He's positive, I'm negative

[peggygee]

Ask Dr. K: He's positive, I'm negative
Dr. Jeffrey Klausner

I'm currently talking to a guy and there's definitely the possibility of a relationship. The thing is, he's HIV-positive and I'm HIV-negative. If this relationship progresses and becomes intimate, I would be the top and he would be the bottom. Now, I know that if we use a condom properly every time, I'm at very low risk of getting HIV from my partner. I'm wondering, though, if his viral load were to increase, do I need to be more concerned about transmission? Or am I safe as long as I continue to use condoms?

There is some risk, albeit small, from topping a man known to be HIV-positive, even if you use a condom. The risk is estimated at about one in 2,500 -- a low risk, but not zero. Without using a condom, the per-contact risk for tops with an HIV-positive partner increases to about one in 1,666.

A high viral load or the presence of an STD (for either partner) increases the amount of virus and/or cells that can get infected, consequently increasing risk of HIV transmission. Even if your potential partner has a low viral load, it only reflects the level of HIV in his blood. The level of HIV in his genital tract where semen is produced can be much higher, particularly if there is an STD (STDs have been proven to increase production of HIV). A recent study has also shown that the amount of HIV in the rectum can be greater than the amount in the blood, even in those people who are on effective medications.

For this reason, a full STD checkup -- including rectal screening for chlamydia and gonorrhea, throat screening for gonorrhea and blood testing for syphilis and herpes -- may be in order for both of you. In general, you can take charge of your health by getting regular STD checkups and using lots of lube and condoms every time you have anal sex. You're doing a great job by thinking about this and doing the research before you start a relationship. Communication with this new man about your preferences and fears will serve you well in friendship, love and satisfying safer sex.

To your health,
Dr. K

[rvince]

The risk is estimated at about one in 2,500 -- a low risk, but not zero. Without using a condom, the per-contact risk for tops with an HIV-positive partner increases to about one in 1,666.

Wait! If I read that correctly, using a condom doesn't even divide my 2 the risk to get infected too?!

[muhmuh]

how would screening for other stds help?
all those would do is increase the risk of infection but the simple fact of the matter is that as long as the chance is above 0 sooner or later you will catch the hiv infection

[peggygee]

how would screening for other stds help?
all those would do is increase the risk of infection but the simple fact of the matter is that as long as the chance is above 0 sooner or later you will catch the hiv infection

HIV and other STDs can impact upon each other. The presence of STDs in an HIV infected person can increase the risk of HIV transmission. This can be through a genital ulcer which could bleed or through genital discharge.

An HIV negative person who has an STD can be at increased risk of becoming infected with HIV through sex. This can happen if the STD causes breaks in the skin (e.g. syphilis or herpes), or if it stimulates an immune response in the genital area (e.g. chlamydia or gonorrhoea). Nevertheless, HIV transmission is more likely in those with ulcerative STDs than non-ulcerative.

but the simple fact of the matter is that as long as the chance is above 0 sooner or later you will catch the hiv infection

In a serodiscordant relationship (describes couples where one individual is HIV-positive and the other is HIV-negative) is there a a certainty that one of the partners will seroconvert or become HIV positive. Not necessarily if adequate precautions are exercised, thus all due diligence and precautions should be implemented by all parties in a sexual act.

Most HIV+ persons are very concerned about not infecting others and make efforts to prevent transmission.3 Sadly the fact reamains that a significant percentage of HIV+ persons struggle with prevention: from 20-50% of HIV+ persons report unprotected sex with partners who are HIV- or whose HIV status they do not know.4 For many HIV+ persons, the same structural, inter-personal and behavioral challenges that put them at risk for HIV persist beyond their HIV diagnosis and play a role in their inability to prevent HIV transmission.4
http://www.caps.ucsf.edu/pubs/FS/revPwPFS.php

What can HIV+ persons do?

Many HIV+ persons are using strategies that limit HIV transmission. One strategy is having sex mainly with other known HIV+ persons.11 Knowing that your sexual partner is also HIV+ avoids the risk of transmission and allows for sex without consistent condom use. Though there have been recent concerns about superinfection among HIV+ couples, where one HIV+ person might acquire another strain of HIV from their HIV+ partner. However, superinfection among such couples appears to be rare.12

Another strategy is switching from high-risk to lower risk activities. HIV+ persons can avoid high-risk activities such as being an insertive partner (top) during anal and vaginal sex, having sex while menstruating, breastfeeding and sharing syringes. Lower risk activities can be having oral sex and being a receptive partner (bottom).11 However even in these instances it is extremely important to follow safe sex guidelines ie use of condoms, dental dams, etc.

Finally, there is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Read more about HIV and circumcision.

http://www.avert.org/circumcision-hiv.htm

[peggygee]

[muhmuh]

the point still stands that it doesnt really matter how high or low the risk is as long as its above 0 the law of large numbers dictates that you will get infected sooner or later (and all of murphys laws dictate it will be sooner rather than later)

[peggygee]

Don't leave home without them.

[peggygee]

(Click image to make me big)



I said click me.

[peggygee]

[crayons]

.... the more you realize how much you don't know!