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Author Topic: Can two HIV partners with no viral load safely have sex without condom?  (Read 15308 times)

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Offline jm1953

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Quick question.  I haven't seen my long distance friend in a long while.   Plan on a trip down to CA. soon to see him.  I know this question has come up before, and I have asked docs, just wanted your opinions.  Can two people with no viral load have unsafe sex without passing on their virus and resistancy to drugs to each other?  Personally I prefer having sex the natural way, but don't want to further infect him with my virus or vice versa.
Positive 25 years. 7/21/2012 Current CD 4: 780 Viral load: less than 50. 38 to 40%
Current drug regimen, Isentress, , Emtriva, Sustiva Wellbutrin, Klonipin, Allegra, Ambien, Testosterone, Nandrolone, Vicodin, Benedryl, Aspirin, lots of vitamin supplements.

Offline jkinatl2

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Quick question.  I haven't seen my long distance friend in a long while.   Plan on a trip down to CA. soon to see him.  I know this question has come up before, and I have asked docs, just wanted your opinions.  Can two people with no viral load have unsafe sex without passing on their virus and resistancy to drugs to each other?  Personally I prefer having sex the natural way, but don't want to further infect him with my virus or vice versa.

Yes.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline mikeyb39

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you are prettty safe with that as far as the HIV is concerned.  Unless you guys play on the side or not monogamous then you would need to worry more about all the other nasty bugs out there such as syphillis, herpes, and etc.
11/02/2010  cd4-251, vl-591000
12/09/2010  started Atripla
02/18/2011  cd4-425, vl-800
06/10/2011  cd4-447, vl-70
10/10/2011  cd4-666, vl-80
01/05/2012  swiched med (prezista,norvir ,isentress, )
02/10/2012  cd4-733, vl-UD  Viread removed
06/10/2012  cd4-614, vl-UD
12/14/2012  cd4-764, vl-UD
09/01/2013  cd4-785, vl-UD
03/06/2014. cd4- 1078, VL-UD

Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #3 on: August 01, 2012, 06:59:11 PM »
It is all a numbers game. Your chances of transmission are greatly reduced but there still is that possibilty. From personal experience in heat of the moment reason flies out the door.
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #4 on: August 01, 2012, 07:26:05 PM »
of course if HIV poz partners with UD viral loads were barebacking and transmitting HIV, we'd be seeing another wave of illnesses and deaths in this epidemic. Instead we don't see that at all.  ;) There are no waves of treatment failure or waves of super-infection showing up in the data, and yet a lot of people have serosorted and have condom-less sex.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline newt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #5 on: August 02, 2012, 06:42:08 PM »
Quote
It is all a numbers game. Your chances of transmission are greatly reduced but there still is that possibilty.

Provided people have been taking their meds proper, the chance is zero, or statistically zero (same thing in real life). Anyone who wishes to say otherwise quantify the risk please.

- matt
"The object is to be a well patient, not a good patient"

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #6 on: August 02, 2012, 08:26:08 PM »
Provided people have been taking their meds proper, the chance is zero, or statistically zero (same thing in real life). Anyone who wishes to say otherwise quantify the risk please.

- matt


Completely agree, and await quantification.
Thanks, Newt.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline joeyg624

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #7 on: August 02, 2012, 09:59:21 PM »
there is one thing to be concerned about, and that is hepatitis C, which to a small extent can also be transmitted through anal intercourse. if both of you have cleared that bar, and as you said, have undetectable viral load, then have fun with each other!
Apr 10 CD4 60 VL 256,000
May 10 CD4 130 VL 724
Aug 10 CD4 188  VL <75
Nov 10 CD4 170  VL <75
Mar 11 CD4 272 VL <48
Aug 11 CD4 272 VL <20
Nov 11 CD4 267 VL <20
Mar 12 CD4 297 VL <20
Nov 12 CD4 312 VL <20

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #8 on: August 03, 2012, 01:10:47 AM »
there is one thing to be concerned about, and that is hepatitis C, which to a small extent can also be transmitted through anal intercourse. if both of you have cleared that bar, and as you said, have undetectable viral load, then have fun with each other!

Well, Hep C and all other STDs. If they are monogamous and have tested negative for other STDs - including the three month window for syphilis then you are correct. The OP was specifically talking about HIV re/superinfection.

For the other STDs the best bet is to a) monogamous or b) get an STD panel twice a year.

Even if two non-monogamous partners use condoms, many STDs can be transmitted anyway. And for pozzies, that can mean bad news gets REALLY bad quickly.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline 0608

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #9 on: August 03, 2012, 01:06:31 PM »
Good point about the other STDs!  It's just my 2 cents, but why not use condoms?  Is the added pleasure worth the possible hassle of hepatitis or what-have-you?  After all, we've learned that it wasn't worth being told we're HIV-positive.  So let's play safe!!!

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #10 on: August 03, 2012, 01:21:52 PM »
Good point about the other STDs!  It's just my 2 cents, but why not use condoms?  Is the added pleasure worth the possible hassle of hepatitis or what-have-you?  After all, we've learned that it wasn't worth being told we're HIV-positive.  So let's play safe!!!

Seeing as how one can get almost any STD orally, do you recommend we use condoms for oral sex as well?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline 0608

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #11 on: August 03, 2012, 01:29:44 PM »
Interesting question, jkinatl2.  I may be wrong, but as I understand, the chances for STD transmission are considerably higher for unprotected anal/vaginal sex than oral sex.  Personally, I wouldn't have my partner ejaculate in my mouth, but I wouldn't use a condom for oral sex, just for anal sex.

