Dear Dr. Bob
I love your forum and your compassionate work, and I want to thank you do the kind guidance you give. My question is rather straightforward, but I guess a bit unconventional.
I am in a very committed relationship with a wonderful guy who is well over a decade younger than me and who happens to be living with HIV now. Sadly that wasn’t always the case. In a drunken moment of adventure he had unprotected sex last summer in a sauna, and at least he was brave enough to tell me about it and to get tested. It was easy to forgive him, knowing how many close calls I’d had myself but also feeling so much shock and disbelief.
I’m grateful for how honesty and love has brought us closer together than I ever could have imagined, and especially because we both live in Japan and health care is totally covered for him as a Japanese national, now with special disability insurance, I’m amazed by how bright the future looks.
But I admit that I’m very scared. We have as safe sex as we can– never penetrating without a condom and usually just jerking off or coming on unbroken skin. We also either use a condom during oral sex or we are really careful there’s no pre-cum present. But we do kiss openly and deeply (French kissing), though always careful there is no blood present- and it’s hard to give up kissing anyway.
I’ve consistently tested negative and doubt I am infected. But what is the risk, provided no condoms break and we stay within the guidelines i outlined above? His viral load is still high and his cd4 count is close to 500, so his doctor has not advised him to start treatment yet. What does that mean for me and do you think we are being safe enough, given the circumstances?
Honestly the recent earthquakes here in Tokyo give me pause to even ask what safety is in the first place, and to just celebrate life and love more, but I want to know we are doing the best we can to protect each other’s health. Any thoughts from your own personal experience would be especially appreciated.
Response from Dr. Frascino
You are strictly following the safer sex guidelines. HIV cannot penetrate intact latex. No way. No how. Consequently, if the latex condoms are being used properly and don’t fail (break), your HIV risk from “protected” sex is essentially nonexistent. Kissing is not considered an HIV-transmission/acquisition risk. Oral sex carries only a very low risk.
Regarding ways to make your already extremely low risk even lower, there are several harm-reduction techniques you might consider:
1. Have a starter pack of PEP (post-exposure prophylaxis) ready in case there is an accidental exposure (broken condom).
2. Consider having your positively charged partner begin antiretroviral therapy (even though his CD4 count is above 500). Driving the HIV plasma viral load to undetectable levels with effective combination antiretroviral therapy significantly decreases the risk of transmission.
3. Consider beginning PrEP (pre-exposure prophylaxis). Preliminary studies suggest that if the HIV-negative partner takes Truvada, the risk of HIV acquisition is significantly decreased.
Certainly proper use of latex condoms for all penetrative sex remains your first line of defense against becoming virally enhanced.
Finally, I must mention that happily-ever-after, including mind-blowing, toe-curling, own-name-forgetting, wake-the-neighbors fusion sex does exist for magnetic couples. I speak from personal experience as the positively charged component in my 17-year relationship with my legally married spouse Steve (Dr. Steve, the expert in the Body’s Tratamientos forum).
Be well. Be happy. Be safe.