A reader asks me about sex #HIV #AIDS
I received this question on my Formspring account this morning, and I think it’s important to answer it here. I receive alot of emails on HIV from those that have recently seroconverted and my Google keyword search is usually loaded with people seeking some answers. My response is going to be a bit lengthy, if only to make sure that I put out as many facts as I can, as well as completely eliminate the risk of my perpetuating HIV stigma.
To be clear: I am not a medical professional; I’m just a fairly educated guy who’s been an HIV advocate for 20+ years. I’m always willing to share what I know or find on the internet, but the final word on your health needs to be between you and your doctor.
Here’s what I woke to on my Formspring account today:
“I’ve had unprotected sex with someone who is HIV+. How many chances are there that I’m not infected?”
That is a very tough thing to answer because it depends on so many things.
1. The other person’s viral load: someone who says their viral load is undetectable is not telling you it’s nonexistent. That simply means that they have a reduced risk of exposing you to their HIV virus. The virus is still transmittable:
Myth – I’m HIV-positive and my viral load is undetectable, so I can’t transmit HIV.
Fact – While this myth is based in some truth, it’s also dangerous. If you are on HIV medication, the goal is to get your viral load (the amount of virus in your body) to an undetectable level. This is measured through lab testing you get every few months at your doctor’s office. If your viral load is undetectable, that is awesome news. It means you are keeping yourself as healthy as possible and it does lower your risk of transmitting HIV. However, and repeat after us boys, it doesn’t eliminate it.
Why? There are a couple reasons. First off, the viral load test, which shows how much virus there is, doesn’t measure viral load below a certain point. In plain English, this means there is still HIV virus in the body (you never get rid of it), but that it’s below a level we can detect through standard lab testing. Secondly, this test looks for the presence of viral load in your blood and not your semen. Just because your blood viral load is undetectable doesn’t mean your seminal viral load is the same. Third, people go through what we call viral blips. Did you get a cold? Have a stressful week at work? There’s a good chance your viral load went up during these periods. That’s why we call them blips. So you’re viral load may not truly be undetectable all the time.
So what does all this mean? If you are HIV+ positive and undetectable, congratulations! You’ve lowered your risk of transmitting HIV but you haven’t eliminated it. You can still easily transmit HIV. People do get infected with HIV even when their HIV+ partner is undetectable. Condoms, lube and communicating openly with your partner about risks are still the best ways to protect yourself and others.
The other thing to consider is whether or not the person is truly undetectable. The vast majority of guys I know who are HIV positive are not only very truthful about their status, they are also taking care of their health in terms of getting and staying on antiretrovirals. Be sure you know that your partner is a/undetectable, and b/taking their medication. Taking someone at their word in a casual encounter is foolish and playing your health. If the other person is your partner, then you obviously know far more about them than you would in a one-night stand.
2. The sex act. Let’s face it, busting a load on each other is the happy ending of sex, right? However, having serodiscordant unprotected sex, and busting a load in each other is problematic at best. The risk of exposure depends on the act itself.
While it is agreed that oral sex has a much lower HIV-infection risk than vaginal and anal sex, HIV can be transmitted through both insertive and receptive oral sex,[23] when there is contact between semen or vaginal fluid and the mucus membranes of the mouth. The risk of infection from a single encounter is small, but it increases with frequency of activity. To date the CDC lists no documented cases of transmission to the insertive partner of such activities.
Transmission risk may be elevated in the case of open sores on the genitals and/or mouth, or significant gum disease or bleeding, i.e., when there is direct contact between semen and breaks in the skin or surface of the mouth
Whether you were the top or bottom, there is risk of exposure:
If you are HIV-positive, using condoms during sex with people who know that they are HIV-negative or are unsure of their HIV status will protect them against HIV and protect both of you from STIs.
There’s a lot of debate about how infectious people with HIV are if they are taking HIV treatment and have an undetectable viral load. Most experts seem to agree HIV treatment means that the risk of HIV transmission is reduced, but that some risk still exists.
In short, a one time casual encounter is, logically going to carry minimal risk of exposure and conversion. However, the more you expose yourself, the greater the chances.
Say you do convert, now what? It’s not the end of the world, right? Guys who are HIV positive live longer, healthier lives and science is moving in leaps and bounds to find a cure for HIV/AIDS. But here’s the thing: meds aren’t cheap, and in some cases if you’re attempting to get on ADAP (if you’re in the US) getting them at this point in time is not an option.
A year of meds can cost $10,000 to $15,000 on their own, so if you have insurance your own out of pocket deductible is going to depend entirely on what your plan provides. Is that an expense you can absorb regularly?
Depending on where you live in the US, getting on ADAP is not even an option at this point. 4,329 people in twelve states are currently on waiting lists, so if you lived in Georgia for example there are 1,011 also waiting on ADAP assistance. If you have no insurance of your own and meet the income guidelines in a state that has no waiting list however (like NY for example) you don’t have to wait any longer than the time it takes for you to get to a doctor who can begin treatment. Keep in mind too: until there’s a cure, the success of your health if you convert to being HIV positive depends on your taking meds regularly. Going off your meds or not maintaining doses in your system adds to the risk that the HIV virus you carry is going to get stronger and become resistant to your particular meds when you start taking them again.
There is also a risk of not only side effects from HIV meds, or (in a very limited number cases) there are instances where a patient’s virus doesn’t respond to medications at all. The science is all over the map on this one, but I’m regularly in contact with a friend who converted two years ago and has not had any luck in finding the right medication to combat his HIV. His health at this time is not great.
So, while I know scores of guys who are HIV positive who will tell you that converting is not the end of the world, their stories about the logistical nightmare of meds, regular doctor visits, ADAP waiting lists, out of pocket expenses with their own insurance and a host of experiences in being discriminated against by other gays who don’t want to sleep with someone who’s HIV positive are enough to make me ask a simple question: do you want to continue to run the risk of becoming HIV positive?
I’ve put alot of information out there for you to read, so let’s wrap it up, ok?
Should you avoid sexual contact with your HIV positive partner because of his status? HELL NO! To me, as well as alot of people I know that’s just a hateful form of discrimination, especially if you’re both attracted to each other and have a healthy sexual relationship. If your partner insists on having unprotected sex, you have to decide if you’re willing to continue to put yourself at risk for seroconverting.
My advice? Talk to your partner, openly, about the risks of continuing to bareback, as well as options you’re both comfortable with that will have you playing safely. You should also get tested ASAP. Education, conversation and knowledge is the best defense there is to keeping you HIV negative.
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