DEAR EXPERT, I am a 24 year old mother of one and just this year I found out that I am HIV positive. I either recieved it from my x husband or a rape incident. Both occured after the birth of my child. I really need your advice. I have no one to turn to. I have a boyfriend that I really love and he knows my status we have been together for about 2 1/2 months. When I fould out I was positive I told him right away. He has been tested once and the test result was negative. Now (1 month after I told him) he has asked me to marry him then called it off, he now says that we need to take it slow, and he is also doing whatever he can to make me not like him so I will break up with him. I finally got him to tell me why he was doing all this before I broke up with him and his excuse is that he is scared the longer that we are together(sexually) the greater his risk will become(the condom slipped off when he was pulling out plus he wants to enjoy sex without worrying). We also read an article about the SMART five(women that believe that female to male transmission is so low that it's almost non-existant). We are so confused. I want to convince him that it is still o.k. to make love to me. We used to do everything (protected)(except oral), then we began to do less (he wouldn't perform oral on me), now we do nothing (he waits until I am sleep to releave himself). It hurt's. I don't want to leave him. And I feel that he doesn't want to leave me. If only he could know more so he can feel comfortable. I try to educate his as much as possible but it's different hearing it from an expert. His main questions are ... 1. Can you list from lowest risk to highest, what the sexual acts, positions, etc. are? 2. How can oral sex be performed in a way that will be the safest (with a woman) without using dental dam/plastic wrap. 3. How many cases have men recieved hiv from women that are undetectably positive, have a normal immune system, non-drug users, and are over all healthy? I don't know what to do. I am scared of being alone with this. I am more scared that if I can't convince him what am I going to do if I meet someone else and have to tell them. I have been rejected by friends and loved onesrepeated I can't afford to be rejected again.

First of all, I want to say that I'm sorry that you are having such a difficult time with your partner and in other relationships. Unfortunately, you are experiencing what many HIV infected people experience when disclosing their HIV status to others. It is important to remember that you are not alone in your experience and that, while you will encounter people who are not understanding or compassionate, many people out there are. Do your best in managing the difficulties in your current relationships, but also seek out involvement with people who are unconditionally understanding and supportive.

This is where counseling for people struggling with HIV and AIDS in their lives is vitally important. Individual, couple, and group counseling/support can be extremely helpful, insightful, and healing for infected people and those who are close with them. Visit Dr. Remien's forum on Mixed-HIV-Status Couples (http://thebody.com/Forums/AIDS/Couples/index.html) for more information.

Now, in terms of risk of transmission to your partner, there is no easy answer. The basic facts are:

1) If you and your partner have unprotected vaginal or anal intercourse, he is at risk for infection with HIV. It is not true that women cannot transmit HIV to their male partners during sex. The insertive partner (him) is generally considered at lower risk for infection than a receptive partner (you). However, since transmission is always possible, consistent condom use is important in preventing transmission.

2) His risk for infection when performing oral sex on you is very low. Only a few documented cases of transmission to a person performing oral sex on a woman have been recorded. His risk is basically increased if he performs oral sex on you when you are menstruating, if there are sexually transmitted infections present, or if he is having problems with his oral health. The use of a dam practically eliminates his risk.

3) He is not at any real risk for infection when you perform oral sex on him, kiss him, masturbate with him, etc. HIV is known to be transmitted through anal and vaginal sex, and to the person performing oral sex.

4) Condoms are very effective in preventing HIV transmission. Studies do show that when condoms are used all of the time and correctly that the infection rate in mixed-status couples remains extremely low. Studies show that many mixed-status couples don't use condoms all of the time. Many factors can contribute to these lapses: safe sex fatigue, false confidence in antiviral treatments, depression, drug/alcohol use, denial, wanting greater intimacy, and the in-the-heat-of-the-moment slip. Failure to use condoms consistently (or ever) probably explains the majority of seroconversions.

5) Recent reports out of the XIII International AIDS Conference in South Africa give some information on viral load and it's role in sexual transmission. Studies of mixed-status heterosexual couples (serodiscordant) in Uganda showed that when serum viral load was less than 3500 copies/mL, transmission rate was 0.9 per 1,000 episodes of intercourse. The rates increase when serum viral load was greater than 50,000 copies/mL (2.98 per 1,000 episodes of intercourse). Translation: viral load does affect likelihood of sexual transmission (heterosexual intercourse, not oral sex). More studies need to be conducted.

6) Other studies suggest that if your partner is circumcised and isn't infected with any STDs, his risk for infection when having unprotected sex with you is lower than those who are uncircumcised and/or have STDs. Again, this is based on studies in Africa and are only preliminary.

It's most important that you and your partner use condoms for vaginal and anal sex to prevent transmission.

Best wishes in trying to sort this out.

RMK