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How to deal with fear in mixed status relationship
Mar 1, 2013

Hello, thank you for your wonderful site. I'm neg and I recently started a relationship with a pos guy. He's on therapy with viral load undetectable. We are deeply emotionally involved, though I had (and still have) a lot of concern regarding sex. It's my first time that I deal with hiv issues, and I really had to learn a lot in these 2 months. Up to now we only practiced mutual masturbation, he has performed (unprotected) oral sex on me (which as far as I know is an extremely low risk practice) and I have practiced oral sex on him using condoms. We have also fingered eachother and I don't think there were any cuts on our fingers. So I don't think that I was exposed to any significant risk. The problem is that now he would like to perform anal sex. I would like too, but I really really fear that the condom will break (even if I got those strong condoms specifically for anal). He says that he never ejaculates inside because he doesnt like it, so this should reduce the risk in the case of a condom failure. He also says that when the condom breaks he realizes it and pulls out immediatly and he considers this case as realitively safe. I'm really concerned about this. As far as I know if the condom breaks, ejaculation or not, I should immediatly ask for PEP. Unfortunately this anal sex issue is mining our relationship because I really don't know how to reduce my fears on this sex practice. The strong condoms are indeed extremely strong (I tried one and it took me over half an hour of stress and strain and water filling and manipulating to break it!), but something inside my head is making me run away from this potentially dangerous situation. Am I selfish? I like this guy and the fact that I'm not able to fulfill his desires makes me depressed. Thank you.

Response from Mr. Cordova

Hi there:

First, I want to thank you for being open enough to allow yourself to be in a relationship with someone who is HIV positive. Not everyone is as open and understanding as you.

It's completely understandable that your nervous about your risk for HIV transmission. Asking lots of questions and being patient is going to be important for BOTH of you as you move forward in this relationship.

I'd like you both to check out our section on Mixed-HIV-Status Couples. It's one of our inactive forums here on TheBody.com. There are thousands of questions and answers from people in a situation just like yours. I would encourage you to look through this together. As you move forward in your relationship open and honest communication is going to be imperative to long-term success. Going through the questions together will be an opportunity for you both to talk about your levels of comfort, talk about risk, and to share your feelings.

In regards to actual risk...

Since your partner is on HAART and has an undetectable viral load, the likelihood of transmission is fairly low. This is assuming that you two are in a monogamous relationship and the risk for acquiring other STD's is limited. A co-infection with another STD such as Syphilis, Gonorrhea, or Chlamydia can increase the likelihood that the virus could be present in your partners semen and pre-ejaculatory fluids.

Using a condom for each and every act of penetrative sex is a great way to prevent transmission of the virus. Be sure to use lots of lube too. Using enough lube will help reduce friction and reduce the chance of the condom breaking.

In regards to PEP...

If you were the insertive partner and the condom broke once, I would not be concerned. I do not think that would warrant PEP. If you were the bottom partner and the condom broke once (without ejaculation), I doubt transmission would occur, and if you were the bottom partner and the condom broke once WITH ejaculation, I would argue that transmission would still be unlikely to occur, BUT would understand if you felt the desire to start a course of PEP.

If you are going to consider PEP as an option, I would suggest talking with your doctor about this now. Being prepared will be helpful in the event you need to start this course of treatment. You must start taking PEP within 72 hours, and immediately is best.

I hope this helps.

In health,

Richard

p.s. You're not being selfish, you're just being cautious. Arm yourself with knowledge, and be open to discussing your fears with your partner. If it is meant to be then you both will work through this together. Good luck.



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