My Bf is Hiv POZ

[pozboyfriend]

Hi All,

I am currently dating a guy who is HIV poz but undetectable and will be soon moving in together. We live in the UK and I do Love him so much. Currently we are having sex with condoms but I want have sex without it from now on. Is it safe? I am negative so dont want to catch HIV from him. I have been reading about this and even spoke to my doctor. I just want a 3rd opinion.

They all seem to say I wont catch it but there is a slight chance! That is not convincing! Can you guys help!

Cheers

[Jim Allen]

Hi

Welcome to the forum and congratulations on the relationship and moving in with each other, big step and wishing you both the best.

I have moved your post to "someone I care about" section, you can post your questions or thoughts here in this section going forward.

I am negative so dont want to catch HIV from him. I have been reading about this and even spoke to my doctor. I just want a 3rd opinion.

They all seem to say I wont catch it but there is a slight chance! That is not convincing! Can you guys help!

Have a look here I think this is a very informative statement: https://www.preventionaccess.org/consensus
 
Truth is however I can not guarantee TaSP (Treatment as Prevention) and none of the other moderators here will either, see TaSP is a great thing and has been studied a number of times now and is very reassuring to both people living with HIV and their HIV negative partners, and some people will go condom-less based on that reassurance accepting the slight risk and trusting their partners.

This is something you have to decide firstly for yourself, and it all depends on what level of risk you want to accept/are comfortable with.

TaSP (Treatment as prevention), is not something new, and has been shown to work a few times over and the short version is that if he has confirmed and sustained (>6 months) undetectable viral load than the risks of transmission greatly reduces to negligible.  That is of course if he is on treatment, remains adherent to his treatment and remains undetectable. (UD) 

From a general safer sex point of view and something you will see back in messaging we give in the "Am I infected section" nobody can guarantee TaSP as it requires the individual to remain on the meds and monitored etc and not to experience treatment failure and to remain UD. 

I could personally never in good faith tell a HIV negative and sexually active person not to reduce risks where possible and to protect themselves additionally next to testing regularly.

Safer sex is simple a combination of tools used to reduce risks, TaSP is one thing but its not something within your control and so with keeping all of that in mind we tell people to use condoms and/or PrEP as additional layer of protection against HIV. Condoms also give some protection against other STIs

It all depends on what level of risk and trust you are comfortable with and willing to accept. This widely differs from person to person.

Anyhow best of luck with the moving in together

Jim

[mecch]

Options -

him reliable undetectable and adherent - you unprotected sex with him = "negligible" - lots of people do it but doctors can't say 100%

him reliable undetectable/adherent - you having sex with him with condoms for anal = in my opinion - NO risk

him reliable undetectable/adherent - you on PrEP and unprotected sex with him = double layer - but in my opinion, overkill. but to each his own. plenty of hiv neg people are going on PrEP now to have unprotected sex and even though it is not the official recommended use

him reliable undetectable/adherent - you on PrEP and having protected anal = that is 3 layers of protection and way overkill, in my opinion.  but to each his own.

[CaveyUK]

Key is if he is UD and has been a while, adherent to meds and whether or not you are in a truly monogamous relationship (you never truly know for sure, but to the best of your knowledge).

If he is, and you decide to go condomless then as has been stated the risk is 'negligible'. Many will define this as being as close to zero as you can get without actually stating zero (no medical person will ever state an absolute like zero for anything). There are studies which drove the consensus statement that Jim linked to, which show zero transmissions over a large sample size.

All that said, it is a discussion needed by the both of you. Everyone's risk tolerance is different. One person may be horrified by even a fraction of a fraction of a percent risk and want to layer up protection by way of condoms and/or PrEP...other people would be prepared to take that 'risk' in the hunt for a more satisfying or intimate love life.

You don't state whether you are male or female. This only plays into things by way of anal sex being riskier generally due to the potential for trauma. Statistically, the same things mentioned above stand, but it's just another variable to throw into the mix when discussing risk acceptance.

My GF has stated a desire to go condomless (with the Dr's blessing), so thats what we have done. She understands the slight risk and is prepared to take that risk in pursuit of a more 'complete' (in her eyes) love life. She accepts that if the unlikely scenario presents whereby she does contract HIV, she will have to deal with that but is going into it with her eyes open. It is really important for pressure to not be applied from either side, but a measured, joint decision to be made.

The monogamous thing is really important too. If there is a chance that unprotected sex with other partners are involved, then you open up the possibilities of other STI's - some potentially more difficult to treat than HIV, and with the added issue that STI's can cause viral load to spike, and skin trauma as a result of infections can assist the transmission of HIV. So, if there is even the slightest risk that this could be the case, then you need to maintain condom use.

I mentioned PrEP however you wouldn't be able to get that on the NHS in the UK at the moment so would need to pay privately for it, and frankly when the NHS do eventually provide it, they will likely provide for people who have sex with multiple partners, rather than those in a monogamous relationship.
If you did want to explore PrEP, then this link may help
https://www.iwantprepnow.co.uk/prep-on-the-nhs

So it's all about your risk tolerance. If the 'negligible' risk of acquiring HIV outweighs your desire to go condomless, then you should stick with the status quo. If not, then discuss it and take an informed joint decision.

You won't find anyone who will say 'Go for it!' and you will find fewer and fewer nowadays due to the weight of evidence who will say 'No Way!'. It is a very personal decision that only you guys can make.

[pozboyfriend]

Hi All,

Thank you for all your replies. It was very informative.

I am Male and he is too. I am 26 years and he is older (47) and have been HIV poz since 2000. He has also been undetectable since 2000 and is very adherent to his meds, we are totally monogamous! I am the bottom, so hence my dilemma!

[awakening]

This topic is discussed frequently on the blog of HIV doctor, Dr. Joel Gallant. If you're interested in more perspectives, you can check it out here:
http://hivforum.tumblr.com/