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Sex and the Serodiscordant

Headlines About How a Low Viral Load Can Cut the Risk of HIV Transmission Lead Many to Wonder: "What Do These Findings Mean for People Living With HIV? And How Do They Affect My Sex Life?"

Summer 2013

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Extra Measures

Whether or not condoms are used, there are several things that can be done to keep the risk of HIV transmission as low as possible when on treatment. The most important is to make sure the viral load in the blood is undetectable and stays that way. (In Canada, this level is normally 40 or 50 copies per ml of blood.) Scientists and doctors generally agree that your viral load should be undetectable for six months or more to minimize the risk of HIV transmission. Taking your medications every day exactly as prescribed is critical to getting your viral load to an undetectable level and keeping it there. If meds are missed, the viral load can increase, drug resistance can develop -- leading to the need to switch HIV drugs and resulting in fewer drug options in the future -- and the risk of HIV transmission can increase. Getting your viral load tested regularly can help ensure that the meds continue to suppress HIV. All of these things are also important for staying healthy.

Stephanie Rawson is a young HIV-positive woman who lives with her HIV-negative husband in Prince George, British Columbia. Her viral load is undetectable but she and her husband take extra steps to keep their HIV transmission risk low. "My partner and I use condoms when I am close to or on my period. This is because menstrual blood contains HIV even when the viral load is undetectable and can potentially increase our risk of transmission. I also make sure to take my meds regularly and get my blood work done every three months. If for some reason I forget to take my meds, we use condoms until the next time I get my blood work done, so that I know my viral load is still suppressed."

Although having an undetectable viral load reduces the risk of HIV transmission, it is still possible for other STIs -- such as gonorrhea, chlamydia, syphilis and herpes -- to be transmitted. Whether it's the HIV-positive or HIV-negative partner who has an infection, STIs increase the risk of HIV transmission, even when the viral load is undetectable. This means it's important for both partners to look after their sexual health, get tested for STIs regularly and get appropriate vaccinations. Treating the STI as soon as possible and using condoms help to reduce the risk of STI and HIV transmission.


Nick combines having an undetectable viral load with additional strategies to reduce risk: "When I was single and with a guy who didn't want to use condoms, I would minimize the risk by not ejaculating in my partner, using lots of lube and avoiding rough sex to reduce the chances of tearing. I also got tested regularly for STIs. I am now in a monogamous relationship with an HIV-negative guy. We are both STI-free and we use condoms most of the time, particularly if we're engaging in sexual activities that could cause tearing. However, recently we didn't use a condom and there was some tearing, so my partner started post-exposure prophylaxis (PEP). Now he's thinking about starting pre-exposure prophylaxis (PrEP)."

Rawson feels that our new knowledge has had a positive impact on people's sex lives. "People living with HIV have to deal with a lot of stigma, particularly when it comes to their sex lives," she says. "Being undetectable allows my partner and me to have the sex we like to have and at the same time reduce our risk of HIV transmission. It has increased my sense of well-being and helps me feel less anxious and guilty about having sex."

Nick believes he might not even be in his current relationship if it wasn't for this new research. "Before me, my partner always said he would never date someone who is HIV positive because he was so worried about transmission. I think the understanding around undetectable viral load has put him at ease."

The changing HIV landscape is good news for people living with HIV and their sex partners. Treatment turns out to be good not only for the physical health of people living with HIV but also for the health of their partners. By taking one's meds consistently, getting viral load checkups regularly and looking after one's physical and sexual health, the health of people living with HIV can be improved and the risk of HIV transmission reduced. Importantly, this helps reduce some of the fear, shame and stigma that some HIV-positive people experience when it comes to their sex lives and has a positive impact on their relationships as well as their mental and physical health.

Starting Treatment

Most people with HIV start taking treatment at some point to improve their long-term health. For some people, HIV treatment can also be part of a plan to reduce the risk of passing HIV during sex (along with other strategies, such as condoms) and several treatment guidelines support this position. But the decision to start treatment rests with you, the person living with HIV. You need to be ready to start.

For the most up-to-date information on starting HIV treatment, call us at 1.800.263.1638 and discuss these issues with your doctor.

James Wilton is CATIE's Biomedical Science of HIV Prevention Coordinator. He has an undergraduate degree in microbiology and immunology and is currently completing a master's degree in epidemiology at the University of Toronto.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
See Also
More on Safer Sex for the HIV Positive


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