HIV levels in vaginal secretions increase significantly in the presence of active gynecological (GYN) conditions (e.g. vaginal yeast infections, herpes, etc.) or vaginal inflammation. Several studies in test tubes have shown that certain common sexually transmitted diseases, such as chlamydia, increase HIV reproduction. Vaginal inflammation, a common symptom of such infections, causes tiny scrapes and cuts to gather on the delicate skin of the vaginal area, that can then harbor HIV. HIV levels can also increase temporarily after receiving treatment for some of these conditions.
In short, in the absence of practicing safer sex, there's no way to know when you're more or less likely to transmit HIV to your partner(s). Exposure to vaginal secretions with high levels of HIV increases the risk of transmission. The risk increases further when one's partner has an infection or inflammation. It's possible to have active GYN conditions or infection without having symptoms or knowing it. (Click here for general guidelines on safer sex practices).
Finally, a number of documented cases have shown transmission of multi-drug resistant HIV from people living with HIV to their partners. What this means is that the newly infected person has a form of the virus that is not affected by currently available anti-HIV drugs, leaving them with limited options to treat their infection.
Again, when CMV causes disease, it's most often the result of a CMV infection acquired previously (i.e. latent infection becoming active). CMV prevention issues are probably much more relevant to women than to men, particularly gay adult men. The prevalence of CMV infection among women is generally lower (40% among women living with HIV) than what's observed among gay adult men (80-90% of whom are already infected with CMV, regardless of HIV status). The bottom line is that if you're not already infected with CMV, safer sex remains a potent tool in preventing the potential for later developing CMV disease.
Like CMV, human papilloma virus (HPV) is another STD that requires concern. One of the major causes of cervical cancer, HPV is prevalent and difficult to treat among women living with HIV. Some types of HPV are more associated with the development of cancer than other types. While it appears that the types of HPV which cause cervical cancer are more prevalent among women who have sex with men, a recent study of women who have sex with women shows that women who have never had sex with men can transmit and get HPV. This again demonstrates the importance of practicing safer sex among women who have sex with women.
Hepatitis, cryptosporidiosis, parasites and other types of disease-causing pests can also be transmitted during sexual activity. Every condition described above can be deadly in women living with HIV, particularly when the immune system is suppressed. (Click here for more information on non-HIV-related infections and how to prevent them.) It's important for HIV-positive women to protect themselves from these unwanted and potentially dangerous pests during sex.
While the issue of re-infection with HIV remains unresolved, increasing evidence shows that it can and does happen. Re-infection could occur if you're taking anti-HIV therapies which you've become resistant to and then transmit the drug-resistant strain of HIV to your partner. Conversely, if your partner is taking anti-HIV therapy, you could become infected with drug-resistant strains of HIV. (Click here for more information on drug resistant virus.)
Finally, it's important to remember that your partner's viral load is not necessarily associated with the level of HIV in his semen or her vaginal secretions. Therefore, while viral levels may be below the limit of detection in the blood, they may be present in high or low levels elsewhere. (note: Standard viral load tests do not measure the amount of HIV in semen or vaginal secretions. Moreover, in studies, even when HIV levels in semen were "undetectable," HIV-infected cells in the semen could still be found. These cells are believed important for transmitting HIV from man to woman.)
In settings where both partners live with HIV, consider these points when negotiating safer sex practices:
You put yourself at risk through unprotected oral sex with a partner or other sex play or activities that expose you to your partner's blood, blood products, feces, semen or vaginal secretions. These risks include possible infections that may never harm your partner, but may be life-threatening to you should your immune system weaken as a consequence of HIV infection.
If your partner(s) is living with HIV as well, neither of you is immune to new infections. Be aware of both real and theoretical risks as you negotiate safer sex. Every sexual behavior or activity carries a risk. It's generally believed that some activities are less risky than others, but low risk obviously doesn't mean no risk.
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