New partner HIV +

[RW194988]

I am in a new relationship with a HIV + guy. He is undetectable and has been for over 10 years. He's been positive since college in 1998. We have talked in depth about being safe. He's very conscious about things. We are versatile and always safe no matter who is on top. He doesn't like for me to give him oral sex due to fear but will give me oral sex unprotected. Is it true that with safe sex and being undetectable that it's hard to transmit? How often should I get tested? I really have no fear being with him. I love him deeply! Just want to be educated for us both.

[CaveyUK]

He has been UD for a while
You use condoms for penetrative sex

You have no discernible risk.

He shouldn't worry about oral sex, as this is non-risk for HIV transmission.

There is a study called the 'PARTNER' study which has looked at HIV transmission rates between partners who are mixed +/- and so far, have yet to see a single case of virus transmission. Hence, the risk - even without a condom - is close to zero. You will see this referred to as TAsP (Treatment as Prevention).

Of course, HIV isn't the only thing to be concerned about and any sexually active adult is advised to have regular STI checks as a matter of course. Even more important if the relationship is not completely monogamous or you jointly play with others.

[harleymc]

Here's a very long article, not the easiest read but the take away is that people with HIV considerably overestimate their chance of infecting someone.
No relationship seen between a person’s view of their infectiousness and their viral load

Gus Cairns
Published: 24 February 2016

http://www.aidsmap.com/People-with-HIV-considerably-overestimate-their-chance-of-infecting-someone/page/3038671/

[Jeevsey1968]

It's natural and sensible to be concerned at first, and it's good that you are thinking about this. If he is undetectable then the risk is minimal, but the risk is still there as with any sexual encounter with someone else of unknown status.

Undetectable does not mean negative, and also does not mean there is no risk.

Risk is a difficult thing to determine and viral load status is not a reliable indicator of risk, due to viral blips and sensitivities of different tests as well as different modes of transmission. so best advice is use a condom, and don't allow ejaculation in your mouth, and standard good sense about any blood to blood contact.

You should be fine 🙂 I know many guys who are neg that have had pos partners, including myself and still neg.

[leatherman]

If he is undetectable then the risk is minimal, but the risk is still there as with any sexual encounter with someone else of unknown status.

Undetectable does not mean negative, and also does not mean there is no risk. 

Risk is a difficult thing to determine and viral load status is not a reliable indicator of risk, due to viral blips and sensitivities of different tests as well as different modes of transmission. so best advice is use a condom, and don't allow ejaculation in your mouth, and standard good sense about any blood to blood contact.

your comment is mostly untrue 

the partner study, which has been going on for years, has recorded 100s of thousands of sex acts between serodiscordant partners (both straight and gay) where the HIV+ partner has been UD (the exact length of being UD has not been determined but 1 yr seems a safe limit at this point) and there have been NO transmissions. Hence, as Cavey referenced, we have the TasP policy - treatment as prevention. We could quite literally treat all HIV+ people and end all HIV transmission and the epidemic (of course that's easier said than done though) Someone UD for 10 years will have zero risk for transmitting HIV.

also saliva contains over a dozen different proteins and enzymes that damage hiv and render it unable to infect; so although many people claim that oral sex is their only risk behavior, the biological science shows that route of transmission is actually incredibly rare (if not impossible)

but the risk is still there as with any sexual encounter with someone else of unknown status.

absolutely untrue. Outside someone who has recently been tested HIV- and has no other STDs, the next safest person to have sex with is someone who is HIV+ and has been Undetectable for at least a year because not only is the transmission risk zero, but treatment guidelines mean that HIV+ person should have also been checked and treated for STDs and other issues.

[zach]

thank you Michael

[leatherman]

thank you Michael

it's what I do    
Advocacy = Education

[Jeevsey1968]

I've yet to see a paper that recommends considering undetectable as if it were negative, and any clinician stating this would likely be struck off. Undetectable also is technically not a possibility, it mean that viral numbers are below the cut off. It varies widely per test from different manufacturers, as does the design of genetic primers with regard to identifying variants. So it is not a perfect science unfortunately.

