been so readily willing to repeatedly expose you to HIV/AIDS. Add that to his history of crack cocaine abuse, a reckless sex life and your having to pay his hospital bills because he only has a part-time job and no insurance, and this guy is not exactly shaping up to be a likely Mr. Happily-Ever-After. It's worrisome that he clearly should be on antiretroviral medications (CD4 of 250) and is not. I don't know where you are writing from but your boyfriend should qualify for some kind of governmental assistance program if he cannot afford his medications. Untreated he is much more infectious (likely to transmit the virus).

Regarding your risk of being infected, you'll need HIV testing at the three- and six-month marks from your last potential exposure. Post-exposure prophylaxis (PEP) is not felt to be effective if more than 72 hours has elapsed since the exposure.

For information about magnetic couples and safer sexual techniques check out the archives of this forum. We have entire chapters devoted to these and other pertinent topics. HIV cannot permeate intact latex (or polyurethane). However, condoms are not 100% effective, because often they are not used properly and also rarely they can fail (break). Proper condom use is also discussed in the archives. If you have a condom failure (break) and are in a magnetic relationship, PEP would be warranted. I'll post some information below from the archives that discusses harm-reduction measures for magnetic couples.

Dominique, your decision to take a break from this unsavory dude is a good idea.

Good luck.

Dr. Bob

condom failed (HARM REDUCTION STRATEGIES FOR MAGNETIC COUPLES, 2009) May 27, 2009

I am an hiv neg. female, my boyfriend has been hiv pos. for 20 years.and his viral load has always been undetectable.3 nights ago,after sex, we realized the condom had come off and was still inside me,it took some digging, but he got it out.and it was evident that he had come inside me.. afterwards, i started spotting, and started my period the next day. wich has me concerned.i get tested every 4 to 6 months, and had just been tested a week before..i am not going to get all stressed out about it,i know nothing is ever 100% safe,and it can only make things harder. but, the fact that i was bleeding a little has me worried.. how likely is it i've been infected ?, and how long should i wait to get tested again?.this is the first, and hopefuly the last accident we have had.!!

Response from Dr. Frascino

Hi,

Condom failure does place you at some degree of risk for HIV. That your positive boyfriend has an undetectable HIV plasma viral load would significantly decrease the risk of HIV transmission. However, your spotting may increase the HIV-transmission risk. In situations where there has been a significant HIV exposure, post-exposure prophylaxis (PEP) would be warranted if it can be started soon and no later than 72 hours after the exposure. Your exposure was three nights ago; consequently, this is no longer an option for you. But I would encourage you and your boyfriend to review the information about harm-reduction strategies for magnetic couples in the archives of this forum. We have an entire chapter devoted to magnetic couples. I'll reprint below a sample of what can be found there. At this point we would recommend you have an HIV-antibody test at the three- and six-month marks. The six-month test is recommended by the CDC because you had a significant HIV exposure from a partner confirmed to be HIV positive.

Good luck. I agree getting all stressed out won't help!

Dr. Bob

Undetectable Viral Load in Semen MAGNETIC COUPLE SEXUAL RISK 2009) May 26, 2009

A "big G'day" from Australia to you, Doctor Bob!

I am an HIV positive male involved in a relationship with an HIV negative female.

I have been on Atripla (or the Aussie equivalent) for a year now, and for 10 of those months been undetectable.

My girlfriend and I always practice safe sex - I wouldn't put her at risk for anything!

However, during sex last night, the condom broke. We were unaware that it broke and probably had vaginal intercourse for about 15 minutes before realising it had snapped.

I did not ejaculate inside her, but (obviously), can't tell you how much pre-cum would have "leaked" during this 10 minute period.

What are the chances she would have contracted HIV from me?

We are both frantically worried about it and it is putting a strain on our (otherwise wonderful) relationship.

I have read that a recent Swiss study found that a consistent undetectable viral load in the blood correlated with the semen, but I have read other reports that say this might now be the case.

I am hoping that being undetectable and not cumming inside her stacks the odds well and truly in her favour. What would be the chances of her contracting something from this one-off incident?

Thanks if you can shed any light on the matter, and good luck to you and your partner in your own magnetic relationship - opposites attract!!

All the best, Oz Boy. xx

Response from Dr. Frascino

Hello Boy from Oz,

Here's what we know:

1. The HIV plasma viral load usually, but not always, correlates with the HIV viral load in semen (or cervical secretions).

