Sero-Discordant Sex What do you do?

[scottieman]

I've recently been seeing a guy, who I like very much.  We have yet to have sex, because we are trying to take it slow and get to know each other.  He is neg, I am poz.  We are both versatile.  I am on meds, and have an undetectable viral load, and have never had any other STD's (this one's enough)

We've been talking about sex, and what precautions we need to take to ensure his remaining negative, however we both like BB Sex.  I read a lot on websites about this topic and am just curious what other "longer" term sero-dis couples do?  Do you always wear condoms?  Condoms when only the (+) is the insertive partner, do you not wear condoms with an undetectable viral load?  I know that the safest route to take is always wear condoms for anal sex.  If you don't feel comfortable telling me here, you can always private me.  Sorry if this is too private a question to ask.

Thanks!

[xman]

A recent study showed that transmission with an undetectable viral load is extremely unlikely to occur. But (and this is a big but) the study was only about hetero sex, more precisely vaginal intercourse. It is believed that in presence of an undetectable viral load any person is much less infectious, however anal sex differs a lot from vaginal sex due to an increased risk of trauma during intercourse and the different anatomy of the two sites. Taking all this in consideration anal sex carries more risk of transmission if no condoms are used. So it is a personal decision on how much risk a couple is willing to accept. The overall risk is very low.

[denb45]

Welcome     I've been in a sero-discordant relationship for the last 20 yrs. I'm POZ, and my partner in NEG, we practice safe sex for the most part, and we occasionaly skirt around the unsafe egdes of that, we just don't go too far outta of it, so to speak, (you can fill-in-any-blanks if you wish) hope that helps..........good luck to ya!

[scottieman]

Thank you for the information, I appreciate it. 

[buginme2]

I am positive and my partner is negative.

If you decide not to use condoms there are some steps you can take to reduce the risk.

-don't stray outside the relationship.  There was recently a study where having another std (in addition to HIV ) increased the chance of having a detectable viral load in your semen even if your blood plasma viral load was undetectable.  So regular std checks (as many std's can go unnoticed) on both you and your partner is prudent and being monogamous to reduce the chance of catching another std is wise.

-stay adherent to your meds.  Maintaining an undetectable viral load can help reduce the chance of spreading HIV.

-you could choose to wear a condom if the positive person is topping.  You could be more flexible when the positive person bottoms.

-your negative partner could consider taking Truvada as a preventative measure.  It would be off label right now but they should be approving it for preventative purposes this year.  Talk to your doctor if you decide to do that.

-most important, in my opinion at least, talk it over with your partner and only do what both of you are comfortable with.

Another thing, my partner came with me to some of my doctor appointments with my HIV doctor.  That made him a lot more comfortable with what was happening and learning about HIV.   Also, he went to see an HIV specialist on his own to discuss transmission, and any questions he had that he didn't want to ask in front of me.  That helped a lot and I highly recommend it. 

[newt]

All other things being equal, the risk of transmission when not on treatment and using condoms is the same as the risk of transmission when on treatment with an undetectable viral load and not using condoms.

There are some differences ie condoms are a barrier, and obviously condoms + treatment equals even lower than low risk.

As has been said, STIs increase risk, as does genetic disposition to get/not get HIV, poppers, type/duration of sex.

I would prob go bare (sometimes I reckon) with someone neg who I had been shagging for several years if we were up for it and after disclosure/much discussion but not someone I had just met and was likely to get real physical with. For sex without rubbers is a gift for special people with a track record who think and behave like an adult.

- matt

[GSOgymrat]

All other things being equal, the risk of transmission when not on treatment and using condoms is the same as the risk of transmission when on treatment with an undetectable viral load and not using condoms.
- matt

I was unaware of this. Which study is this from?

[newt]

There are many sources

For one, Garnett & Gazzard, The Lancet, 27 July 2008 in an editorial comment on various studies summarise research thus: treatment reduces transmission by 90%, the same as condoms do.  This review was in an issue about the time of the arrival of the "Swiss Statement" and consequent controversies, and discussed the research for and against including an important study on gay men having anal sex (one of the few studies on this).

Clearly condoms work if you use them properly, but so does treatment. Both are imperfect prevention technologies, and both have risks/benefits.

- matt

[Neil]

I would say there are not enough studies in this area, as prevously mentioned, most have been done on hetrosexual couples. Also viral load can be different in semen than it is in blood (this is what I have heard recently), and viral load can fluctuate depending on other infections and possible resistance to medication through non-concordance. I am in a serodiscordant relationship, and we always use condoms for anal, both ways. If you get some really good condoms, they can feel as good as sex without, so to use them these days with such a variety of choice should not really be an issue.

[surf18]

what condoms are you using?thanks

[scottieman]

Thanks for all the great advice guys, I really appreciate it, it helps alot.

[jkinatl2]

While it's true that further studies are needed and that HIV levels in semen may differ from those in blood, it is the blood level only that matters if the positive partner is bottoming. In that case, a low/undetectable viral load is considered as safe as sex with a condom.

There are caveats to every situation, but we should not overlook the obvious valid points made about viral load and at least certain forms of unprotected anal sex. Especially of ones partner is gentle and relatively talented at avoiding unnecessary roughness that can cause anal trauma.

[Neil]

what condoms are you using?thanks

Pasante Naturelle. They are provided here in sexual health clinics for gay and hetrosexual patients, so I presume that means they are safe to use for anal sex as well. However, it is better not to recommend a  brand as it is better to experiment with several on your own to find your preference.