Discordant risk


Hi Dr. Bob, I am happily partnered to my partner who has HIV. He always bottoms and I always where a condom. Can you tell me the degree of my exposure if I allow him to perform oral sex on me without a barrier and if I choose to rim him without a barrier. He is very healthy and not on any meds after two years (CD4 690 and viral load 800)



The HIV-acquisition risk for protected insertive anal sex is essentially nonexistent, assuming the latex condom is used properly and doesn't fail. The risk for unprotected insertive oral sex is extremely low. Rimming is not considered a significant risk for HIV transmission/acquisition, although other STDs can be transmitted via this route. You can read much about these topics in the archives of this forum. Your overall HIV-acquisition risk is quite low, but not completely nonexistent. I would suggest you review the information in the archives of this forum where you will find an entire chapter devoted to magnetic couples. You and your partner may want to consider some of the harm-reduction strategies discussed there. For instance, the positive partner in magnetic couples will sometimes decide to begin antiretroviral therapy earlier than the stated guidelines, knowing that driving the plasma HIV viral load to undetectable levels with antiretroviral therapy (ART) significantly decreases any risk for viral transmission. You could also consider PrEP (pre-exposure prophylaxis) as an extra level of protection in addition to the latex condoms.

Good luck to you both. Happy New Year.

Dr. Bob