Tuesday, July 7, 2009

Peter, I keep having men that are undetectable tell me that unprotected sex with them is ok. What makes them think that?

[Peter Pointers is here 4 YOU, as a service to LifeLube readers - whatever question you may have regarding sexual health, physical health, mental/emotional and spiritual health - ask him. He will find the answers you are looking 4. Below is a recent Q&A you may be interested to read.]

Question: I keep having men that are undetectable tell me that unprotected sex with them is ok.....What statistics are out there that make them think that????? I have always took the opposite stanz with these folks....but it has been thrown at me so many times by different men....that I am assuming they are getting some sort of stats somewhere making them think that.....

Answer: This is such a great question and, frankly, one that I wonder why I don't hear more often. I know that information about unprotected sex with undetectable men is out there... and there is a lot of back and forth about what the most accurate information is.

So, I'm not sure how much you want to read about this, but there are a number of studies that have recently come out that have to do with your question. Here is a link to several articles about them on LifeLube.

But the short of it is: In January of 2009, researchers in Switzerland published an article saying that "an HIV-infected person on antiretroviral therapy (ART) with completely supressed viraemia (effective ART) is not sexually infectious, i.e. cannot transmit HIV through sexual contact." Importantly, some important additional factors must be present, also: that the viral load must have been undetectable for over 6 months, the person must be completely adherent to ART, and both partners must be free of other STDs.

Since that statement, a number of other studies have come out challenging the Swiss statement.

1. Some argue that while viral level may be undetectable in blood, it may be found in higher amounts in semen.
2. Others stress the STDs issue, expressing concern that many men may not know they have an infection (such as rectal herpes with or without symptoms or HPV, the virus that causes genital and anal warts).
3. Furthermore, criticism came from the fact that the studies that the Swiss researchers looked at were done only on heterosexual couples from sub-Saharan Africa – not on men who have sex with men.

It is true that if someone is on HAART and has a non-detectable viral load, it will DECREASE the chances of HIV infection, but it will not eliminate any chance. And, in a real life situation, it is very difficult (if not impossible) to know if the person you are deciding to have sex with has been undetectable for a full 6 months, or if they have never missed a dose of their meds. It is even a challenge to be sure if they have had a recent STD test that was either negative or that they had gotten treatment after. In other words, we're still not sure. The U.S. government has not signed onto the Swiss statement in any way.

We still advocate that if you know someone is HIV positive and you are not, then it's best to use condoms correctly and consistently. It still remains the best way we have to prevent HIV transmission.

If you are not going to use condoms, try to use other safer sex strategies like using lots of lube to reduce tearing and friction, make sure you and your partner have been tested for STDs and treated for any that may have been there, and try not to have your partner cum inside of your ass or mouth.

Let me know if there is more information that you would like to have on this topic! I'd be happy to pass it along.

Be Well,
Peter Pointers
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1 comment:

  1. As an outreach worker for gay men in online chat rooms, bars and bath houses, I find I'm being asked more and more about this question too.

    Enough so that I wrote an article to make the Swiss statement a little easier for gay guys to understand:

    I've also found some guys find the concept of "viral load" a bit confusing. Here's an article to help you figure out what viral load might mean for your sex life:


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