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Pulling out while being undetectable

Feb 7, 2014

I was found being positive in August 2013 with a VL of 13,000 (rounding). I started my meds in November and was found to be undetectable in December 2013 VL below 20 copies.

My girlfriend wants to have unprotected sex. She knows my status and feel comfortable with unprotected sex as long as I pull out. Her reasoning being, "since you don't produce precum, transmission should be miniscule." I've looked all over the net and search this forum and really would like a direct answer to this question.

What's the risk of transmission without pre-ejaculation/ejaculation?

Response from Ms. Southall

Hi First, I'm happy to hear that you have found someone who loves you completely. Having an undetectable viral load dramatically reduces the risk of HIV. 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. My husband is negative and I'm positive and we sometimes use protection and sometimes we don't. I make sure that my viral load stays low and he is tested every 6 months or so. What I would caution you about is that there is HIV in pre cum it's not just in ejaculate.

The other option would be talking with your health care provider about your girlfriend possibly starting Truvada. This HIV medication has been approved for PrEP, Pre Exposure Prophylaxis.

Be well and stay safe, Shannon

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