This is all just speculation, though, LOL; I haven't had any kind of sex since I found out I'm + (in June) except the kind with myself. :)
« Last Edit: August 03, 2012, 04:30:40 PM by 0608 »

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #12 on: August 03, 2012, 01:52:23 PM »
Seeing as how many if not most of us see a doctor for labs every three months (if not more often) wouldn't a better advisory for non-monogamous sexually active people to simply have an STD panel done with the other lab work?

As far as transmission is concerned, I am unaware of any study that places the oral cavity at lesser risk for, say, gonorrhea or syphilis or chlamydia than the vaginal/anal canal. Especially since many people also believe that exposure without ejaculation is substantially more protective against those pathogens.

I totally understand the urge to "over correct" when newly diagnosed (less than five years, say) and eschew all sex, or promote an ideal of safer sex that is very stringent. For most people, this is an unsustainable goal - and one that tends to change over time.

On point though, and as specifically regards HIV, there is no medical reason to use condoms between positive persons on ART.

For anyone with multiple sexual partners (or whose partner has them) it seems far better to take the educated risks we lump together and call "safer sex" AND get regular STD panels done - and if necessary, get any STDs treated.




"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #13 on: August 04, 2012, 04:45:39 PM »
"On point though, and as specifically regards HIV, there is no medical reason to use condoms between positive persons on ART."


I think this opinion is a bit naive. Pose this assertion to 100 HIV physicians and I doubt the majority would agree. They would agree that the probability of transmission is greatly reduced but it is not by any means zero. As we all know VLs can flucuate and the reliability of a load test is not 100%. Factor in HIV in semen which is not part of a plasma viral load test and we've got another source of virus.

Another inaccurate assumption is that folks are 100% med compliant. Among Veterans we are lucky if 25% of the population is compliant.




HIV Med. 2009 Sep;10(8):470-6. Epub 2009 May 6.
How reliable is an undetectable viral load?
Combescure C, Vallier N, Ledergerber B, Cavassini M, Furrer H, Rauch A, Battegay M, Bernasconi E, Vernazza P, Hirschel B; Swiss HIV Cohort Study.
Source
Division of Clinical Epidemiology, University Hospital Geneva, Geneva, Switzerland. christophe.combescure@hcuge.ch

http://www.ncbi.nlm.nih.gov/pubmed/19459990

Int J Androl. 2010 Feb;33(1):e98-108. Epub 2009 Jun 15.


HIV infection of the male genital tract--consequences for sexual transmission and reproduction.
Le Tortorec A, Dejucq-Rainsford N.
Source
INSERM U625, Rennes, Rennes I University, Groupe d'Etude de la Reproduction chez l'Homme et les Mammifères, IFR 140, Campus de Beaulieu, Rennes, France.

http://www.ncbi.nlm.nih.gov/pubmed/19531082

Curr HIV/AIDS Rep. 2011 Jun;8(2):85-93.
Antiretroviral therapy: a key component of a comprehensive HIV prevention strategy.
Hull MW, Montaner J.
Source
British Columbia-Centre for Excellence in HIV/AIDS, at St Paul's Hospital, Providence Health Care and Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
Abstract
Transmission of HIV is critically dependent on the level of HIV viral load within blood and genital secretions. Antiretroviral therapy results in sustained reductions in viral load to undetectable levels. Thus, antiretroviral therapy has long been postulated as a potential means to curb HIV transmission. Observational data have now confirmed that antiretroviral therapy is associated with a decrease in transmission among heterosexual serodiscordant couples, injection-drug users, and in population-based studies. Mathematical models suggest that further expansion of antiretroviral coverage within current guidelines can play a major role in controlling the spread of HIV. Concerns regarding the potential for transmission during acute HIV infection, behavioral

http://www.ncbi.nlm.nih.gov/pubmed/21445551


« Last Edit: August 04, 2012, 05:13:04 PM by Mishma »
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #14 on: August 04, 2012, 05:09:02 PM »
I think this opinion is a bit naive. Pose this assertion to 100 HIV physicians and I doubt the majority would agree.
however, as I mentioned earlier, if this truly was greater than a next-to-nil possibility, shouldn't we be seeing people who (while remaining adherent and UD) are experiencing treatment failure? But of course we're not seeing that because quite simply - ART acts like both PrEP and PEP. ;) Then when you throw in either an UD or lower amount of virus being transmitted, it's no wonder there is no real world issue about poz-on-poz UD sex.

For me, it's also hard to take the assertion of any 100 physicians without a grain of salt when we're discussing sexual practices. Sadly, many tend (intentionally or unintentionally) to push their own prejudices against sex, be it "gay" sex, anal sex, sex outside wedlock. Also, because of malpractice lawsuits, I doubt any physicians would ever condone unprotected poz-on-poz UD sex. :D
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #15 on: August 04, 2012, 05:18:37 PM »
"On point though, and as specifically regards HIV, there is no medical reason to use condoms between positive persons on ART."


I think this opinion is a bit naive.

With all due respect, it is not.

I have rather made transmission theory my pet project in the 19 years since I've been positive, and the ten years I have been helping out in the AM I INFECTED forum.

Asking 100 physicians about HIV transmission will also get a lesson in how HIV can be transmitted through kissing as well.

Give me a day or so to get my studies in order, as I see that having this discussion to the nth degree is nigh - something I strongly suspected from your first postings.



