Barebacking in undetectable/STD free poz-poz relationship (BAREBACKING IN A POZ-POZ RELATIONSHIP, 2011)
May 3, 2011
Dr Bob, hi from Denmark - thanks for a great forum and your time and efforts in educating us all! Quick question: You generally advice the use of condoms, even in poz-poz relationships, due to the risks of superinfection and contracting other STDs. But what if both parties in the relationship are (i) under succesful antiviral treatment with stable, undetectable viral levels and (ii) don't have and (known) STDs? It is my understanding that the HIV infectiousness of a HIV+ person on antiviral treatment with stable, undetactable viral levels is very limited (some doctors say zero) - if the partner is also on a succesful antiviral regimen, that should further reduce the risk, if any, of contracting the different strain of HIV - would you agree? I am not trying to argue against your general advice, but just sounding an idea of specifik circumstances where it might actually make sense to believe that barebacking is an extremely low/no risk activity....?
Response from Dr. Frascino
This really has become a QTND (question that never dies).
Your "but what ifs" include:
Both partners on successful antiviral treatment and have undetectable viral loads. OK fine, but how do you know this is the case every time you have Brokeback Mountain bareback sex? What if someone misses a few doses of or perhaps becomes resistant to his meds? The viral load could spike. You wouldn't know this until the next routine blood draw. Just because someone has an undetectable viral load at the time of his last test doesn't mean it's still undetectable today. Also, there may be some differences between the HIV viral load in the blood versus that in the cervical/vaginal fluids and/or ejaculate.
Both partners don't have STDs. Again, that's great, but how do you know that's always going to be the case? What about the drunken tryst while out of town on a business meeting or some extracurricular activities during a lover's quarrel or the hot pizza deliver guy who delivers his own Italian sausage with the pizza? In other words your "but what ifs" are not always predictable.
I continue to advise using latex condoms for the extra layer (so to speak) of protection -- just in case! Hey, did you guys order pizza to be delivered tonight????
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