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Sero-discordant relationship

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wonderboymi:
Hi everyone; I'm not sure the best place to post this question so I thought here would work  ;)

I've been HIV+ for 14 years now and except for a small blip twice I have been undetectable for 13 of those years.  I've never posted here, although I have read the site for years and years.  I used to be well versed on all things HIV but the first 6 or so years of my diagnosis I was unemployed and really didn't have a lot of other things to do besides read.  Moving to NYC 8 years ago put HIV knowledge on the back burner for me, but I am mostly okay with that.

My question is this.  I am currently "seeing" someone.  We're not in a relationship per se, in Facebook parlance I would say "it's complicated".  I am poz, he is not.

We've made a decision to not use condoms when we have sex with each other. (He has a few buddies he has sex with besides me).  I am generally the insertive partner although sometimes he is, and I don't ejaculate inside of him. 

I guess my question is, how unsafe is it?  I know that it's certainly not totally safe, but my feeling is that it's more like an educated safety level.  For example, it is far more risky for him to have unprotected sex with someone whom believes himself to be negative, when in actually they seroconverted recently and just don't know it  than it is with me when he can gauge the risks.

I am trying to get him to speak to my doctor or his doctor about doing PREP.

I'm not looking for an excuse to have unsafe sex, I'm just hoping someone will have some advice to help me figure out how I feel?

Thanks so much.

jkinatl2:
Well, the thing is, no one knows for sure. The Swiss study, though compelling, doesn't factor in several important considerations important to your situation.

1) anal sex

2) the possibility of your partner perhaps acquiring an STD in an extracurricular activity, which could cause inflammation of and sores in the anus, thus rendering him more vulnerable to infection -

3) passing aforementioned STD to you during sex, which could facilitate a spike in seminal viral load. This, combined with a similar vulnerability in your partner's anus, could theoretically facilitate infection.


It is known that spikes in seminal viral load can and do happen, even when the blood serum remains undetectable. The studies I have read so far, however, do not say exactly what that spike WAS, but it was obviously detectable. There has also been no testing of these spikes to see how much viable virus was released, and what the tipping point for infection would be. I suspect the latter of these considerations varies tremendously in each couple, and possibly each sexual act.

It's a calculated risk, for certain. How much of one is unknown. We DO know that, as the insertive partner, the risk is greater for your negative mate than if you were the receptive partner.  How much? Hard to tell. You have introduced variables that make your situation more fluid than others.

Obviously, if your partner went on PrEP then this response would be way shorter.

In each relationship we set boundaries and establish assumed risk. Knowing that your partner has other sexual partners does open up the possibility for a more complicated scenario, as many other STDs are robust enough to be transmitted despite condom use.

There is also the factor you mention of not ejaculating inside him. While it's possible that pre-ejaculatory fluid might contain viable virus even in people with an UD VL, how much, and under what circumstances are factors for which I can't find decent answers. Again, the presence of another STD and accompanying inflammation would come into play here, but the research is pretty vague.

All I could say is that you guys are grownups and have armed yourself with the facts. Your choices are yours to make and, frankly, no one's to judge. An informed accepted level of risk is what you are basically discussing here. And the more informed you both are, the better you both will feel about it.

jkinatl2:
PS: I never answered your question. How DO you feel?

weasel:

     Hi Wonderboy ,
                         Nice to meet you  :)

     I have been in a POZ - NEG   relationship now for over 30 years .
     I am undetectable  and have a 465 ?   T-cell count .
     Bob and I try to be safe  , sometimes it  does not work out that way  :-[

     I hope your relationship works out well , Knowing you have HIV is a plus .
     There are still 1,000's of guys out there not willing to find out they are POZ .

     The fact he does not seem to care tells a lot , I think .     I  always assume
    most guys are POZ , it works out better that way  ;)

                                            Be well , have fun ,
                                                                        Weasel 

Jmarksto:
Hey Wonderboy;

Welcome to being active in the forums.  It seems others have answered your question, in that no one can quantify the risk.  In terms of how you feel - I think the fact that you are posting here and trying to get him on PREP, says that you would feel better if he were on PREP - the question is, how do you get him to see the benefits of PREP. 

Here is my argument for PREP:

1.) I think the vast majority (all?) of us that are poz, in hindsight would welcome the opportunity to take PREP to avoid being poz. 

2.) Even if he doesn't mind the thought of being poz, PREP would protect his buddies if they are neg, or protect him from them if they are poz. It seems like the right thing to do if his other partners are neg.

3.) Any downside to PREP is by far less of a downside to being poz. The one short term downside of PREP may be the cost of the meds - while PREP may seem expensive to a neg person, it looks pretty darn cheap to a poz person - especially if you don't have great insurance, or are at risk of loosing insurance, etc.

Those are my thoughts anyway,

I wish you well,

JM

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