"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline newt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #16 on: August 04, 2012, 05:59:01 PM »
What jk said

If there is no chance for the virus to transmit, what is the issue?

 - matt
"The object is to be a well patient, not a good patient"

Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #17 on: August 04, 2012, 06:55:45 PM »
Practically speaking I agree with those of you that think there is a "zero" chance of transmission-with both partners being undetectable, that "unprotected anal intercourse is relatively safe all things being equal." I never claimed otherwise.

My point is that there is a possibly, albeit remote that the virus will be transmitted. Making claims that there is no valid medical reason or that there is zero chance of transmission is patently false and possibly criminal.

Furthermore the intestines are perhaps the greatest reservoir of the virus and most drugs do not penetrate it in pharmacological relevant concentrations to control the virus in those tissues. We do not routinely sample this reservoir so plasma viral load doesn't even begin to tell the complete story.
 
I'll be sure to bring this subject up next week at our  HIV Prevention Meeting for the State of Utah where prevention for positives has been emphasized for the 18+ years I've been involved.

From the CDC:

What is the Risk of Sexual HIV Transmission for HIV-infected Persons With Undetectable Viral Load?

ART is considered effective when it consistently suppresses plasma viral load to undetectable levels. However, sexual transmission of HIV from an infected partner who was on ART with a repeatedly undetectable plasma viral load has been documented [8]. An infected partner's genital (seminal or vaginal) fluid viral load may play a greater role than plasma viral load when evaluating the risk of sexual transmission of HIV. The likelihood of HIV transmission in the setting of ART is influenced by a number of factors, several of which are described below.

http://www.cdc.gov/Hiv/topics/treatment/resources/factsheets/art.htm
« Last Edit: August 04, 2012, 07:22:20 PM by Mishma »
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #18 on: August 04, 2012, 06:56:44 PM »
Quote
Another inaccurate assumption is that folks are 100% med compliant. Among Veterans we are lucky if 25% of the population is compliant.

Please reread the title of the thread. If two partners have undetectable viral loads, then there is no risk dangerous HIV exchange. This presumes either compliance with medication or a genetic variable keeping viral load at bay. THAT was the question asked.

Maybe you are confusing serodiscordant couples and primary infection? Two of your links discuss infection, not "reinfection" or "superinfection," which of course are controversial in their own rights - and also the topic of this thread.

For serodiscordant couples, my opinion is more guarded when the vaginally/anally insertive partner is positive, but the risks are still minimal in even that scenario.

I rather think it important to stay on task when dealing with these situations. Otherwise you get this sort of exchange:



Patient: Can I get HIV from getting sucked off by my poz boyfriend?

Doctor: You can certainly get (and give) a host of other STIs.

Patient: But what about HIV?

Doctor: Research indicates that in certain extreme circumstances it might be theoretically possible.

Patient: Has it ever been documented?

Doctor: Well, no, but theoretically possible - is that a risk you want to take?

Patient: Are there any studies of long term serodiscordant couples and oral sex?

Doctor: Well, evidence of absence does not equal absence of evidence.

Patient: So ... no, then?



Clouding the salient issue (reinfection/superinfection among couples with an UD viral load) with primary infection science isn't a valid way to "prove" the existence of any real risk fo those already infected with HIV.

Remember when the "reinfection" stories broke about ten years ago? There was the terror that a new wave of pozzies who were otherwise compliant with treatment would suddenly turn up resistant to meds thanks to the superimposition of another strain of virus.

This has yet to materialize.

Of course, the relative risk, if any, depends on the type of sex we are discussing. If such a risk exists, it is likely exclusive to the female partner in vaginal sex, and the bottom in anal sex.

But again, the evidence has yet to materialize that this is a health issue for those with undetectable viral loads.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #19 on: August 04, 2012, 07:09:39 PM »
Practically speaking I agree with those of you that think there is a "zero" chance of transmission-with both partners being undetectable, that "unprotected anal intercourse is relatively safe all things being equal." I never claimed otherwise.

My point is that there is a possibly, albeit remote that the virus will be transmitted. Making claims that there is no valid medical reason or that there is zero chance of transmission is patently false and possibly criminal.


My point is, no one here has said "zero." Newt said it was "statistically zero" which is an important distinction.

And you keep talking about "transmission" instead of "reinfection or superinfection." Your research seems to point exclusively towards primary infection.

I hope your conversation with the "HIV Prevention Meeting for the State of Utah where prevention for positives has been emphasized for the 18+ years" goes well.

 It always disquiets me to see people using misinformation and disinformational "scare tactics" to dissuade sexual activity or further stigmatize HIV positive persons. Often eighteen years is more than enough time for opinions to become set in stone, despite advances in science that mitigate or disprove them.

Believe me, I had an uphill battle when the Romero and Page-Shafer studies came out, insofar as transmission theory goes. It's hard to incorporate new information into a paradigm, even when it is initially understood that the paradigm is evolving.

Perhaps the opposite of "naive" in this case would be "jaded."



*modified to fix typos I found. Surely I missed some.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #20 on: August 04, 2012, 08:02:37 PM »
I'm just trying to save lives not stigmatize or dissuade individuals from sexual activity.

I was stupid enough to believe 27-30 years ago that HIV was not a theoretically transmitted virus and it was simply a lifestyle disease (poppers and other drugs). I ignored the warnings and I've paid big time. The science was sketchy then too.

