risk? Pos-undetectable/condom-prep

[xolinlevh]

Hey so ive been talking to someone for a while and we want to have some fun, hes pos but undetectable, im clean and on prep. If we use condoms, what are the odds of infection? what about for oral?

 

[KaraBulut]

If we use condoms, what are the odds of infection? what about for oral?

There's not really an answer to your question. The research that is out there indicates that lowered to immeasurable viral load is associated with lowered risk of transmission, however the studies have focused on heterosexual couples or couples where there was intermittent condom use.

The question for you is whether it is worth it to take the risk for someone you've been "talking to" and whether "some fun" is worth a life-changing event.

 

[hotatlboi]

Have to disagree with the last post. Condoms while used properly have been proven for decades. Solid research has shown very low risk of infection from oral unless you have open mouth sores or some kind of easy bleeding disorder. Pretty solid research shows that lowering your viral load to undetectable and PreP when used daily both individually offer a 90%+ reduction in risk. Combine both of those and your risk of infection is essentially zero.

Just saying well we don't know ignores the facts and just serves to further stigmatize positive people and encourage backward attitudes of extreme avoidance toward them like we had in the 80s.

 

[KaraBulut]

Combine both of those and your risk of infection is essentially zero.

Source?

 

[hotatlboi]

Source?

Simple statistics.

Treatment as prevention was shown to be 96% effective and Prep 99% when taken daily.

If you combine those your effective rate is 99.96%.

Now obviously this is an oversimplification and relies on the underlying statistical models in those studies as well, but the poster did not ask if there had been a scientific study which categorically 100% disproved any chance he could become infected if he engaged in this situation. I'm quite sure instead he was looking for some practical straight talk on what his likely risks would be. Your reply completely glossed over the basic reality of the situation which is that however you want to quantify it, his risk is VERY low.

Now I get where you are coming from, clinicians cannot just say oh sure you will be fine for liability reasons. But sometimes people just need a dose of reality.

 

[KaraBulut]

...Now I get where you are coming from, clinicians cannot just say oh sure you will be fine for liability reasons. But sometimes people just need a dose of reality.

That's it, yes.

We have statistics about driving impaired and how that is a factor in car accidents. We have statistics about how seat belts reduce mortality and morbidity. We have statistics about how reduced speed reduces fatalities in car accidents.

However, if someone were to say, "What's the risk, if I wear my seat belt while driving drunk while obeying the speed limit", it might be possible to mathematically extrapolate a risk factor, but it would be irresponsible to ignore the inherent risk of driving drunk.

Humans are not particularly good at evaluating comparative risk- airplanes are perceived as more dangerous than automobiles; people perceive terrorism to be a higher risk to their children than having a gun in their home; people perceive Ebola to be more deadly than influenza. And in HIV terms, gay men perceive sex with a person known to have HIV to be more risky than sex with a partner whose status is unknown to them.

There's an important piece of the 80s strategy of HIV risk reduction that seems to have gotten lost with the focus on condoms, HIV status and safer sex: pick your partners wisely and assume everyone is potentially infected. That change in attitude was the cornerstore of the risk reduction strategy.

In the late 70s and 80s, STDs were a fact of life in the gay community. Gonorrhea, syphilis and "non-specific urethritis" were just viewed as part of the gay experience and easily resolved with a trip to the free clinic. What happened in the 80s was the realization that there were a host of viruses that were being transmitted during sex- HPV, CMV, EBV, HSV, HIV, Hepatitis (now known to be multiple viruses A/B/C/D/E), etc and that behavior modification was going to be necessary for the gay community (or in Larry Kramer's words, "gay population") to survive.

It was also part of an awakening that the treatment of gay men as second class citizens was not counteracted by "sexual freedom". Straight people had choices- they could be sluts, they could be in long-term unmarried relationships or they could marry. Gay men didn't have those choices and long term stable relationships between same sex couples often were dismissed as "heteronormative". What HIV changed in the 1980-90s was the perception that gay men were defined solely by their sexuality and it made gay men more aware that they were entitled to the same choices as straight people.

What concerns many gay men who survived the 80s, is the way that gay men are being given the impression that HIV is their only worry and that it's just a chronic condition easily treatable by taking a pill a day. This seems very much like the attitudes that public health officials had toward gay men back in 70s- that STDs were a fact of life and that they're not a big deal. That blase' attitude was blissfully ignorant of the number of non-curable STDs that were being transmitted by a community that was stereotyped as "promiscuous".

In OP's post, there's two different messages: responsibility (knowledge of viral load, PrEp use and condom use) but there's also another question about what level of risk is acceptable. It's that slippery slope that leads to more risky behaviors under the guise of "well, just this one time" or "he's clean" or "he said his viral load is low"...

The advice underlying my original post is this: gay men have to accept a certain amount of risk is omnipresent in sexual activity- risk that is both known and unknown. There's no way to reliably quantify risk. People lie about their HIV status and statements about "viral load" shouldn't be taken at face value as somehow being a free pass. Every gay man has to be responsible for his own health and weigh all of their options for risk reduction- including condoms, including PrEp, including avoiding exchange of body fluids and including saying, "no, it's not worth the risk for a NSA encounter".

 

[mbamike]

OK, now let's discuss the last part of his question, "What about oral?"

Personally, I don't use a condom when I am sucking cock. Never met a guy who suggested he wear a condom while I sucked his cock. All information about oral sex is inclusive because the participants usually engage in other sexual activities like anal sex. So,if a condom is not used for "just oral" is the risk still very low?

 

[KaraBulut]

...if a condom is not used for "just oral" is the risk still very low?

For HIV, yes.

For everything else, no.

 

[luckynumbah7]

OK, now let's discuss the last part of his question, "What about oral?"

Personally, I don't use a condom when I am sucking cock. Never met a guy who suggested he wear a condom while I sucked his cock. All information about oral sex is inclusive because the participants usually engage in other sexual activities like anal sex. So,if a condom is not used for "just oral" is the risk still very low?

I highly doubt it. Microscopic abrasions and/or irritated fumlines from brushing teeth and/or gingivitis increase the risk of infection as does not using a condom as precum also contains the virus. 'Pulling out" is not a viable option when considering transmission - just like it doesn't work for pregnancy.

-It's why you're not supposed to brush your teeth if you plan on not using condoms for oral and gingivitis should be self-explanatory - gums are bad barriers when they're infected/bleeding. Most people don't realize they're having a gingivitis problem until after it's set in and then they get to fight it back.