Dear Alice,

I recently began dating a guy who is HIV positive. I know how it is transmitted and the risks involved, but I was wondering if there are any statistics out about being infected in my similar situation. How high are my chances of contracting it if we are careful?

Dear Reader,

There is no way for a sexually active person to be 100 percent certain that s/he is protected from HIV infection or any other sexually transmitted infection (STI). However, there are many ways to significantly reduce risk of transmission, even for an uninfected person in a sexually active relationship with someone who is HIV-positive.

Many studies have been conducted on serodiscordant couples, meaning that one partner is HIV-positive and the other is HIV-negative. Growing evidence suggests that as HIV medicines become more efficacious, HIV-positive individuals taking antiretroviral medications are significantly less likely to transmit the virus to a sexual partner than someone not taking medication. In fact, in a study of almost 3,000 monogamous serodiscordant couples, it was found that with the use of antiretroviral therapy, only 3.4 percent of sexually active couples would transmit HIV from the infected to uninfected partner over a period of 100 years. Risk is reduced even further when the following qualifications are met:

  • The HIV-positive partner complies fully with her/his health care provider's instructions for antiretroviral medications and is evaluated regularly. This is crucial, because even a temporary slip-up in the HIV-positive individual’s medication regimen may facilitate rapid virus replication, thereby increasing viral load.
  • The HIV-positive partner’s viral load has been undetectable for at least six consecutive months.
  • Neither partner has any additional STIs. Having another STI can facilitate HIV transmission.

Risk of transmission varies with viral load, which is entirely unique to each individual. Consistent and correct condom usage is key to lowering transmission risk in mixed status couples, regardless of viral load. Condoms are highly effective in preventing the transmission of HIV, but sometimes fail. Those failures are most often due to user error. To reduce condom failure, try the following:

  • Only use water- or silicone-based lubes.
  • Never oil-based ones such as petroleum jelly, cooking oil or shortening, or hand-lotion as they weaken the latex and can cause breakage.
  • Keep condoms away from heat or direct sunlight.
  • Check the expiration date and the package. Condoms that are too old or expired, or have packaging that appears to be weathered or deflated, need to be thrown away.
  • Carefully open the condom with your fingers, trying not to tear it with your fingernails (or teeth).

HIV can complicate relationships in many ways. Not only is HIV highly stigmatized, but it can also be difficult to manage. However, under the close supervision of a good physician, you and your partner can be safely sexually active. If you need more help or want to talk about risks and options further, reach out to your health care provider or your partner's HIV specialist.

Alice!
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