On the practical point, we don't know (to my knowledge) if there has been  a large number of either superinfections or reinfections since we don't routinely qualify an individuals viral clades while an individual is UD. Another point that is being studied as I type is what exactly is an "undetectable" viral load and what are the ramifications.

An assumption I've made from the beginning is that we were talking about  unprotected anal sex. You've been quite accurate in pointing out the big differences in transmission depending on what tissues/fluids were involved.




« Last Edit: August 04, 2012, 08:14:41 PM by Mishma »
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #21 on: August 04, 2012, 08:40:05 PM »
The science was sketchy then too.
the science is less sketchy now, 30 yrs later ;)

we don't know (to my knowledge) if there has been  a large number of either superinfections or reinfections since we don't routinely qualify an individuals viral clades while an individual is UD.
if superinfection/reinfection were happening, we wouldn't need to know viral clades to prove it. We would be seeing treatment failures in adherent UD individuals. Perhaps if enough treatment failures were already happening scientists would be examining the clades. Currently though treatment failure can almost always be explained by non-adherence.

of course, the studies on PrEP and PEP give us much better data on why superinfection/reinfection isn't happening. ;) (That's why Truvada is now prescribed as a preventative medication. ;) ) Mix PrEP and PEP with UD viral loads, or even low seminal viral amounts, to see why no transmission is happening which might lead to treatment failure. 
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline newt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #22 on: August 05, 2012, 06:33:38 AM »
Quote
Provided people have been taking their meds proper, the chance is zero...

I said zero in the real world, and I stick to my guns on this. This is a practical position. Life is practical not a discussion of minute margins of possible error on vanishingly small risks.

If two HIV-positive people on effective treatment want to have sex without condoms reinfection should not be a real concern. It's a simple question to answer. Do it if you want, don't if you don't want.

- matt
"The object is to be a well patient, not a good patient"

Offline mecch

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #23 on: August 05, 2012, 08:13:12 AM »
Practically speaking I agree with those of you that think there is a "zero" chance of transmission-with both partners being undetectable, that "unprotected anal intercourse is relatively safe all things being equal." I never claimed otherwise.

My point is that there is a possibly, albeit remote that the virus will be transmitted. Making claims that there is no valid medical reason or that there is zero chance of transmission is patently false and possibly criminal.

Furthermore the intestines are perhaps the greatest reservoir of the virus and most drugs do not penetrate it in pharmacological relevant concentrations to control the virus in those tissues. We do not routinely sample this reservoir so plasma viral load doesn't even begin to tell the complete story.
 
I'll be sure to bring this subject up next week at our  HIV Prevention Meeting for the State of Utah where prevention for positives has been emphasized for the 18+ years I've been involved.

From the CDC:

What is the Risk of Sexual HIV Transmission for HIV-infected Persons With Undetectable Viral Load?

ART is considered effective when it consistently suppresses plasma viral load to undetectable levels. However, sexual transmission of HIV from an infected partner who was on ART with a repeatedly undetectable plasma viral load has been documented [8]. An infected partner's genital (seminal or vaginal) fluid viral load may play a greater role than plasma viral load when evaluating the risk of sexual transmission of HIV. The likelihood of HIV transmission in the setting of ART is influenced by a number of factors, several of which are described below.

http://www.cdc.gov/Hiv/topics/treatment/resources/factsheets/art.htm

You have got to walk this back man.
Why are you even talking about "transmission" between HIV+ partners?  You are worried about super-infection?? Is that it?  Your fears went out of fashion years ago, darling.
Ok, you pull a good one about what the majority of HIV doctors are willing to say.  Doesn't mean they are correct. 
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Offline LM

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #24 on: August 05, 2012, 08:51:26 AM »
But again, the evidence has yet to materialize that this is a health issue for those with undetectable viral loads.

I would say evidence has yet to materialize that this is a health issue even for those with detectable viral loads. Like, reinfection may happen then, but there is a lack of evidence that this becomes indeed a serious health issue.

Offline drewm

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #25 on: August 05, 2012, 11:11:27 AM »
I just stumbled into this thread to see what the latest take is. It really has not changed so excuse me while I get back into my doggy style position and get ready for my BF  :P
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Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #26 on: August 05, 2012, 11:32:24 AM »
While I stand by my first response that HIV transmission is a numbers game where risk of transmission is determined by a myriad of factors AND that HAART has greatly reduced those risks: risks still exsist. The paper below supports my point as well as those of you who would assume no risk whatsover. I never claimed this was at this point a serious health issue. 

I greatly appreciate the feedback and as usual the interaction forced me to review the science. 

It is, in my opinion given the caveats, not in the publics interest for the CDC or physicians to assert that there is a zero possibility for superinfection between serconcordant couples with undectectable plasma viral burdens at this time. 

http://www.aidsmap.com/page/1429357/

Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex
Edwin J. Bernard
Published: 30 January 2008
Jump to
Implications for doctors
Implications for HIV-positive people
Implications for HIV prevention
Implications for the legal system
Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.

The statement, on behalf of the Swiss Federal Commission for HIV / AIDS was authored by four of Switzerland’s foremost HIV experts: Prof Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV / AIDS; Prof Bernard Hirschel from Geneva University Hospital; Dr Enos Bernasconi of the Lugano Regional Hospital; and Dr Markus Flepp, president of the Swiss Federal Office of Public Health’s Sub-committee on the clincal and therapeutic aspects of HIV / AIDS.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
the viral load has been suppressed (< 40 copies/ml) for at least six months, and
there are no other sexually transmitted infections.
The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

It then states that the evidence for the Commission’s current assertion about the relationship between treatment and sexual HIV transmisson is much more informed than what was available in 1986 regarding the transmission of HIV through kissing.