As for oral sex, as we know all safe sex advice advocates not getting seem in your mouth, especially if someone has oral,problems. This is standard advice, and should also be applied to pos situations. I did t write this, it's standard.

[Jeevsey1968]

So Leatherman, I'm advocating normal safe sex practices, what would you suggest please?

[Jeevsey1968]

I'm hearing statements like 'absolutely' and 'zero' and as you can see these are unfounded claims. Best advice, ask your healthcare provided what they recommend, but as I said, the risk is minimal.

PARTNER is still recruiting gay male couples and, as noted above, its full results will not be out till 2017. Till then we need to be cautious about what it has proved, and, as Jens Lundgren pointed out, it will probably never be possible to show with mathematical certainty that the risk of transmission from someone on successful HIV therapy is absolutely zero. In addition, these results exclude situations where ART failed in the HIV positive partner, though there were relatively few of these cases.

Reference

Rodger A et al. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study. 21st Conference on Retroviruses and Opportunistic Infections, Boston, abstract 153LB, 2014.

Q: If taking anti-HIV drugs has made your viral load undetectable (meaning that the virus isn't showing up on blood tests), can you still pass the virus to another person through sex?
There's no way to know whether suppressing the HIV viral load through ARV therapy will be protective for you or for any specific individual. Keep in mind that a viral load test measures the amount of HIV virus in your blood. But sexual partners are usually infected by virus in sexual fluids, such as semen or vaginal or anal secretions. Unfortunately, the viral load in these fluids can be high even when the viral load in blood is low. And factors like STDs (sexually transmitted infections) can increase the risk of HIV transmission.
VA » Health Care » HIV/AIDS » Veterans and Public Home » FAQs » FAQ: If your viral load is undetectable, can you still pass the virus to another person through sex?

[zach]

So Leatherman, I'm advocating normal safe sex practices, what would you suggest please?

suggest you leave it at that

you haven't had sex with your partner at all in years, i think the blame for that lays on you and your attitudes, not him

[Jim Allen]

@Jeevery.

I'm advocating normal safe sex practices, what would you suggest please?

So are the guys. TaSP and PrEP is part of safer sex, I am not sure why your so against this, it is simply part of a safer sex strategy.  I have seen nobody claim anything untrue so far except for you.

Safer-Sex Without a Condom, some people will never use one, simply as.

Treatment-as-prevention (TasP) this is use of antiretroviral (ARV) medication to decrease the risk of HIV transmission. Treatment-as-Prevention (TasP)
HIV TasP

This has been studied at length and to mention 1 of the studies as an example the "Partner" study is a major study looking at the chances of transmitting HIV with an undetectable viral load, there have been no transmissions between either gay or heterosexual serodiscordant partners.

Partner study
transmission-zero

IAS 2015 (HPTN 052) An older study found a 96 % reduction rate (1,763 HIV sero-discordant couples) https://www.hptn.org/research/studies/33 This was a landmark study proving that early ART can prevent HIV transmission.

Following the interim results of the HPTN 052 study in 2013, the World Health Organization recommended that antiretroviral treatment be offered to all people living with HIV who have uninfected partners to reduce HIV transmission in 2013. Study was finished as IAS 2015 confirming the interim results. 

Finally the The Swiss statement reads "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.”

Safer sex also means considering PrEP as an additional layer of protection going forward. PrEP PEP and PrEP

Jim

@Jeevery.

Look stay out of this thread as you have nothing to add and this is not a suggestion. Also any claims you make on this forum provide links to back it up.

[Jim Allen]

I really have no fear being with him. I love him deeply! Just want to be educated for us both.

Hi,

I hope you do come back and let us know how you are getting on, I am gad to hear you do not fear your partner and that you are talking the time to get educated on the subject.

Wishing you both the best and looking forward to an update on how your getting on.

Jim

[CaveyUK]

I've yet to see a paper that recommends considering undetectable as if it were negative, and any clinician stating this would likely be struck off.

No-one has said undetectable is negative. It clearly isn't.

