Sex and prevention concerns
for positive people

September 2002     View PDF     En español

We’re both positive: What are our concerns?

For people whose partner(s) also live with HIV, prevention messages and reasons to practice safer sex sometimes become unclear. A common question is: “If I’m positive and my partner is positive, then why do we have to practice safer sex?” Simply put, safer sex remains important among positive partners. This is because in addition to preventing new infections as discussed above, other factors place positive sex partners at risk.

One of these factors is re-infection with HIV. While the issue of re-infection remains unclear, some new evidence shows that it can and does happen. If you’re on therapy that HIV has become resistant to, it’s possible for you to transmit the drug-resistant strain to your partner, possibly crippling the benefits of those therapies for your partner. On the other hand, if your partner is on anti-HIV therapy, you could become infected with his or her drug-resistant strain(s) and have decreased benefits from therapy. (For more information on drug-resistant virus, click here.)

Finally, it’s important to remember that your partner’s viral load (amount of HIV in blood) may not relate to the level of virus in semen or vaginal or anal fluids. Therefore, while HIV levels in blood may be undetectable by a lab test, they still may be present in high levels elsewhere. (Note: Standard viral load tests do not measure HIV in semen or vaginal or anal fluids. Also, in studies, even when viral load tests of semen came back undetectable, HIV-infected cells could still be found in the semen. These cells are believed important for passing HIV from person to person.)

When both partners live with HIV, consider these points when discussing safer sex:

• Infections like CMV, HPV, herpes, hepatitis (B and C) among others, remain major concerns. All these are potentially deadly infections in people living with HIV, but they can be prevented, to some degree, through practicing safer sex.
• Re-infection with drug-resistant or more aggressive strains of HIV remains a theoretical possibility. It must be considered when negotiating safer sex between positive partners.