For example, they note, Quinn and colleagues found that in sero-discordant couples the risk of transmission depended on the viral load of the HIV-positive partner, and refer also to a prospective study of 393 heterosexual sero-discordant couples from Castilla and colleagues found that there were no infections among partners of persons on antiretroviral therapy, compared to a rate of transmission of 8.6% among partners of untreated patients. They also note that transmission from mother to newborn also depends on the maternal viral load, and can be avoided by taking antiretroviral therapy.

They go on to assert that effective antiretroviral therapy eliminates HIV from genital secretions. They say that HIV RNA, measured in sperm, declines below the limits of detection on antiretroviral therapy, and that HIV RNA is also below the limits of female genital secretions is, as a rule, during effective antiretroviral therapy. “As a rule,” they write, “it rises after, not before, an increase in plasma viral load.”

They also assert that although cell-associated viral genomes are present in genital secretions, even on antiretroviral therapy, these are not infectious virions since “HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA.”

They note that the concentration of HIV RNA in sperm correlates with the risk of transmission and that “transmission risk declines towards zero with falling sperm viral load. These data indicate that the risk of transmission is greatly decreased by antiretroviral therapy.”

They add, however, several exceptions and caveats to the above statements:

After a few days or weeks of discontinuation of antiretroviral therapy, plasma viral load rises rapidly. There is at least one case report of transmission during this rebound.
In patients not on treatment, STIs such as urethritis or genital ulcer disease increase the genital viral load; it falls again after the STI is treated.
In a patient with urethritis, sperm viral load can rise slightly even while the patient is receiving effective treatment. This rise is small, however, much smaller that the rise observed in patients not on treatment.
They conclude the scientific part of the article by saying that: “During effective antiretroviral therapy, free virus is absent from blood and genital secretions. Epidemiologic and biologic data indicate that during such treatment, there is no relevant risk of transmission. Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small.”

Implications for doctors

The Commission then discusses the implications for doctor-patient discussions. It says, "the following information aims to communicate to doctors criteria allowing them to establish whether or not a patient can sexually transmit HIV.

HIV cannot be transmitted sexually if:

The HIV-positive individual takes antiretroviral therapy consistently and as prescribed and is regularly followed by his/her doctor.
Viral load is ‘undetectable’ and has been so for at least six months
The HIV-positive individual does not have any STIs."
Implications for HIV-positive people

The Commission states that an HIV-positive person in a stable relationship with an HIV-negative partner, who follows their antiretroviral treatment consistently and as prescribed and who does not have an STI, is "not putting their partner at risk of transmission by sexual contact."

"Couples must understand," they write, "that adherence will become omnipresent in their relationship when they decide not to use protection, and due to the importance of STIs, rules must be defined for sexual contacts outside of relationship."

"The same goes for people who are not in a stable relationship," they add. However due to the importance of STIs, use of condoms is still recommended.

They add that heterosexual women will have to consider eventual interactions between contraceptives and antiretrovirals before considering stopping using condoms.

They also say that insemination via sperm washing is no longer indicated when "antiretroviral treatment is efficient."

Implications for HIV prevention

The Commission says that it "is not for the time being, considering recommendations that HIV-positive individuals start treatment purely for preventative measures." Aside from the cost involved, they argue, it cannot be certain that HIV-positive people would be sufficiently motivated to follow, and apply to the letter, antiretroviral treatment on a long-term basis without medical indications. They note that poor adherence is likely to facilitate the development of resistance, and that, therefore, antiretroviral therapy as prevention is indicated only in "exceptional circumstances for extremely motivated patients."

The Commission also says that their statement should not change prevention strategies currently taking place in Switzerland. With the exception of stable HIV-positive couples where HIV-positivity and the efficacy of antiretroviral therapy can be established, measures to protect oneself must be followed at all times. "People who are not in a stable relationship must protect themselves," they note, "as they would not be able to verify whether their partner is positive or on efficient antiretroviral therapy."

Implications for the legal system

Finally, the Commission says that courts will have to take into account the fact that HIV-positive people on antiretroviral treatment and without an STI cannot transmit HIV sexually in criminal HIV exposure and transmission cases.

They conclude by stating that the Commission thinks that unprotected sex between a positive person on antiretroviral treatment and without an STI, and an HIV-negative person, does not comply with the criteria for an “attempt at propagation of a dangerous disease” according to section 231 of the Swiss penal code nor for “an attempt to engender grievous bodily harm” according to section122, 123 or 125.

Reference
Vernazza P et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.
« Last Edit: August 05, 2012, 11:44:04 AM by Mishma »
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Offline Jeff G

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #27 on: August 05, 2012, 11:40:26 AM »
Jeez Mishma ... I lost my boner reading all that so I wont be infecting anyone today .

I am the aids monster .   

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #28 on: August 05, 2012, 11:45:22 AM »
sigh. I honestly doubt we are even close to having the same discussion. Your references have been almost exclusively regarding primary transmission. I am beginning to doubt that this is accidental.

Do you honestly not understand what the Swiss study is talking about and - more importantly, what it is not?
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Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #29 on: August 05, 2012, 01:22:06 PM »
Sigh. To my knowledge no one has conducted clinical trials specifically looking at superinfection between serconcordant couples (MSM) with undetectable viral burdens. If there is please provide us the references. Without well documented clinical trials to that affect, the prudent coarse of action is to extrapolate from studies looking at primary infections, infections controlled by HAART, infections in serodiscordant couples and tissue studies-all of which I have provided.

