Dear Alice,

If my husband takes antivirals or post-exposure prophylaxis can we still have sex with a condom and still complete the process like normal? It is affecting our sex life because he does not want to infect me. I don't want to be infected but I knew what I was getting into from the start. I might start PrEP as it is now available to me. What are your thoughts?

Dear Reader,

It’s great that you recognize that there are ways to be sexually active with your partner while also minimizing your risk of contracting human immunodeficiency virus (HIV). You mentioned four critical ways that HIV risk can be minimized, both before and after potentially infectious contact. Since you and your husband are in what is referred to as a HIV-discordant or sero-discordant relationship (where one of the two of you, not both, are HIV positive), understanding the many medications that may help reduce the risk of HIV transmission can go a long way to fostering a healthy, safer, and fulfilling sex life.

Post-exposure prophylaxis (PEP), refers to the drugs that can be taken immediately after someone who is HIV negative is exposed to potentially HIV positive body fluid like blood or semen. Who might need to take PEP? A health care worker who got accidentally stuck with a needle that was used to take blood from someone who might be HIV positive, or someone who got blood or body fluid into their eyes, mouth, or skin that was blistered, chapped or cracked, might be evaluated for PEP use. Other people who might need PEP are those who had a single episode of unprotected sex with someone who could be (or is) HIV positive. Under these types of circumstances, PEP is typically administered within 72 hours of exposure. It’s also recommended that other protective measures (sterilizing needles, using condoms and other barrier methods) are used as well just in case you did contract HIV. PEP is not 100 percent effective, but if it’s used properly, it could reduce your risk of developing HIV. For greater detail about PEP, including where you can get it check out the AIDS.gov website.

Unlike PEP, which is intended for short-term, emergency use directly after risky contact, the three other tools you mentioned: anti-retrovirals for your husband, using condoms, and pre-exposure prophylaxis (PrEP) are all intended for ongoing use to minimize the transmission of HIV between HIV-discordant sexual partners.

First, let’s chat a little about PrEP. PrEP is a prevention method endorsed by the Centers for Disease Control and Prevention (CDC) for people (like you) who are HIV negative but who could be at risk of getting HIV. PrEP combines two drugs, 300 mg of tenofovir disoproxil fumarate (TDF) and 200 mg of emtricitabine, into one pill that is taken once a day. For people who take the drug every day, and engage in other HIV prevention activities (e.g. consistent condom use, HIV couples counseling), research has found that (depending on the population) PrEP is between 62 to 92 percent effective at preventing HIV transmission. In one recent study with subjects who identified as men and transgender women who have sex with men, an effectiveness rate of 0.0 infections per 100 person-years was found among those who took four or more doses of PrEP weekly during the study period. In pregnant women, PrEP might also be a good way to reduce the risk of HIV transmission to the fetus.

Next on the list: the antiretroviral medications that your husband takes. Yep, antiretroviral therapy (ART) consist of a combination of medications that are recommended as ongoing therapy for those who are HIV positive, in order to keep the viral load of HIV in check. ART can be used in combination with PrEP — so for example, your husband could be on ART and you could take PrEP daily. However, the use of ART and PrEP does not completely eliminate the risk of transmission or infection, therefore, a critical final step to minimizing risk of transmitting HIV is by using a barrier such as a condom or dental dam when having sex.

Finally, you mention you want to “complete the process like normal.” What is considered “normal” when it comes to sex may be different for different couples. While there is no 100 percent effective way of preventing transmission of HIV while having sex, it's possible to have a satisfying sex life while also taking steps to minimize the risk.

To your health!

Alice!

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