But my doctor has said that once undetectable for a period of time, having sex with my negative partner without a condom is 'an option' which is not actively discouraged as long as it continues to be within a monogamous relationship (ie. so you are not introducing other STI's into the relationship). The only additional caveat is that the partner has regular STI checks, which is good practice anyway.

The term 'safe sex' is a misnomer, in it's common usage....The only genuinely 'safe' sex is abstinence, ie no sex.

As that simply isn't an option for nearly everyone, the next best thing is 'safer' sex - or 'protected' sex, where strategies such as TasP, condoms, PrEP are options. Obviously doubling-down on any of these add's even more protection but isn't mandatory to be protected.

I know it's been said in this thread already, but it bears repeating - especially to any casual reader of this thread.... Outside a monogamous relationship, the most dangerous sex you can have is unprotected sex with someone of unknown status (and this includes someone who claims to have tested negative at some point in the near-past). The safest is with someone who is HIV+ and is stable on treatment.

Although there is a theoretical transmission route via oral sex if the receiving parter has open sores or bleeding within their mouth, the reality is that this scenario is unlikely and therefore oral is essentially zero risk. The problem here is that anecdotally it doesn't appear this way because a lot of people blame oral for transmission as a way of avoiding admitting to far more likely transmission routes (such as vaginal or anal sex).

No doctor or medical profession will ever talk in absolutes, including stating anything as 'zero' risk, about ANYTHING, let alone HIV. That doesn't mean the risks as so close to zero as to be considered as such though.

HIV is actually a very difficult virus to 'catch'. It requires a fairly high viral concentration under very specific biological conditions to make it into the bloodstream and survive to a point of replication. That said, other STI's are FAR more easy to catch - even without having any penetrative sex and why STI screening is important.

[leatherman]

The term 'safe sex' is a misnomer, in it's common usage....The only genuinely 'safe' sex is abstinence, ie no sex.

copy/paste/save this whole post away somewhere. it was a beautiful summation and something you'll be pasting/posting again and again thru the yrs. 

[zettainaoru]

you haven't had sex with your partner at all in years, i think the blame for that lays on you and your attitudes, not him

Poz & Undetectable here.
Partner negative. Been doing a lot of unprotected sex and kinky stuff for 2-3 years almost EVERYDAY. And he is still negative.
Just saying.

[DANIELtakashi]

Positive  and undetected here.
Having had no sex at all since leaving hospital two years ago.
Just afraid of getting reinfected in whatever way but mostly having lost interest because of the shocking experience.

[leatherman]

Just afraid of getting reinfected in whatever way

there really is no such thing as "reinfection"; at least NOT for people who are on successful treatment. Your medications work as PrEP and PEP. If you have sex with someone who is also HIV+, who does NOT have a UD viral load, your meds would stop you from getting "reinfected". Of course, if you have sex with someone who is also HIV+ and who DOES have a UD viral load, there is no chance of them transmitting HIV so there is no reinfection.

There are only about a dozen reports of reinfection. In ALL cases, both partners had a very high detectable viral load - meaning BOTH were off medications! (in one case both partners were actually in the hospital with OIs when they had sex. One had resistance to some meds, and the other had a different resistance profile, and they "reinfected" one another) So one partner was off meds, had a viral load and was transmitting HIV; while the other partner was also off meds and also had a viral load, and therefore had no meds to fight off the HIV (no medications were acting like PEP or PrEP). There's one other condition for reinfection to happen in these kinds of cases - the HIV+ partner transmitting HIV has to have a resistance profile different from the other person for the other HIV+ partner to be "reinfected" - because you can't be "reinfected" with the same mutated HIV you are already infected with. 

I hope you can get past the mental barrier of not wanting to have sex. As an HIV+ person with an undetectable viral load, you are actually one of the safest people for people to have sex with because you actually know your status and have nearly a zero chance of transmitting HIV to someone who isn't not infected.

[CaveyUK]

As an HIV+ person with an undetectable viral load, you are actually one of the safest people for people to have sex with because you actually know your status and have nearly a zero chance of transmitting HIV to someone who isn't not infected.