Yes I honestly understand the Swiss study.

The risk I speak of is not only with regards to superinfection but also the additional immunoactivation of suppressing yet another HIV virus.

Interesting, with regards to superinfection, there appears to be the suggestion in the literature that it confers an advantage to the host-although that would be the subject of another thread. 

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Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #30 on: August 05, 2012, 01:54:56 PM »
To my knowledge no one has conducted clinical trials specifically looking at superinfection between serconcordant couples (MSM) with undetectable viral burdens. If there is please provide us the references.
Results from PrEP and PEP studies along with studies about UD viral transmission, all taken together, would seem to indicate that the chance of superinfection even happening would be slim to none. To study this in clinical trials there were need to be some evidence that this supposed "superinfection" was happening.  Obviously it would have to be evidenced by the treatment failure of the med-adherent partner who was "infected" by the other med-adherent partner (otherwise ART would continue controlling the virus and there would be no superinfection). Since that kind of treatment failure is not being reported (reported treatment failure is nearly always related to non-adherence), obviously no clinical trials have been done to study this situation.
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Offline LiveWithIt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #31 on: August 05, 2012, 02:06:45 PM »
Short answer: Yes
Long answer:  yeeeeeeeeeeeessssssssssssssss
Pray God you can cope
I know you have a little life in you yet.
I know you have a lot of strength left.

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #32 on: August 05, 2012, 02:55:52 PM »
Sigh. To my knowledge no one has conducted clinical trials specifically looking at superinfection between serconcordant couples (MSM) with undetectable viral burdens. If there is please provide us the references. Without well documented clinical trials to that affect, the prudent coarse of action is to extrapolate from studies looking at primary infections, infections controlled by HAART, infections in serodiscordant couples and tissue studies-all of which I have provided.

Yes I honestly understand the Swiss study.

The risk I speak of is not only with regards to superinfection but also the additional immunoactivation of suppressing yet another HIV virus.

Interesting, with regards to superinfection, there appears to be the suggestion in the literature that it confers an advantage to the host-although that would be the subject of another thread. 



Actually, no it doesn't. You cannot take primary infection studies and simply reinterpret them by substituting "superinfection/reinfection" for "primary."

They are vastly different things.

For instance, we know that with the exception of elite controllers, people who are infected with HIV will progress to AIDS and die without treatment. We know no such thing about super/reinfection. To the contrary, we have yet to see, as Leatherman points out (and you ignore) any statistical evidence whatsoever that this is even a thing.

To the best of my knowledge there is not a study that tracks positive couples who practice unprotected sex to determine the instance of super/reinfection. But even if there were, the real question is whether that super/reinfection compromises either party, conferring resistance to drugs or accelerating HIV progression. And to date, the answer to THAT question has been "not that we can tell, to any significant degree."

The few cases where super/reinfection HAS been detected seems isolated to people within the first year of infection, with high viral loads and mostly in the absence of treatment.

The original poster was quite specific when he asked whether it was an issue if both partners had undetectable viral loads. And our answer was no, it was not something worth worrying about.

Which, given our understanding of super/reinfection, I certainly stand by wholeheartedly.

I honestly question your use of the scientific/Socratic method at this point, and I do not say that as an insult. Coming from a history of HIV denialism, do you not concede that perhaps you have not been interpreting the studies you cite as they were meant to be interpreted? That perhaps you are taking them out of context in order to fit an existing personal paradigm/bias?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

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Offline Mishma

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #33 on: August 05, 2012, 07:33:37 PM »
Lack of of treatment failure is not sufficient evidence that superinfection has not occurred. I agree the absence of failure is encouraging however plasma viral burden is misleading as summed up in this excellent review by Cohen in Science in December of last year. Citing research by Schacker, Stevenson, Fletcher, Mellors at an HIV Reservoir Conference, Cohen begins the review:

DAWN BEACH, ST. MAARTEN—Three backto-
back talks at a meeting* here earlier this
month provided fresh insights into why HIV
is so difficult to eliminate from the body:
Even when antiretroviral drugs (ARVs) knock
down HIV to undetectable levels in blood, the
virus remains active in tissues. “It’s a beautiful
story,” said Steven Deeks of the University of
California, San Francisco, who was not part
of the new work. “We can no longer rely on
the blood to inform us about what’s happening
with therapeutics.” And this, Deeks says,
could transform the approaches he and others
take to curing the disease.

http://www.sciencemag.org/content/334/6063/1614.summary

NEWS & ANALYSIS
HIV/AIDS RESEARCH
Tissue Says Blood Is Misleading, Confusing HIV Cure Efforts
Jon Cohen
Three back-to-back talks at a meeting earlier this month provided fresh insights into why HIV is so difficult to eliminate from the body: Even when antiretroviral drugs (ARVs) knock down HIV to undetectable levels in blood, the virus remains active in tissues. Sparked in part by the apparent cure of the "Berlin patient," many of those attending the meeting are exploring ways to seek out and destroy the tiny amounts of HIV left in the bodies of people who take powerful ARVs. The main obstacle to a cure is that reservoirs of cells that harbor latent HIV still persist.

