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I'm POZ, he's not but he wants to ditch the condoms.
Sep 17, 2010

Hello, I've been HIV positive for four years and have been undetectable for the last three. I have not had unprotected sex since my diagnosis but I've been dating a negative guy for a few months now and he wants to have unprotected sex. He said he recognizes that there is risk involved but that as long as I'm the receptive partner and being that I'm undetectable it is greatly reduced and something he isn't worried about. He wants to stop using condoms. While the idea of "barebacking" is appealing I'm still wondering about the level of risk and whether we should do this. Any advice would be greatly appreciated.

Response from Dr. Frascino

Hello,

There is no doubt the thought of condom-free sex is appealing. However, the reality remains that barebacking is risky business for both partners. Your boyfriend is correct that the risk of HIV transmission is significantly decreased if the positive partner is on effective combination antiretroviral therapy that has reduced the HIV plasma viral load to undetectable levels for greater than six months. However, even on effective antiretroviral therapy the risk of HIV transmission is not completely eliminated. I've addressed this topic many times in this forum, and you can read more detailed discussions in the archives that address issues, such as unanticipated jumps in viral load due to intercurrent illnesses, vaccinations or the development of drug resistance; potential differences in HIV viral load in the blood versus the ejaculate; the risk of other STDs to the poz partner that could result in a rise in viral load; etc.

Also, even though your feckless new boyfriend is willing to take the risk, it takes two to do the unsafe dance with no pants. How would you feel knowing that you are placing him at risk? It's certainly something I would never do to my partner-lover-best friend-husband, Dr. Steve. No way. No how. Think it over.

Dr. Bob



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