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Serodiscordant male couple anal sex
Jul 12, 2000

My partner and I have been together for 6 months. I am and have been HIV+ since 1982, he is HIV- as of 2 months ago. Before and since his last HIV test, we have had unprotected anal intercourse, with me as the receptive partner. My viral loads have been undetectable for over a year and a half. I never bleed when we have sex. Other than the fact that researchers will always tell us to have "safe" (condom protected) sex, what is the data on transmission from a receptive (passive) HIV+ partner, to an active (Top) HIV- partner?

Response from Mr. Kull

You ask an important question, so I'd like to answer it point-by-point:

1. The specific data on HIV transmission from a receptive to insertive partner (or bottom to top)during unprotected anal sex are controversial. We know that the risk for an insertive/top is much lower than for a receptive/bottom partner. The risk is probably higher for the top than for someone performing oral sex on an HIV-positive man.

2. An undetectable viral load does not eliminate risk of transmission to your partner. Some studies have shown that a lower viral load (amount of virus) in an infected person's blood reduces the chance that they will transmit the virus to their HIV-negative sexual partners. However, there is some evidence that HIV can be found in an infected person's semen when there is none detected in plasma (blood).

3. Viral load can change over time, even if your treatments are successful now. An unexpected increase in your viral load could put your partner at greater risk.

4. Because you haven't seen blood during sex doesn't mean that blood isn't present. Sure, it's a good sign, but anal sex often causes microscopic tears in the rectal membrane, thus exposing both partners.

5. Do you and your partner talk about the risks involved? Contact Robert Remien, PhD about your situation in the Mixed-HIV-Status Couples forum at The Body. He should have some good advice for you and your partner.

6. Here are some links related to your question:

· Per Contact Risk of HIV: Odds Don't Tell the Whole Story.

· Per-Contact Risk of Human Immunodeficiency Virus Transmission between Male Sexual Partners, American Journal of Epidemiology, 1999;150:306-11.

· The temptation to do it without one.

The bottom line: the insertive partner's risk is somewhere between receptive anal and receptive oral sex. I'd highly recommend condom use in your situation. Good luck.

Ryan M. Kull, CSW



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