So far as bias or my personal paradigm (I read T Kuhn's book in a Philosophy of Science coarse as an undergraduate) I challenge you to search for the Terms: HIV and Superinfection on PubMed and tell me the subject is not openly debated to this day.

However the following study would support your assertions:

Unprotected sex between long-term partners with HIV: no evidence for superinfection
HOW HIV WORKS >
Keith Alcorn
Published: 19 January 2009
A study of long-term HIV-positive partners who do not use condoms when they have sex with each other has found no evidence of HIV superinfection, and instead a clear relationship between long-term frequent exposure to their partner’s virus and a strong immune response to that virus, suggesting that repeated exposures eventually build immunity against superinfection.

The findings, published in the October 2008 edition of PLoS Pathogens, a free access online journal, are important, say the University of California researchers, because of the growing practice of `serosorting` - unprotected sex between people of the same HIV status.

Current guidance for people with HIV from many sources is that unprotected sex poses a risk of superinfection – infection with a new strain of HIV that over-runs the existing virus population due to lack of immunity to that virus.

However there is limited evidence about the frequency of superinfection and little evidence that it has harmful effects even when it takes place.

Superinfection seems to happen not only in people who have been recently infected with HIV, but also in those with longstanding HIV infection. A recently reported study in Kenyan women estimated an annual incidence of superinfection of at least 4%, but no evidence of disease progression as a consequence of superinfection. A study in gay men reported an incidence of 5% per year.

Although superinfection has been associated with CD4 cell declines, and a handful of cases of transmitted drug resistance, it does not appear to have a widespread compromising effect on either the health or treatment outcomes of people with HIV.

There is much stronger evidence that unprotected sex with other HIV-infected people is harmful for people with HIV where it involves the risk of exposure to sexually transmitted infections – especially syphilis – or to hepatitis C, both of which have been on the rise among men who have sex with men in Europe and North America.

http://www.aidsmap.com/Unprotected-sex-between-long-term-partners-with-HIV-no-evidence-for-superinfection/page/1433055/
« Last Edit: August 05, 2012, 08:04:01 PM by Mishma »
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Offline mecch

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #34 on: August 05, 2012, 09:20:53 PM »
Really what is the point of this rather long winded hijack - how does it help the OP?
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Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #35 on: August 05, 2012, 09:34:06 PM »
Lack of of treatment failure is not sufficient evidence that superinfection has not occurred.
. . . . .
"and instead a clear relationship between long-term frequent exposure to their partner’s virus and a strong immune response to that virus, suggesting that repeated exposures eventually build immunity against superinfection."
. . .
"Although superinfection has been associated with CD4 cell declines, and a handful of cases of transmitted drug resistance, it does not appear to have a widespread compromising effect on either the health or treatment outcomes of people with HIV."
although that bit about "cd4 decline" (just what is the range and duration of decline? an amount would have to be sustained around >75-100 at least to be of much concern) and "resistance" sounds intimidating; in the data I've read over the last 4-5 yrs, those effects were only seen in people who did not fit the situation of UD poz/poz sex. The word "resistance" itself implies quantifiable treatment failure marked by a rising viral load.

Really what is the point of this rather long winded hijack
exactly LOL
i would submit, that if someone's body has adapted to their partner's HIV and their meds have continued to work (as evidenced by the viral load having not increased), what does it matter? Obviously the "risk" was so infinitesimal that they are able to have unprotected undetectable poz/poz sex without negative health consequences.
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Offline bocker3

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #36 on: August 06, 2012, 07:34:17 AM »
It seems to me that Mishma is being a bit obtuse here......  he is hanging on to being "technically" correct in saying there is not an absence of risk.  However, he seems dead set against admitting that this "risk" is really not significant enough to answer the OP with anything but, "Yes".  Instead, he keeps dredging up superficially applicable articles to back his academic stand up and never really gets to the real-world question.  As my mother would say, "put your textbooks down and use the common sense you were born with".

We will never see the CDC or most doctors tell folks that there is no risk for a number of reasons:  as pointed out statistically zero and zero are not, technically, equivalent, the US is a tremendously litigious society and no doc wants to get sued, etc.

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Offline Ann

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #37 on: August 06, 2012, 09:10:03 AM »

As my mother would say, "put your textbooks down and use the common sense you were born with".



I like your mother. :)


We will never see the CDC or most doctors tell folks that there is no risk for a number of reasons:  as pointed out statistically zero and zero are not, technically, equivalent, the US is a tremendously litigious society and no doc wants to get sued, etc.


Very true and sadly so - and not just when talking about their stance on poz-on-poz transmission. All they do is further ignorance and stigma and sit idly by while their misinformation fuels the stupid, counterproductive hiv laws. Pisses me off no end.
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Offline Miss Philicia

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #38 on: August 06, 2012, 02:44:01 PM »
I wrap my body in Saran™ Wrap whenever I copulate.
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Offline Dr.Strangelove

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #39 on: August 07, 2012, 06:08:24 AM »
Very true and sadly so - and not just when talking about their stance on poz-on-poz transmission. All they do is further ignorance and stigma and sit idly by while their misinformation fuels the stupid, counterproductive hiv laws. Pisses me off no end.

Yes, I agree. But let's not ignore the positive developments elsewhere. The 'Swiss statement' seems to make its way down into the judicial system and its effect extends beyond the borders. In Germany there where a few court cases where the judge ruled that undetectable viral load equals negligible risk of transmission and thus the undetectable poz person who had unprotected sex without disclosure did get cleared by the court.

