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Availability of PEP

Aug 26, 2009

Dear Dr. Frascino, I've been reading The Body for 6 months or so and have learned a lot from you and other experts that contribute. I'm the negative pole of a newish magnetic couple considering having a starter kit for PEP on hand, especially when traveling internationally. In general I have good communication with my partner and we're agreed that we need to have a set of sexual habits that keep things within mutually accepted safety limits. I've encouraged him by saying that mastering the limits of a form can allow a sense of freedom within it. We're not there yet. He has a problem maintaining an erection with condoms involved that seems to be improving after my suggestion he practice masturbating in one as I do. While I keep most of my wits during sex, he completely looses himself early on. I try not to be envious of his transported states: name, date, planet -all gone- but realize we might be working on this a while! Meantime mishaps are possible. He arranged for us to meet with his HIV specialist and we had a good discussion, but surprisingly this rather prominent doctor had not heard of PEP. Although I assured him I understood that the goal would be never to have to use it, he didn't seem to understand why I wanted something like that on hand and has not made it available to us. Am I being reasonable in thinking it would be a good thing to have in the situation and can you advise how to get it? Are resistances that might have appeared in the positive partner taken into account in selecting the drugs for PEP? My partner currently takes Truvada, and Viramune, 200 mg, with an undetectable viral load under this regimen, but I don't know if his regimen has been varied due to resistance at some point. Many Thanks, Mart

Response from Dr. Frascino

Hello Mart,

A "prominent" HIV specialist that has never heard of post-exposure prophylaxis (PEP! WOWZA! That's more than a bit shocking. Print off a copy of the recommendations from the U.S. Department of Health and Human Services entitled "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposures to HIV in the United States" at and give it to him.

You are not being unreasonable in requesting an emergency supply of PEP. (If push comes to shove, take a dose of your partner's Truvada and Viramune and then see an HIV specialist within the next day for evaluation and ongoing management.) I'll reprint below some information from the archives that discusses harm-reduction measures for magnetic couples. You can share this information with your partner's HIV specialist as well.

Good luck! Stay well!

Dr. Bob

"Dealing with HIV+ Fiance' when I have OCD (HARM REDUCTION STRATEGIES FOR MAGNETIC COUPLES, 2009) Aug 1, 2009

Dear Dr. Fascino: I've never seen this ? before but is there any advice on the day-to-day dealing w/magnetic couple issues? (i.e. my fiance' is 15 yrs w/HIV. Still undetectable viral load). Each and every day I don't know if I can deal with this. I suffer from OCD and have spend many visits w/his ID specialist asking ?. He has assured me that since we follow ALL safe sex practices everything should be fine. I also test every 6 months. I'm still -neg but with the OCD I am having a hard time coping. Any books suggested to read? Is there anyone else that has such concerns? Am I incapable long term of dealing with this? He's a wonderful man and I do love him. Maybe this is why I haven't settled on a wedding date? Signed - Living with daily panic.

Response from Dr. Frascino


This is much more of an OCD than HIV problem! You've already spent "many visits with your partner's ID specialist asking questions." He has assured you that since you follow safer sex practices you should be OK. I doubt reading the same advice in a book will help your problem. I'd suggest both you and your positively charged fiancé read through the archives of this forum. We have entire chapters devoted to magnetic couples, safer sexual techniques, HIV sexual prevention, HIV non-sexual prevention and related topics. I'll repost below some information from the archives concerning harm-reduction strategies for magnetic couples. In addition I strongly recommend you seek professional help for your OCD problem. Psychotherapy (counseling) can be extremely helpful in confronting and conquering irrational fears and anxiety. Hopefully your OCD won't cause you to be singing "The One That Got Away Blues!"

You may or may not know that I and my legally married spouse Steve (Dr. Steve, the expert in The Body's Tratamientos forum) are a magnetic couple. We've been together for 16 years in a union that most people only dream about. Consequently I can advise you from personal experience that "happily ever after" can come true for magnetic couples.

Good luck.

Dr. Bob

In love with + man, NOW worried about myself Jun 19, 2009

Hello Dr. Bob. I've been reading your responses for about 2 weeks now and you are a great man for giving us your vauable time. So long story short: Met a guy in Aug 08. we had protected and unprotected sex. He got deployed but came back early because he was told he was +. I got tested at 8 weeks and was -. He came back and to his surprise I still wanted to be with him. From then on we always had sex with a condom. Around March 29,during sex, the condom broke. He didnt realize and he ejaculated inside me. Today I went to get tested and got the ClearView hiv 1/2 stat-pak (15 minute results). The test came out negative. I didn't get tested exactly at 3 months (about at 12 weeks). So I'm wondering how accurate is the ClearView and should I go back to get tested again?

Response from Dr. Frascino


Your 12-week negative HIV-antibody test is very encouraging. However, because you had a significant exposure to someone who is confirmed to be HIV infected, the CDC recommends HIV tests at both three and six months to assure you are not infected. The odds at this point are dramatically in your favor that you did not contract the virus.

I would suggest you and your positively charged mate read through the chapter in the archives of this forum devoted to magnetic couples. I'll reprint below a sample of what can be found there pertaining to harm-reduction measures for magnetic couples (one poz and one neggie).

Good luck.

Dr. Bob


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


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


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

Please help me get some piece of mind

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