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Mitigating the risks of a serodiscordant relationship
Jul 29, 2010

Dr. Frascino,

I have recently entered into a relationship with an HIV+ man. I'm HIV- and this is my first experience with a sero-discordant relationship. He has had undetectable viral loads for three years and takes his medication regularly. We haven't yet taken our relationship sexual (beyond frottage and mutual masturbation), due to some apprehension on my part. (for reference, he is typical receptive and I am typically insertive).

Obviously proper condom use is a must, but I am wondering if there are other steps I can take to mitigate my risk for infection. While no actions are risk-free, I'm interested in protecting myself as much as possible. I've heard of pre-exposure prophylaxis in relation to HIV prevention, but am unsure as to how effective this has proven (or not) to been.

Is receptive unprotected oral sex with no open sores/cuts considered a risky venture?

Response from Dr. Frascino

Hello,

I would suggest you and your positively charged Mr. Happily-Ever-After read through the chapter in the archives devoted to magnetic couples as well as the chapters on safer sexual techniques, HIV sexual transmission and HIV sexual prevention. The information found there should address your concerns and also provide you with some harm-reduction strategies to decrease the risk of viral transmission. PrEP (pre-exposure prophylaxis) is currently still being evaluated in clinical trials. Some HIV specialists will offer PrEP to magnetic couples; however, we cannot definitively comment on its efficacy until the clinical trials are completed. You might check with your partner's HIV doctor to see if a PrEP trial is enrolling in your area. You should also be prepared with a starter dose of PEP in case you have a significant accidental exposure, such as a condom failure.

Oral sex is considered to have only a low risk for HIV transmission/acquisition. The insertive partner is at less risk than the receptive partner in all types of penetrative sex. Many magnetic couples have decided the risk of unprotected oral sex is an acceptably low risk; others have decided even a low risk is not acceptable. Only you and your partner can decide what level of risk you are comfortable with at this stage in your relationship.

Good luck.

Dr. Bob



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