Offline Rockin

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #40 on: August 07, 2012, 01:05:24 PM »
I found this recent article by Aundaray Guess quite amusing, because it's precisely about this very same subject:

Positive Plus Positive
http://blogs.poz.com/aundarayguess/

Here we have a HIV+ advocate, writing for POZ magazine, who clearly believes that HIV+ on HIV+ unprotected sex is risky and also believes in super infection (or re-infection, as he calls it).

Even though I think he's not wrong in advocating safe sex, regardless of HIV status, he should have done his research a bit better, don't you think?

Offline jkinatl2

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #41 on: August 07, 2012, 02:30:27 PM »
I found this recent article by Aundaray Guess quite amusing, because it's precisely about this very same subject:

Positive Plus Positive
http://blogs.poz.com/aundarayguess/

Here we have a HIV+ advocate, writing for POZ magazine, who clearly believes that HIV+ on HIV+ unprotected sex is risky and also believes in super infection (or re-infection, as he calls it).

Even though I think he's not wrong in advocating safe sex, regardless of HIV status, he should have done his research a bit better, don't you think?

I think his understanding of the term "superinfection" is so flawed as to be laughable. The "super" in superinfection simply means a virus has superimposed itself onto an existing viral paradigm. It does not give it a cape and super powers.

That this man, with barely a middle schooler's understanding of HIV science, is an HIV educator is chilling. Moreso to think that he specializes in African-American outreach, which comprises a hugely disproportionate amount of new infections in the USA. Ignorant people teaching others only teaches ignorance.

Of course there's the off chance that he is not that uneducated, and is simply dumbing-down his stuff to make it palatable. I am not sure what's worse, a genuinely ignorant person or a smart person pretending to be ignorant in order to condescend to the very population he is trying to reach.

The fact that he is given a blog platform on POZ.com when we have so many more educated people - and better writers here - is just fucking sad.

Hell, I'd be happy to start my blog back up and talk safer sex, denialism, pozzie criminalization, and other stuff. Sure it would be controversial, but page hits are page hits. At least my shit is documented and researched.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Jeff G

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #42 on: August 07, 2012, 06:20:53 PM »
Hell, I'd be happy to start my blog back up and talk safer sex, denialism, pozzie criminalization, and other stuff. Sure it would be controversial, but page hits are page hits. At least my shit is documented and researched.

I think you should do it . I have been poz longer than most but that hardly makes me an expert . I used to be better informed but I made a conscious decision many years ago to back off the research for my own sanity , its people like you I turn to when I need to know something these days and its because you have taken the time and did the work that has kept you current .   

Offline mecch

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #43 on: August 07, 2012, 06:21:29 PM »
He's ignorant partly because of his need to anthropomorphize the virus.
So many lose their way down that road. Its easier than facts and science.

Grammar mistakes and his penchant for light google sourcing, suggest critical reading and thinking skills are not being dumbed down.

A good argument for safe sex between HIV+ partners is condoms help avoid other diseases. Nobody doubts the logic of that.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #44 on: August 07, 2012, 07:16:22 PM »
Positive Plus Positive
"...the following is just my own belief and also maybe a little bit of Googling on the internet..."
i almost quite reading at that point.  :o maybe if this poz blogger had spent a little time in the forums, he'd be more informed. Or he could have just linked to this thread if he was trying to pass along any helpful information
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline drewm

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #45 on: August 07, 2012, 10:59:34 PM »

(MEECH SAID) -"I used to be better informed but I made a conscious decision many years ago to back off the research for my own sanity

I totally agree! You can find any argument to support any position in a gazillion different places on the internet. The bottom line is (I ♥ that word) is that the peeps on this board, for the most part, are living with this virus and I respect their opinions and positions more than some Johnny Cum Lately pseudo-expert. I am happy to announce that my BF and I are banging away, raw as the day is long. We are both poz and have not had any issues.
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline Rockin

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #46 on: August 08, 2012, 06:11:13 PM »
"...the following is just my own belief and also maybe a little bit of Googling on the internet..."
i almost quite reading at that point.  :o maybe if this poz blogger had spent a little time in the forums, he'd be more informed. Or he could have just linked to this thread if he was trying to pass along any helpful information

That's what I thought was so uncanny...doesn't he read this forum at all? It's just one click away. I've been diagnosed for a year and I seem to know more about it than this guy. And that picture of him actually creeps me out a little bit  :o

I do like Regan Hoffman's texts though...she is a great writer and seems to know her stuff.

Offline LiveWithIt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #47 on: August 09, 2012, 01:14:51 PM »
Is superinfection possible, maybe.  There are people naturally immune to HIV so anything is possible.  Are there guys out there taking raw loads and not taking their medications.  Yes.  Is there a new superinfection epidemic.  No.
Pray God you can cope
I know you have a little life in you yet.
I know you have a lot of strength left.

Offline Miss Philicia

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #48 on: August 09, 2012, 01:29:17 PM »
Taking a raw load of cum is kind of like someone blowing their nose and wiping it on your face.
"I’ve slept with enough men to know that I’m not gay"

Offline LiveWithIt

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Re: Can two HIV partners with no viral load safely have sex without condom?
« Reply #49 on: August 09, 2012, 01:36:40 PM »
Taking a raw load of cum is kind of like someone blowing their nose and wiping it on your face.

It really isn't.  It's kind of like being in heaven.  If you are going to go with one extreme I will go with another.
Pray God you can cope
I know you have a little life in you yet.
I know you have a lot of strength left.

 


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