Does protection matter if both people have HIV/AIDS?

Originally Published: July 12, 2013
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Dear Alice,

My best friend has AIDS and he's sexually active. He has unprotected sex with other men with HIV/AIDS. Should he use a condom instead or can does unprotected sex make no difference at all at this stage? Thank you.

Dear Reader,

It does make a difference — absolutely! Kudos to you for looking out for the health of your friend. Here's the scoop: Sex between HIV-positive partners is not without risk, both from other types of HIV and other sexually transmitted infections (STIs). There are many different types or “strains” of HIV, and some change or “mutate” over time and exposure to medication. When a person who is infected with one strain becomes infected with a second strain, it is referred to as “superinfection.” Not much is known about how often this occurs, but it may be that individuals with more recent HIV infection are more susceptible to it. In addition to superinfection, HIV-positive men who have unprotected sex with other HIV-positive men may be at higher risk for rapid loss of CD4 cells and contracting other STIs. This puts folks at higher risk for opportunistic infections such as Karposi’s Sarcoma, co-infection with hepatitis C, as well as immune system deterioration.

The achievement of treatment in the form of antiretroviral therapy (ART) has allowed so many to live longer, healthier lives; however, it may also cause complacency in some people towards safer sex behaviors. It’s a misconception that HIV is no longer as dangerous since treatment is available. More virulent and drug resistant strains of HIV have emerged as a result of people failing to maintain an ART regimen.

One study on “barebacking” — a term that refers to intentional unsafe anal sex without a condom or barrier — found that men chose to engage in unsafe sexual behavior due to a variety of different physical and emotional reasons, and often for perceived benefits of pleasure and intimacy. Some of these reasons included not having a condom available, having a condom but not using it, or having a condom that broke and not stopping sexual activity. Other reasons included curiosity, the heat of the moment, and thrill-seeking and fantasy fulfillment. Some men who have sex with men have reported “AIDS-related fatigue” and the desire to intentionally rebel against the safer sex movement.

For more information about HIV/AIDS or other STIs or if you’d like to provide your friend with some resources, check out the Centers for Disease Control and Prevention and Gay Men's Health Crisis (GMHC).

If you’re a member of the Columbia University community, the Gay Health Advocacy Project provides information about transmission, treatment, and prevention of sexually transmitted infections and peer counseling around issues of sexuality. If you, or your friend, are students at Columbia on the Morningside campus, you can learn more about where to get safer sex supplies by using the interactive safer sex supplies map. If you’re on the Medical Center campus, the Center for Student Wellness can provide you with safer sex supplies.

Alice