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Sexual Transmission Risk when undetectable
Feb 3, 2014

HEllo, I am a 36-year-old woman. I was diagnosed in 2001. I have been on meds (Prez/Nor/Tru)and undetectable for nearly 3 years and have no STDs. I am in a relationship with an HIV- 34-year-old man. We have only had sex with condoms. He is very unfamiliar with this disease and has some fears. I would like to know from you, although I have already spoken to my doctor and have read plenty, who I consider a legitimate source of knowledge in this field, what the actual risk for him would be to practice unprotected intercourse and oral sex. I keep reading how there are no cases of woman to man transmission as long as she is on ART, undetectable VL for at least 6 months and NO STDs. Is this so, is the risk really low enough that he can relax about this? I also understand that refraining from unprotected sex during menstruation is also recommended due to the presence of blood. Could you please give me your thoughts on this particular matter? Thank you very much for the work you do! E

Response from Ms. Southall

Hi You are in the exact situation that I am in. Although we know having an undetectable blood viral load can greatly reduce the risk of HIV transmission, it is unclear exactly what this risk is reduced to.

In the research conducted so far, there have been no recorded HIV transmissions among heterosexual couples where the HIV-positive partner is on treatment and their blood viral load is undetectable. However, this does not mean the risk through condomless sex is zero. All of the couples studied to date have also reported using condoms often. This makes it difficult to determine the risk of HIV transmission when no condom is used.

It is much more difficult for a woman to transmit the virus to a man and decreases with an undetectable viral load. The risk is incredibly low.

Be well and stay safe, Shannon



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