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PrEP and Condomless sex for magnetic couple

Feb 21, 2014

1.) If I'm on PrEP and my partner has an undetectable viral load, what are my chances of getting HIV if we forgo condoms?

2.) If I'm on PrEP and my partner has a detectable viral load, what are my chances of getting HIV if we forgo condoms?

I am negative and my partner is poz. I am considering starting PrEP, but am wondering what my risks are if we stop using condoms once I'm on PrEP. I'm a top and my partner is a bottom. He is currently on Atripla, but I'm not sure of his viral load. He's so ashamed of being Poz that its really hard to get him to talk about it.

Response from Ms. Southall

Hi there,

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.

Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.

Also, the risk of HIV transmission when the viral load is undetectable may not be the same for all types of sex. This risk may be higher for anal sex than for vaginal sex, particularly if the HIV-negative partner is the receptive partner (bottom) during anal sex. This is because receptive anal sex generally carries a higher baseline HIV risk than other types of sex.

There are ongoing studies following serodiscordant heterosexual and same-sex couples who are taking HIV treatment, have an undetectable viral load, and do not always use condoms. These studies will provide a better understanding of the risk of HIV transmission when the viral load is undetectable.

PrEP is a great thing to help reduce the risk of infection and even more so with an undetectable viral load.

I hope this information helps.

Be well and stay safe, Shannon

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