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Author Topic: Pulling out while being undetectable  (Read 1645 times)

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Offline eagleheart

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  • Posts: 4
Pulling out while being undetectable
« on: February 07, 2014, 08:08:41 PM »
 I was found being positive in August 2013 with a VL of 13,000 (rounding). I started my meds in November and was found to be undetectable in December 2013 VL below 20 copies.

My girlfriend, she's negative, wants to have unprotected sex. She knows my status and feel comfortable with unprotected sex as long as I pull out. Her reasoning being, "since you don't produce precum, transmission should be miniscule." I know of the Swiss study of 2008 and the HPTN 052 study of 2011 but would like more info on this. I've looked all over the net and search this forum and really would like a direct answer to this question.

What's the risk of transmission without precum/pre-ejaculation/ejaculation? And is she accurate with her assumption?

Offline eagleheart

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Re: Pulling out while being undetectable
« Reply #1 on: March 08, 2014, 05:01:05 PM »
I know my question couldn't be answered but came across a new study, Partner. Apparently chance are slim but I'm not going to risk anything.

Sharing but be please do not be an idiot, be safe out there.

http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748

Key Notes from article:

In order to be in the study, couples have to be having sex without condoms at least some of the time. The HIV-negative partner cannot be using post-exposure or pre-exposure prophylaxis (PEP or PrEP) and the HIV-positive partner has to be on ART, with the most recent viral load below 200 copies/ml. This is different from HPTN052, which measured the efficacy of the HIV positive partner starting therapy (versus partners who did not).

At the start of the study, the HIV-positive partner had been on ART for five years in the gay couples and for 7-10 years in the heterosexuals; the proportion reporting an undetectable viral load was 94% in the gay men and 85-86% in the heterosexuals.   

The link below has video with the head of the study.

http://www.hivandhepatitis.com/hiv-prevention/hiv-test-treat/4551-croi-2014-hiv-transmission-through-condomless-sex-video

Thoughts?


Offline eric48

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Re: Pulling out while being undetectable
« Reply #2 on: March 08, 2014, 05:47:52 PM »
I would wait Nov + 6 months and next vl to be sure, then go bare
You can make this waiting period a lot of fun, too
Mobile.eric

Offline eric48

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Re: Pulling out while being undetectable
« Reply #3 on: March 08, 2014, 06:28:29 PM »
feel comfortable with unprotected sex as long as I pull out.
I made this mistake once
Now, i am here
Mobile.eric

Offline buginme2

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Re: Pulling out while being undetectable
« Reply #4 on: March 08, 2014, 08:07:25 PM »
I know my question couldn't be answered but came across a new study, Partner. Apparently chance are slim but I'm not going to risk anything.

Sharing but be please do not be an idiot, Be safe out there
Thoughts?

1. This is already being discussed at length in the research forum.

2. Your comment about not being an idiot and to be safe sounds...idiotic.

There were 44,400 condomless sex acts documented in this latest study with ZERO transmissions.  The hptn study which had several thousand participants had one transmission and it was from someone who was not undetectable yet.  The data doesn't support your statement.

I guess you could get struck by lightning twice, or stepping on a crack could break your mommas back but people who step on cracks not worrying about it are not idiots.

« Last Edit: March 08, 2014, 08:10:56 PM by buginme2 »

Offline Dan0

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Re: Pulling out while being undetectable
« Reply #5 on: March 08, 2014, 09:59:49 PM »
That's a bit harsh.

I would think the normal attitude would be to proceed with caution and, yes, worry a bit when you have the virus and your partner does not. That's called being human - not an idiot.

I'm not in that position nor do I plan on it but IF I were, I don't believe for a second that I would not worry about infection even in the face of a near absolute study. I say 'near' because it is one study....albeit a very LARGE study with incredibly promising results. The results, however, are not yet codified in the main stream thinking of much of the medical community. Yes, the data speaks volumes but the discussion is still ongoing and I'm certain it won't be the first or last study of this.
« Last Edit: March 08, 2014, 10:24:27 PM by Dan0 »
"Drink your milk and take your meds!"

"Honey, you should never ask advice from a drunk drag queen who has a show to do." - JG

06/2002 DX
10/2006 Atripla UD
10/2013 Stribild Still UD

Online bmancanfly

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  • Medicare For All !
Re: Pulling out while being undetectable
« Reply #6 on: March 09, 2014, 09:24:44 AM »
There is also the belt and suspenders approach where your girlfriend could get prescribed PrEP (Truvada).  In that scenario her risk would be very very low (if it isn't already)

"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline Giancarlo

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  • Posts: 10
Re: Pulling out while being undetectable
« Reply #7 on: March 10, 2014, 11:30:47 AM »
By the way, having an undetectable viral load and using condoms at the same time is already a belt and suspenders approach. Regarding HIV, I mean.
Nov 2011: HIV-
Jul 2012: HIV+
Aug 2012: VL 8,900 / CD4 822 (28%)
Oct 2012: VL 13,500 / CD4 887 (30%)
Jul 2013: VL 9,000 / CD4 ?
Sep 2013: VL 24,000 / CD4 625 (34%)
Oct 11th 2013: Start Atripla
Nov 7th 2013: VL 84 / CD4 665 (37%)
Dec 11th 2013: VL UD (<40) / CD4 960 (35%)

