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How risky is to be in a serodiscordant relationship?
Dec 21, 2012

Hi Shannon,

It is months that I ponder on whether to post my question/concerns on this forum. I have done a lot of research all throughout the internet and spoken with specialists in the subject to get a definitive answer, but I never seem to achieve full peace of mind.

It is about a year and a half that I am dating this man in Sub-Saharan Africa. After 7 months of relationship, I encouraged him to get tested and he tested positive. We never had unprotected test before the diagnosis. He was put on ARVs immediately due to a very low CD4 count and high VL. It is now about 9 months that he is on treatment and he is doing very well.

On my side, I have continued to test negative. It is now 6 months however that I do not get tested, mostly because I am terrified. We have always had safer sex and never had any incidents. He performs oral sex on me, but I dont on him.

Regardless of the circumstances, the relationship is going ok. Hes an adorable person and I believe hes facing the whole situation with a lot of courage. Nevertheless, at times I feel I am taking enormous risks by continuing a monogamous sexual relationship with a person living with HIV and I am not sure I will be ever able to overcome the fear I experience. For this, I would need your expert knowledge to answer the following: 1. Is oral sex on me a risky situation? 2. Can I feel relaxed every time we have protected sex if the condom does not burst? 3. Are there cases of serodiscordant couples that have seroconverted even when using correctly and consistently a condom. 4. How often should I be tested given I am in a highly-risky situation?

I would really appreciate if you could shed some light on all my concerns. I would not like to stop a relationship with a wonderful person just because I cannot overcome this fear that invades me at times.

Thank you in advance for all the information you might be able to provide. Kind regards

Response from Ms. Southall

Hi Thank you for your question and I consider myself to be a great resource for you as my husband is negative and I'm positive! 1. Oral sex carries the lowest risk of HIV transmission. The only time there would be a concern for transmission here is if there are open wounds, sores, etc. HIV is not in saliva, so he would have to have an open wound or sore in his mouth. My husband and I also have a rule of no oral if either of us has just had dental work done or just brushed our teeth. 2. We know that if someone who is positive and is on treatment, has an undetectable viral load than the risk of transmission decreases by up to 96% without a condom, put a condom on and you are at or close to 100%. 3. No documented cases that I am aware of, for couples that are using protection constantly. Just remember that it is not a guarantee of no transmission but what I had mentioned above do everything "right" and the risk of transmission is dramatically reduced. 4. My husband receives testing every 6 months which I think is a good habit for someone in a "magnetic" relationship.

A couple of other things to look into are "PrEP" pre exposure prophylaxis. Truvada has recently been approved for the HIV free person in the relationship to take to prevent transmission. Also on the other side of that is "PEP", post exposure prophylaxis. This is something to talk with his health care provider to ensure you have the recommended treatment. This you would use if there were to be an exposure, you would start the treatment within 72 hours and this reduces the risk of transmission occurring.

I encourage you to continue getting educated and realize that loving him is no different than loving someone who is HIV free. I'm thankful he has you and that you are staying and getting educated. My husband and I have been together for 5 years and January 1 we will be celebrating 2 years of marriage.

Be well and stay safe, Shannon



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