2. Having an undetectable HIV plasma viral load significantly decreases the chances of HIV transmission.

3. Not ejaculating in the love canal significantly decreases the chance of HIV transmission.

4. PEP (post-exposure prophylaxis) taken as soon as possible and no later than 72 hours after an exposure can decrease the chance of HIV transmission. (You can read much more about PEP in the archives.)

To specifically answer your question, the odds are very much in your girlfriend's favor. However, HIV testing is still warranted. I would also recommend you and your gal-pal review the harm-reduction strategies available for magnetic couples (PEP, PrEP, proper condom use, etc.). I'll reprint below some information from the archives. Please note we have an entire chapter devoted to magnetic couples.

Good luck from one magnetic couple to another! Magnetic couples rock!

Dr. Bob

Hiv infection? Magnet couple stress and fear (MAGNETIC COUPLE SEXUAL RISK 2008) Oct 8, 2008

I am negative at the moment and my boyfreind is HIV positive. he is an HIV educator actually.

After I accepted his status, we finally became intimate with each other. I did oral sex on him 3 times that night. Twice on his penis and once with his ass. He precums almost instantly (I don't know if its just with me lol), but I feel like despite the wealth of knowledge about the risk of unprotected oral sex I feel like I may have exposed myself. I didnt not swallow much if any precum. I had a little after taste and I mouthwashed mid session. I only have minor gum bleed after toothbrushing. I am a little concerned about anal oral intercourse too even thought I saw no possible way i could get infected. He penetrated me with a condom and i am not concerned about infection there.

I just want to feel a little assured about my chances for infection here. I love him so much and I find it hard to be intimate with him without thinking about his status. It's a reason why I can't put myself in a condition to penetrate him. And I feel horrible even thinking about talking to him about it because he is an HIV educator and probably know more than most about safe sex practices. Gawd, Just thinking about it and letting my mind run amok about possible infection makes me want to cry becasue I dont want to hurt nor loose him, but I want to trust him with us and our intimacy. And I want to be able to give him my all when we make love without holding myself back.

Given what I said, what were my exposure risks. And what advise do you have for me and the relationship with the one i can see myself with forever?

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is extremely low. There have been no documented cases of HIV transmission due to rimming or getting rimmed. Oral sex carries only a very slight risk for HIV acquisition/transmission. You can read much more about this in the archives of this forum. We have entire chapters devoted to oral sex and sexual-HIV transmission risk.

Regarding your concerns about sexual activity within a magnetic relationship, as you might imagine, you are not alone. It's something all magnetic couples must come to terms with. Communication is key and that is what is lacking in your current relationship! That your Mr. Right is an HIV educator should make communication easier, not more difficult! Chances are he's as worried about infecting you as you are about acquiring the virus. The two of you are overdue for a heart-to-heart (note that's heart-to-heart, not hard-to-hard) talk! You need to openly discuss your concerns and together the two of you need to develop sexual rituals based on what is known scientifically about the HIV-transmission risk and on your individual levels of comfort. I suggest both you and your Mr. Wonderful read through the chapter in the archives devoted to magnetic couples. You'll soon see your concerns are shared by many of us in serodiscordant relationships. In addition to taking equal responsibility to make sure HIV is not transmitted, there are a number of other measures the two of you might want to consider to further reduce transmission risk:

1. Have your poz-partner take antiretrovirals to drive his HIV plasma viral load down to undetectable levels. This will significantly decrease transmission risk.

2. Get a starter dose of PEP (post-exposure prophylaxis) to have on hand just in case there is an accidental exposure (condom break).

3. Consider PrEP (pre-exposure prophylaxis). This involves the negative partner taking antiretroviral medication prophylactically on a routine basis. We still don't know if this approach is effective. Clinical trials are underway. Some magnetic couples aren't waiting for the results of the trials, but rather are instituting PrEP as a harm-reduction strategy now.

You can read much more about PEP, PrEP and other risk-reduction strategies in the archives.

Finally, I want to assure you from personal experience that opposites attract and that happily-ever-after can indeed become a reality for magnetic couples. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is HIV negative. I'm "virally enhanced." We've been happily-ever-aftering for 15 years and yes, that includes toe-curling, wake-the-neighbor, own-name-forgetting fusion sex. My advice to you is to make sure Mr. Right doesn't get away for all the wrong reasons.

Good luck to you both!

Dr. Bob



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