Amen to that

[helpfuler]

I would say as long as you are using condoms correctly (for penetration) if that is the choice then the risk is quite low but there is some risk. I think the consensus is oral sex has extremely low risk and then only a hypothetical one to the person performing. But for penetration, some people always practice safe sex and use condoms and try to use them correctly and still get infected (or pregnant) through condom failure. I think I've read on a blog somewhere that they have a failure rate of around 2-3% with "correct use" which I think is the lowest figure I have ever seen. There are different numbers around some with a much higher rate of failure.

My understanding is "undetectable" can fluctuate and it only gives a picture at one point in time. It can be very consistent for a long time. But a person could start going into treatment failure for example and the viral load can spike or perhaps  the person is sick and there can be blips.  It also appears to be much easier for some to acquire HIV than others as some have a lot of unprotected sex and don't become poz and others are always safe save for one time and convert or are safe as far as they know and convert. And there are some people with a genetic mutation who are basically immune. You simply don't know for sure what's what.

For example, one person who recently posted here claimed that she had regular bareback sex with her poz and undetectable partner and contracted HIV from him. When she expressed understandable anger and disbelief since it is often stated that undetectable is very, very unlikely to lead to transmission, practically zero risk etc, based on studies, similar to the risk ascribed to BJs, the person was met with criticism that they failed to protect themselves:

http://forums.poz.com/index.php?topic=62387.0

I can certainly understand the persons feelings but I think I agree. I would just say to always protect yourself whether its condoms or prep or a combination. I would not rely on any status or tasp to keep me safe with unprotected bareback sex and would supplement tasp with a condom or Prep if an option. Of course people do it and have success so I guess a lot of this is how much risk taking you are happy with. Of course it should all be discussed with your healthcare provider but this is my view.


I also agree with the statement that if you know your undetectable status you are one of the safest people to have sex with since you know your status and proper decisions can be made. And if you are negative and know your status and test responsibly and engage in safe sex, then that would be even safer since it would be truly impossible for you to pass on HIV if you are negative especially if last safe sex was three months before your most recent test. It's all about knowing your status and being responsible. Neg people and undetectable people can both be equally irresponsible and not test or be compliant or lie etc and its the irresponsible part that has the greatest influence on how safe a person is. Know your status and if negative protect it, if positive treat it in my view.

[zach]

With the exception of the someone I care about has HIV forum ( if it applies to you ) as a person not living with HIV you are not allowed to post in the forums. The forums are intended for people living with HIV.

@helpfuler... You aren't HIV+, and you've never posted anything to suggest you have a loved one that is. You were told this last year, and now you've returned.

What gives? Have you considered introducing yourself and explaining why you're here, before you step into someone else's thread?

[helpfuler]

Hi Zach. I'm a bi male and I do have very dear friends who are HIV+ including one who has been poz for 25 years. Though I'm neg, HIV has impacted my life enormously.  Sometimes I read things and just feel like I have to comment. Sorry if I'm hijacking a thread or if my post doesn't meet the forums guidelines.

[leatherman]

I would not rely on any status or tasp to keep me safe with unprotected bareback sex and would supplement tasp with a condom or Prep if an option. Of course people do it and have success so I guess a lot of this is how much risk taking you are happy with. Of course it should all be discussed with your healthcare provider but this is my view.

the science of the PARTNERS study, a 5+ yr study of homo- and hetero-sexuals reporting literally over 100,000s of sex acts with ZERO transmissions, has shown that TasP works. (not to mention all the studies that have shown that conceiving a child can be safe if the partner is undetectable) Of course, I would always suggest condoms and/or PrEP too; but TasP absolutely works.

As to condom failure, WHO studies shown that condoms have a 2% failure rate when used perfectly and consistently. But the typical failure rate is around 12%, due to user error (not the condoms themselves) such as putting it on too late, not using condoms throughout sex, not leaving space at the tip, or not using enough lube.

perhaps  the person is sick and there can be blips.

Being sick has nothing to do with viral load. Adherence to meds is the only factor.
Blips are often not a problem either. Many studies still use 500 or less as "undetectable".

the person was met with criticism that they failed to protect themselves:

I wouldn't call that criticism; but simply the truth. Everyone who is infected simply did not protect themselves properly.

