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Viral load and risk

What if you do have another STI?
Having another STI could possibly increase your chances of passing your HIV on to someone else. Since you don’t always notice STIs, you could possibly have one without knowing it. If you have an STI, the amount of HIV in your sperm or vaginal fluid can be greater than normal.

What are the conditions for keeping the chances extremely slight?
There are some couples – consisting of a partner with an undetectable viral load and a partner who is HIV negative – who do not use condoms. To keep the chance of transmission very slight, the following conditions are essential:

  • You are in compliance with your therapy, the blood tests have shown that your viral load has been undetectable for at least half a year, and the most recent viral load count was made no more than half a year earlier.
  • Neither you nor your partner has had any kind of damage to the mucous membrane of the anus, penis or vagina, for example due to a recent STI or to rough sex.
  • To be completely sure that neither of you has an STI, neither partner can have had sexual contact with others since the most recent STI check.

Why is the risk extremely low, but perhaps not nil?
The chance of passing on your HIV is extremely slight, but the risk cannot be ruled out altogether:

  • Having an undetectable viral load does not mean that your blood contains no more virus whatsoever.
  • The results of a viral load test are like a snapshot of the situation at the moment the blood is drawn for the test. You can never know for 100% if your viral load has remained undetectable.
  • The test only measures the viral load in your blood. It is possible that the viral load is undetectable in your blood, but not in your sperm or vaginal fluid.
  • Somewhat less is known about the effect of an undetectable viral load when it comes to anal sex. Most of the studies done so far have been based on vaginal contact. The chance of passing on HIV through anal sex will be smaller with an undetectable viral load, but it is not certain whether that chance is just as slight with anal sex as it is with vaginal sex. Generally speaking the chance of passing on HIV and other STIs is always greater via anal contact than via vaginal contact.

Less risk with an undetectable viral load
Many people think sex is just better without condoms. I do too! There are people with HIV who say: ‘I use a condom. That’s just the way it is. Using a condom doesn’t take away any of the pleasure for me.’ But for people for whom condoms are a problem, it is very nice to know that the chances of passing on your virus are strongly reduced if you are taking HIV medicines, if your viral load has been undetectable for more than half a year and if you have no other STIs. Knowing that can be a relief to straight couples in which the woman has HIV and wants to get pregnant, for example. It means you don’t have to mess around with tubes and vials. But also for a gay man who has had an undetectable viral load for a longer period and who has no other STIs, the chance that he can infect someone else is much slighter. And there are also people who say: it is not certain that I have zero chance of passing on my HIV, so I will continue to use a condom.
Luc Gelinck, HIV doctor

Nice to know
We have heard that the virus is hardly transmittable anymore if your HIV medicines are working effectively. We still use a condom when we make love, but even so, it’s nice to know. I am used to using a condom and I’m not going stop doing that. It would be horrible if my girlfriend would get HIV, so I don’t want to take any risk at all.
Hans

I’m not going to push my boyfriend
Obviously is great that you basically can’t pass on your HIV anymore as long as your HIV medicines are working properly. I have had an undetectable viral load for years now. I have done it with several different men without a condom. I think it’s better without condoms, but my boyfriend wants to use condoms, and I respect that. I’m not going to push him. You get used to it, but I think it’s an annoying interruption. I think condoms stink and it’s just nicer without them. That way, I don’t have the feeling that the HIV is creating any distance between us when we make love. He assures me that he doesn’t feel any distance, but maybe my HIV does play a role in his wanting to use condoms during sex. If that were the case, I could understand it. But I can be jealous of women who have a boyfriend or husband who would rather do it without a condom. Since my boyfriend wants to keep doing it with condoms, I somehow have a feeling that I’m not good enough.
Sanna

More relaxed
The insight that with an undetectable viral load it’s almost impossible to pass on your virus to someone else has made me more relaxed when it comes to sex. I’m less afraid of infecting someone. That really makes a big difference. I only later realised that I used to worry about that. My boyfriend does not have HIV and wants to keep it that way. I told him about this insight and he also got information from the GGD. That has put his mind at rest, although he is not completely relaxed when I am fucking him. Every time there is that question: What things do we do with condoms? What things do we do without them? He doesn’t have any problems with fucking me without a condom, since the risk for him is even lower.
Alexander

I brought my new boyfriend with me to see the HIV nurse
When I told my new boyfriend that I had HIV, he was bit shocked at first. But then right away he said: ‘I think you are such a fantastic woman that your HIV doesn’t matter to me.’ I told him about the ‘Swiss stance’, that there is only a very slight chance that I could pass on my HIV within a monogamous relationship since my virus has been undetectable for years already. I brought him with me to see the HIV nurse because I thought it was important that he should decide for himself after having heard her explanation. I thought it was great that he not only spoke with the nurse about the risk, but also asked: ‘What does HIV actually mean for Corina?’ Now we do it without condoms.
Corina

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