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Odds of contraction for + Bottom (undetectable), - Top having protected anal sex
Aug 12, 2010

I'm HIV+ and my new boyfriend is negative. I have been undetectable for well over a year. If we use condoms and follow all the proper procedures, what are the odds of contraction? I know it's minimal, but he'd like to know and it's a fair question.

One variable...he's very large so I don't know if that makes a condom more likely to break. I doubt we'd be overly aggressive though.

As far as I know, that's about as safe a situation as a mixed-status couple could create. But there's always a chance. Should I keep a few doses of PEP on-hand in case a condom breaks? Or can I just give him some of mine to start? (Reyataz and Truvada). I've also looked into discussing PrEP with him, but from what I've read it's experimental and I'm sure it's quite expensive.

He's the sweetest guy and I can't imagine how I'd feel if I hurt him. I want to do everything I can. But I'm I going overboard? If the odds of safe sex with a condom are even 1 in 1000 that isn't good enough for me.

Thanks for your help!

Response from Dr. Frascino

Hi,

HIV cannot permeate intact latex. No way. No how. Therefore, if latex condoms are used properly and don't fail (break), the HIV-transmission risk would be essentially nonexistent. However, it's important to note that many folks do not use condoms "properly," and very occasionally, even when used properly, condoms can fail (break). Consequently there is as a real life risk.

Regarding the super-sized tallywhacker attached to your new Mr. Right, you just threw that in to make our readers envious, right? Yeah, I thought so. Condoms come in a variety of sizes from "gherkin" to "Italian stallion." Just make sure your top gun suits up properly and your risk of condom failure should not increase.

As for harm-reduction strategies -- PEP, PrEP, etc. -- I would suggest both you and Mr. Happily-Ever-After read through the chapter in the archives of this forum devoted to magnetic couples. It discusses many of these issues. Briefly, yes, it's a good idea to have several doses of PEP ready in case of an accidental exposure. Yes, he could use your Reyataz plus Truvada to start immediately and then switch to an alternate PEP regimen if warranted. PrEP can be expensive. Some HIV physicians are offering PrEP to their magnetic couple patients, even though the clinical trials to prove efficacy and safety are still ongoing.

One last thing: You may or may not know this, but I, too, am the positively charged half of a magnetic couple. My negative mate, Steve (Dr. Steve in The Body's Tratamientos forum) recently participated in a podcast discussing what it's like being the negative half of a magnetic couple. Check out the transcript, which can be found on The Body's new HIV/AIDS Rescue Center for Gay Men that can be easily accessed from The Body's homepage.

Hope that helps. Be well.

Dr. Bob



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