Offline aaware72

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  • Posts: 224
Re: Pulling out while being undetectable
« Reply #8 on: March 10, 2014, 12:52:58 PM »
There are risk with everything you do.  Condoms are not 100%  It is my understanding that the risk for using a condom, PREP, and having BB sex with an UD person are all about the same.  Are we just not splitting hairs?  If you going to have BB sex with some who is UD.  The first thing that comes to mind is how do you know they are UD and on med?  In the just tested positive forum someone was just talking about this subject.  They have been having BB sex with their UD partner for years and only when they brought another person in that claimed to be UD that the negative partner became poz. 

I personally know several couple where one partner is neg and the other is poz and they have been having BB for years.  It those that do not know their status that you have to look about for...'

"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline eagleheart

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  • Posts: 4
Re: Pulling out while being undetectable
« Reply #9 on: March 10, 2014, 01:37:36 PM »
1. This is already being discussed at length in the research forum.

2. Your comment about not being an idiot and to be safe sounds...idiotic.

There were 44,400 condomless sex acts documented in this latest study with ZERO transmissions.  The hptn study which had several thousand participants had one transmission and it was from someone who was not undetectable yet.  The data doesn't support your statement.

I guess you could get struck by lightning twice, or stepping on a crack could break your mommas back but people who step on cracks not worrying about it are not idiots.

1.) I'm new to this forum and haven't looked around this forum yet.

2.) Using the term idiot may have been strong on may part. However, based on your response is it safe to assume you're undetectable and had unprotected sex? If so, have you ever been nervous once about transmission?

I total get your position. As you mentioned, the one transmission that occurred during the HPTN study – the positive parnter had a VL of over 80,000. The studies scream one thing but the term "risk" is still being used and makes me uneasy.
 

Offline eric48

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  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Pulling out while being undetectable
« Reply #10 on: March 10, 2014, 03:23:05 PM »
Condom may be pleasure killer.
But you may want to consider your/her risk

In the event the young lady gets the but,from you or someother guy
She'll blame it on you

In that study people where on stable relatioship and Ud for long time
Is that your case?
Mobile. Eric

Offline eagleheart

  • Member
  • Posts: 4
Re: Pulling out while being undetectable
« Reply #11 on: March 10, 2014, 05:46:35 PM »
Condom may be pleasure killer.
But you may want to consider your/her risk

In the event the young lady gets the but,from you or someother guy
She'll blame it on you

In that study people where on stable relatioship and Ud for long time
Is that your case?
Mobile. Eric

Been together for 7 months. Diagnosed in August last year with a VL of 13,000 (rounding). I started my meds in November and reached undetectable in December of 2013 VL below 20 copies. I take my meds daily between 730pm – 830pm, this pass Saturday being the only time I didn't take my meds during my "golden hour," took it at 9:15pm  :( . As it stands now, I haven't missed a day taking my meds.

I feel the risk here but she has zero worries. She understands the risk but with me reaching a VL of undetectable levels her worries aren't there anymore. Early on, we talked about her getting on PrEP but now she scoffs at the idea, and with this studies (PARTNERS) VL limit (200 copies), it doesn't help. I have gotten her to agree to go on PrEP though.


Offline eric48

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Re: Pulling out while being undetectable
« Reply #12 on: March 10, 2014, 06:36:46 PM »
Adherence is very important part of YOUR treatment
Good...
In prep , adherence very imprtant too!
In prep : only 2 molecules so you do not want underdosing

Now that you are UD , timing is not as critical , as long as you do not miss
My rule , now , is anytime before 9 am
At 9 am , Alarm , double check pill scheduler
Flexible AND safe
Sounds like you have found a nice GF
Mobile.eric

Offline buginme2

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  • Posts: 2,834
Re: Pulling out while being undetectable
« Reply #13 on: March 10, 2014, 11:21:00 PM »
1.) I'm new to this forum and haven't looked around this forum yet.

2.) Using the term idiot may have been strong on may part. However, based on your response is it safe to assume you're undetectable and had unprotected sex? If so, have you ever been nervous once about transmission?

I total get your position. As you mentioned, the one transmission that occurred during the HPTN study – the positive parnter had a VL of over 80,000. The studies scream one thing but the term "risk" is still being used and makes me uneasy.

1.  Yes..the word idiot is strong and harsh..the only reason I used that word is because I was responding to a post where the person said not to be an idiot and risk it.

2.  There has NEVER been a documented case of someone transmitting HIV while having a stable undetectable viral load in any of the partner studies.   The one person who transmitted during the HPTN study did so prior to becoming undetectable and had a high viral load (as you mentioned 80,000).  In fact HPTN was ended early because the results were so dramatic that it would have been unethical to continue the study and have one group of patients not on treatment.

