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Undetectable HIV and risks
Jan 7, 2013

Hi there ive been dating someone for a while who is HIV+ but is undetectable. I am top and he is bottom. He says he wants to have sex without a condom and i was just wondering what the risk factor is since he is undetectable, i know it means that its still there but what are the chances of me catching it if i choose to go ahead with it?

Response from Dr. Hightow-Weidman

Hello there Since you are both grown-ups you can make a grown up decision based on the facts. Fact 1: People with undetectable viral load in the blood have a much lower chance of transmitting HIV to others. Much of these data come from heterosexual couples. Is it totally impossible for such people to transmit the virus? Probably not and some of this may have to do with breaks in HIV therapy and possibly transient increases in the amount of shed virus, like during another sexually transmitted infection (this is theoretical). Fact 2: Taking Truvada daily was associated with over 40% reduced risk of acquiring HIV among very sexually active men who have sex with men in an recent study. That is not a great result but shows there is an effect. According to one analysis, those who were better at adhering to the Truvada may have had higher levels of protection. The drug costs money, has some side effects (nausea and bone loss) and for many it is unclear how long they will really take this day after day. Fact 3: Being the top is less risky than the bottom. With you on top, there is somewhat less of a risk of his virus entering you.

So, you have to determine with your partner what makes sense and feels right for you and for him. If any risk is too much risk, or if your worry about your getting infected puts a damper on you wanting to have sex, this would lead you toward sticking with condoms. But, if you interpret the facts to mean there is some but very low risk of infection in this monogamous partnership where the infected partner has reliably undetectable virus, this may trump all else in your eyes.

Hope this helps,

LHW



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