Question

Can two men who are undetectable have sex without condoms?

19 August 2013. Related: All topics, HIV reinfection (superinfection).

What do you think of two HIV positive gay men having unprotected sex?

We are both undetectable with different medication.

I only practice unsafe sex with one person, other partners I practice safe sex only.

I was always against unsafe sex for 5 years since I was diagnosed but my attitude starting to change to do bareback sex with a person I know. He is STD free and HIV undectable…it does make me more connect sexually .

Answer

Answer: Rebecca McDowall

Hello,

Thank-you for your email. I am glad to hear that you and your partner are doing so well on your treatment.

Most studies suggest that the risk of reinfection are likely to be similar to the original risk of infection. It may be much lower than this and viiral load is probably the most important risk factor for transmission, with very high viral loads having the highest risk.

If two HIV-positive people have the same virus and the same resistance, then reinfection is unlikely to directly affect either their health or the effectiveness of treatment. If one partner has, or develops resistance then the impact of reinfection could be more serious.

If neither you nor your partner currently has drug resistance even if reinfection was to occur it would be unlikely to have any effect or your health or treatment. It sounds like you are both being very open about your health- it’s great if you are able to discuss CD4 count, viral load and treatment together.

The fact that you both have undetectable viral loads makes any risk related to drug resistance even smaller. This is the most effective way- except condoms- of preventing infection. In heterosexual couples where one person is HIV positive but has had an undetectable viral load for 6 months or more the risk of infection to the negative partner is thought to be zero, or close to zero. Unfortunately we don’t have the same data available for unprotected anal sex- either between two men or between a man and woman. The protective factor of an undetectable viral load is likely to be similar, but we don’t have enough data to say this for sure right now.

All in all, if neither or you have resistance, or if you both have the same resistance, then there is unlikely to be a problem from not using condoms (other than STIs). But it is important that you are both comfortable before making the decision to stop using condoms. For the positive side, being able to not use condoms can have an incredibly powerful and liberating impact on your quality of life. Lots of people find having another positive partner is also a liberating experience and so I hope whatever you decide goes well.