3.  Yes. I am positive and have had unprotected sex.  However, I am married.  I know my partner and my partner knows me very well.  There isn't a guessing game of "is this person undetectable or taking their meds".    I am positive and my partner is negative...even after several years of unprotected sex.  This is something we have decided together with the knowledge and support of both of our doctors. 

4.  I in no way am advocating for people not to use condoms.  Especially, if you are having sex with someone you don't know.   If I was going to have sex with a stranger, I'd use a condom. 

5.  I think its important to recognize risk.  Condoms have an error rate just like everything else.  I would argue that the failure rate is higher for condoms than it is for someone on a stable medication with an undetectable viral load experiencing a failure and transmitting hiv.  So, when we say "don't risk it and be an idiot" know what your talking about.  The data actually shows having a ud viral load to be very protective against transmission.

6. Your last point is the same as mine.   The studies SCREAM one thing yet everyone says "there's still a risk."  I get it, people are nervous.  But it's infuriating.



Offline kevinazus

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  • Posts: 23
Re: Pulling out while being undetectable
« Reply #14 on: March 12, 2014, 02:41:39 AM »
Hey Eagle, check out this excellent article talking about the new Partner study:

http://marksking.com/my-fabulous-disease/will-hiv-ever-be-safe-enough-for-you/


Offline Dan0

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  • Posts: 362
Re: Pulling out while being undetectable
« Reply #15 on: March 12, 2014, 09:15:28 AM »
Hey Eagle, check out this excellent article talking about the new Partner study:

http://marksking.com/my-fabulous-disease/will-hiv-ever-be-safe-enough-for-you/

What a great article and link!  Thank you - bookmarked!  As much as I can be resolute in what I think, I am very much evolving on this and this just gave me another shove.

I remember that episode on Oprah that he's referring to.  I think that one single episode did more to fuel fears than answer questions. 
"Drink your milk and take your meds!"

"Honey, you should never ask advice from a drunk drag queen who has a show to do." - JG

06/2002 DX
10/2006 Atripla UD
10/2013 Stribild Still UD

Offline zach

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  • Posts: 1,241
Re: Pulling out while being undetectable
« Reply #16 on: March 12, 2014, 12:35:07 PM »
i wonder if there will ever come a time when a majority, or at least a very large %, of people will be positive, but asymptomatic, similar to HSV rates. controlled by some sort individual gene therapy that renders HIV benign.

all this is very enlightening to treat as a thought exercise, and debate statistics of transmission while using haart all day. but i really wonder at the effort to rationalize and justify unprotected sex. seems like a backdoor (pun) to force the hand of acceptance.

i also wonder if that little town profiled on oprah did exactly what they posited to the medical panel at the time? came back and said, we were wrong.

Offline Dan0

  • Member
  • Posts: 362
Re: Pulling out while being undetectable
« Reply #17 on: March 12, 2014, 01:00:41 PM »
There was a follow-up on this segment of  her show:

http://www.oprah.com/oprahshow/Oprah-Returns-to-Williamson-West-Virginia

This lept forward to 2010 when she returned for an update
« Last Edit: March 12, 2014, 01:04:08 PM by Dan0 »
"Drink your milk and take your meds!"

"Honey, you should never ask advice from a drunk drag queen who has a show to do." - JG

06/2002 DX
10/2006 Atripla UD
10/2013 Stribild Still UD

Offline zach

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Re: Pulling out while being undetectable
« Reply #18 on: March 12, 2014, 01:05:27 PM »
if there was a follow up, notice it didn't ingrain itself into the public hive mind the way the original ignorance did.

you can adjust stupidity with that 2x4, and muffle it with duct tape, but its still stupid. usually willfully so.

edited to add: good research on finding the reference though, i notice your edit in the time i posted this comment

Offline newt

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  • the one and original newt
Re: Pulling out while being undetectable
« Reply #19 on: March 12, 2014, 07:32:30 PM »
On treatment the risk is ZERO. Reference: the PARTNER study and others.

Trust your woman, acknowledge your anxiety.

The conversation to be had is: what if the science is wrong/how you feel about this. The science is unlikely to be wrong, so that leaves the second part.

Long life and love well

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

Offline buginme2

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  • Posts: 2,834
Re: Pulling out while being undetectable
« Reply #20 on: March 12, 2014, 11:09:49 PM »
Hey Eagle, check out this excellent article talking about the new Partner study:

http://marksking.com/my-fabulous-disease/will-hiv-ever-be-safe-enough-for-you/

This article is a must read and Mark did an EXCELLENT job putting on paper many of the thoughts I have been trying to convey but have failed.  I found this passage to be quite important. 


I have some “what if?” questions of my own. What if these unrealistic fears were meant to stigmatize and isolate HIV positive people? What if I am undetectable and feel no responsibility to discuss my status with a sex partner because I don’t care to engage in a science lesson? What if everyone availed themselves to prevention options that worked best for them? What if my HIV status were none of your damn business?

 


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