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Unprotected sex, serodiscordant monogamous couple
Oct 16, 2012

I'm looking for realistic advise or opinion on a challenging situation in my relationship. Here are the facts;

I am HIV+, have been so for over 25 years. I am gay, never had heterosexual relations. I am anal passive and oral active exclusively. My VL is undetectable and has been so for several years. My CD4 is likewise stable and above 500.

My partner is non practicing bisexual. He has had heterosexual relations in the past. He is currently having only homosexual relations with me as his partner. He has only had homosexual relations with one other man and that was in the very distant past.

Our relationship is 100% monogamous and within the relationship, our roles never vary. I am anal passive, oral active and my partner is anal active and oral passive. For several years we have both head the desire to have unprotected anal sex (with me as the passive partner.

My question is;

With my being the passive partner and being undetectable. Realistically what are the chances of my partner becoming HIV+ if we engage in unprotected anal sex?

We are completely monogamous and both very healthy. Our commitment to each other is very strong, but so is our desire to have the sexual intimacy condoms do not afford us.

Response from Mr. Cordova

Hi there:

Thanks for writing in. Please know that I can fully appreciate the situation that you are both in. While I am happy to offer you facts, figures, and an opinion or two, at the end of the day this is going to have to be a decision that the two of you make together.

FACTS N FIGURES:

1. The risk of HIV transmission via anal sex is always less risk for the insertive (i.e. the top or active) partner.

2. The estimated per-act risk for acquiring HIV from unprotected insertive anal intercourse with a positive partner is 6.5 per 10,000 exposures.

3. Your undetectable viral load does make you less infectious. The possibility of transmission is lowered, but not eliminated.

4. A monogamous relationship rules out the possibility of other STD's. Other STD's can increase the likelihood of HIV transmission.

OPINIONS

1. This question has been asked in the forum before. Lets see what our previous forum expert Dr. Bob has to say. Click the preceding link for a lengthy list of similar questions & answers from Dr. Bob.

2. I have met many men who are always the insertive partner. They sleep with plenty of different men, and they never use condoms. They get tested regularly, and they remain HIV negative.

3. Is there a risk? Yes. Can it be a calculated risk? Most likely. In this case I would define a calculated risk as making sure that you were doing all that you could to lower the likelihood of transmission. Things such as:

A: Staying on top of your medication, and getting your numbers checked religiously every three months. You'll want to make sure that your viral load remains undetectable.

B. Avoid aggressive anal play. This includes large toys, untrimmed fingernails, hands, or rough penetration with his penis. Anything that increases tearing in your rectum, will also increase the possibility of transmission. If you are going to be engaging in more aggressive anal play then I would avoid letting him penetrate you without a condom.

C. Pre-Exposure Prophylaxis (PrEP) might be another option. The preceding link will take you to more information on PrEP. Long story short, your partner could take a dose of Truvada, an HIV medication, on a daily basis. This can help lower the likelihood of transmission. It might be helpful to read through the above link, and then have a discussion with your doctor to find out if it could be right for you and your partner.

D. Your partner should be tested for HIV every three months.

Bottom line: Given all of the facts, figures, and opinions, it will come down to the two of you making a decision that you both will be happy with. More importantly, you'll need to come to a decision where you can both be OK with any possible consequences. I hope this helps. Good luck, and please write back in. Let me know what the two of you decide.

In health,

Richard



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