Question

The condom broke with a partner who does not know I am HIV-positive…

8 December 2009. Related: All topics, Disclosure, HIV transmission, Sero different couples.

I am HIV positive and am very well. I am in a very worrying situation and would like some advice.

Firstly the facts – my viral load is undectetable. I have been having protected sexual relations with a man but last time the condom broke. I do not want to tell him i am HIV-positive because I am worried that he will go away. This has only happened once, please can you let me know what the risk is to him and whether if he now finds out will I be facing criminal charges?

I have not eaten or slept for days and this is making me very ill now.

Answer

Answer: Simon Collins

Hi

Thank you for your email and the chance to post the answer online.

You question covers several things and I’m sorry that the answer is a bit longer than for most questions.

Firstly, the risk to your partner from this one occasion is very low. This is because your viral load is currently undetectable, because the risks are lower for an insertive partner and because it is likely that the condom was protective for most of the time.

The second question about your worry of your legal situation, will depend on where you live, and you didn’t include this information. In some countries, by not saying beforehand that you are HIV-positive, you could be open to legal charges, even though you used a condom. In a few countries you could be prosecuted even if your partner does not actually become infected.

However. in the UK, although the legal situation can be complex, because you were using a condom to protect your partner from HIV, this would not mean that any charges are likely to be upheld.

In all these situations the legal system only becomes involved in a tiny proportion of cases, although for people where this happens, whatever the outcome, the process is highly traumatic for the HIV-positive person, and not historically protective of their rights, or even common sense. Even though the number of cases is small, it does highlight the benefits of discussing HIV with a partner before having any sexual relationship.

This is difficult in most circumstances and probably happens in less than 5% of occasions, irrespective of whether either partners knows their own HIV-status. This is just how life is. In practice, most people find these discussions difficult, not least because it involves a discussion about important information before you have had a chance to know anything about your partner, or even whether you know whether this is someone you want to develop a relationship with.

So this is difficult, and rare, but probably much better overall for the future. It may mean more rejections, but it also means that you are not vulnerable to any difficult reactions if or when the issue of HIV is discussed later. There is never a good time to have the discussion about HIV after you have slept with somebody, especially if you later decide that this is a person that you want to have a longer relationship with.

For your current situation, I hope that knowing that this was a very low actual risk, will help you become a little calmer. You need to eat, sleep and look after your own health too. It sounds like you would benefit from talking these issues through with a counsellor, healthcare worker or other HIV support line. Please call us or the THT if you are in the UK, or a local organisation if you are in another country,

Each person reacts to HIV very differently, including how they perceive any risk they have taken. Sometimes this can be irrational and difficult or violent even if the risk has been low. Sometimes the reaction could be very positive and matter of fact if the person already has a good awareness of HIV. Sometimes you may find your partner is also HIV-positive and was worrying about the same things – though statistically that is less likely. This will all depend on their age, experience, outlook and views.

The counsellor can help you decide on how to start these discussions if you want to continue seeing this man.

Because you are already so worried about the risk to your partner, you are clearly conscientious, thoughtful and responsible, and you have taken steps to protect his health. If your partner is similarly considerate, this may make it easier to discuss these issues. If your partner already has strong views that are hostile to HIV, then it may be better not to follow any idea of seeing each other, and I would not see any advantage to discussing your own HIV status now.

While your HIV status is your business to discuss only with people you trust, something as simple as a broken condom shows how difficult it is to separate this in practice from any relationship, even when you take responsibility for using condoms (and HIV treatment) to reduce any risk to your partner.

This weblog is a good resource for covering news relating to legal cases relating to the criminalisation of HIV transmission.