[helpfuler]

"Being sick has nothing to do with viral load. Adherence to meds is the only factor.
Blips are often not a problem either. Many studies still use 500 or less as "undetectable"."

I stated that based on information from various sites ex:

 http://betablog.org/undetectable-burning-questions-answered/

that state an infection or std like herpes or even a flu can cause spikes. That thread I posted where the lady acquired HIV mentioned a herpes infection and the partners flu. Assuming its all true, I'm guessing that's what happened given the description and timeline of described events.

[zach]

@RW194988

I want to apologize to you for what has happened to your thread, it has been thoroughly hijacked. The first response by Cavey was spot on, I hope you can focus on that advice and overlook the sideshow that has followed.

[helpfuler]

I guess thinking more about the reason why I posted is that it bothered me that on the one hand people will say "practically zero risk", almost in the same tone as one would describe giving a bj, but then on the other hand when someone says okay, practically zero risk - lets bareback and then when they seroconvert and are confused since there was practically zero risk - they are told they didn't protect themselves. There seems something off with this.

I think the correct message is here are studies that show what they show about undetectable but to prevent HIV, always use a condom or prep, and this way you will be protecting yourself.

I think if you highlight the idea that undetectable is extremely low risk it perhaps encourages bareback sex. But to then say to a person that they didn't protect themselves if they are so unfortunate to seroconvert, it seems to be like talking out of both sides of the mouth and cruel.

[zach]

so you're not even talking about the OP of this thread  but you're not allowed to post there, so you brought your objections here. very smooth

seeing as how i am the person that was "talking out of both sides of the mouth and cruel" i'll address this. but here isn't really the right place for that. start your own thread.

there were other factors for that poster.

first, no one on this board encourages bareback sex. choices are made, and those choices carry responsibility. if you think i'm cruel to suggest that everyone should be personally accountable for protecting themselves.. so be it. call me guilty as charged.

that poster was in a relationship where other STIs were present, namely HSV2 in both partners, a factor which markedly increases transmission risk. a factor that poster didn't weigh in apparently. that poster chose to have barrier free sex while not on prep.

the phrase "gave me the virus" is an especially offensive one, it absolves the infected person of any responsibility, and suggests that it is something that was done "to them"

that simply isn't the case with HIV, you can and should always protect yourself.

edit: and BTW, that article you referenced in your link, that's just a blog, and reading the comments of their own readers... even they were skeptical of some of the generalizations made in that piece... a lot of qualifiers; may, can, sometimes... very fuzzy math

[helpfuler]

I believe my comment was related to the topic OP was raising.
You don't usually hear the qualifiers when talking about undetectable, just that there is nearly zero risk. In that thread you didn't make clear that she had an increased risk and most people don't bring it up when talking about it and blips and stability of viral load. I think since one may not even know of a partners herpes status for instance then undetectable is almost a meaningless number in the context of discussion of tasp as sole protection and one should always use a condom or prep to be protected. I can understand you feeling offended, but some people did make the attempt to protect themselves, whether it's the assumed nearly zero risk tasp or trying to use a condom properly and sometimes where deception was involved. To these people they feel they did the right thing and naturally want to blame someone since they feel they did their part. Doesn't make them better people or anything but I think the feeling they express makes sense and for them is valid.

[zach]

Again, that poster came to the board having already made the choice to have completely unprotected sex. That poster was already in the process of testing positive.

The OP of this thread came here before making that choice, and asked for advice. The very FIRST piece of advice given was use condoms.

then undetectable is almost a meaningless number

Ummm..... no

one should always use a condom or prep to be protected

WE DO SAY THAT!!! Please show me where a member here has recomended otherwise

EDIT: of course it's human nature to feel the need to blame someone, and as i've said many times to people looking for that person... look in the mirror.

sometimes where deception was involved

is that what you're really here to talk about? because you seem to have an agenda... so c'mon, out with it

[Wade]

I have asked Helpfuller not to post in this thread again as it is going nowhere good
and is not helping the OP who started the thread.
So in all fairness he will not be responding.