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PLZ ANSWER! - PrEP instead of Condoms for Magnetic Couple

Mar 5, 2014

I am HIV- top. My Partner is HIV+ bottom with undetectable viral load. I am currently on PrEP and consistently take it everyday.

My question, what are the risks to me of transmission if I stop using a condom for anal intercourse and soley rely on PrEP.

Am I playing Russian Roulette?

I have done a lot of research and from what I can gather the risk to me are very small. But there seems to be a lot of debate.

Response from Ms. Southall

Hi The risk is incredibly low. Being top reduces your risk, your partner having an undetectable viral load reduces your risk and taking PrEP reduces your risk.

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.

Thank you for being with your partner! Being conscious of both you and his health. You are blessed to have one another.

Be well and stay safe, Shannon



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