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Safe sex with HIV+ partner?
Aug 14, 1996

is it possible to have safe sex with an HIV+ person? I guess Im asking how risky is it to have protected sex with an HIV+ person? Is it MORE risky to have sex with HIV+ person with a lower T-cell count, under 100, than it would be with a HIV+ person with higher T-cell count?

Response from Dr. Cohen

Yes, it's possible to have safe sex with an HIV-infected person. If you could only have safe sex with an HIV-negative person, then the concept would be meaningless. The question ultimately boils down your own personal definition of safe. Wearing condoms during intercourse certainly decreases the risk of transmission substantially, but condoms can break, so the risk is not zero. Unprotected oral sex is much safer than unprotected vaginal or anal sex, but it's still associated with a small risk. Kissing, caressing, and mutual masturbation are probably completely safe. Everyone has to decide for themselves where they're going to draw the line.

As for your second question, we do know that someone with more advanced stage HIV disease (or someone with newly-acquired infection who is in the process of seroconverting) is more infectious than someone with asymptomatic disease. The reason has to do with the amount of virus in their blood and semen. People with acute retroviral infection and with advanced AIDS have a lot of virus floating around, and so they can more easily transmit the virus than someone with asymptomatic infection who has relatively little virus in their bodily fluids. The same applies to pregnant women: those with higher viral loads are more likely to transmit HIV to their infants when they give birth.

However, it's important to remember that even someone whose viral load is "negative" (that is, they have no detectable virus in their blood by viral load measurements, but are HIV-positive by the antibody test) is still infectious. No matter how low the viral load is, safe sex is still a must.



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