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Very confused. Oral sex and unprotected sex on treatment
Jan 3, 2010

I'm very confused as you don't consider a dangerous activity making unprotected oral sex in a magnetic relationship when on treatment but caution everytime to use condoms for penetrative sex. If the risks in both activities are extremely low why you continue to recommend condoms for intercourse? I'm talking about sex on treatment just to be well understood. I report an answer from you about the risk of oral sex:

"Many magnetic couples have decided the risks associated with oral sex are acceptably low and forego using condoms. Others try to adhere to an absolutely no-avoidable-risk policy and hence cover their penis popsicles before all oral action. Ultimately only you and your partner can decide how much risk is acceptable. Some risk-adverse folks never drive above the posted speed limit even if there isn't another car in sight for miles and miles. Others never wear their seatbelt and text while speeding on the freeway during rush hour. We all make calculated decisions about acceptable risk everyday. You need to do the same thing with HIV and oral sex."

Here's another more recent answer on unprotected sex on treatment:

"Even with an undetectable viral load, there is still a possibility HIV transmission could occur. Safer sex (latex or polyurethane condoms for all penetrative sex) remains strongly recommended, even if someone has an undetectable viral load. (See below.)"

If I understand it correctly both activities carry a very low risk of transmission. For penetrative sex this level of risk is only reached when on treatment. Please explain the difference of risks in those activities since both aren't totally free of risk.

Response from Dr. Frascino

Hello,

I do not consider these two activities to have the same degree of HIV-acquisition/transmission risk. If you read my responses closely, including the ones you excerpted, you'll find that what I consistently advise is:

1. Oral sex carries only a very low risk of HIV transmission.

2. Being on effective combination antiretroviral therapy that suppresses the HIV plasma viral load to undetectable levels significantly decreases the risk of HIV transmission, but does not eliminate the risk. Condoms are still recommended!

Oral sex has been intensely studied for many years and the conclusion of those studies is consistent: The HIV-transmissions risk is very low, barring extenuating circumstances.

Unprotected insertive sex between magnetic couples is a different story. Even though the risk of transmission is significantly decreased on effective antiretroviral therapy, it is not completely eliminated and other factors can come into play. These play a role in situations where (1) the viral load in the genital tract may be different than what's measured in the blood; (2) there is an unsuspected rise in viral load due to an intercurrent infection, vaccination or "blip;" (3) the unrecognized development of drug resistance results in a spike in viral load; and (4) non-adherence to HIV medications results in a rise in viral load.

Hopefully you begin to see the difference in potential risk between these two activities and consequently the rationale for my recommendations.

Dr. Bob



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