HELP!! Risks of sex with HIV positive, undetectable on ART

[+ Trebor]

I’ve got an escort I really want up set but he is HIV positive,  on ART. What are the risks???

[+ Vegas_Millennial]

Although the topic is now expired, this exact question was asked 2 years ago.  I hope some of the answers provided then are of help to you know. 

 

The only thing I have to add is: 

1.  Assume everyone is positive, even if he or she says otherwise, and protect yourself accordingly.

2.  Negative test results are meaningless if the person has had any sex in the time between when the blood was taken and when you are having sex with him or her.

3.  Ask your doctor what is right for you.

Edited August 27 by Vegas_Millennial

[Luv2play]

2 hours ago, Trebor said:

I’ve got an escort I really want up set but he is HIV positive,  on ART. What are the risks???

Don’t consult this forum. Go to trustworthy medical authorities like the CDC . This information is readily available on the Internet. Check the sources though and use your intelligence. 

[+ PhileasFogg]

You’ve not said if you’re a top or a bottom.  That makes a difference. You’ve not said if you’re on PrEP.  That makes a difference

But in general, Undetectable = Untransmittable. As indicated above, you’ll find comfort in the extensive research that’s out there 

[+ nycman]

13 hours ago, Trebor said:

but he is HIV positive,  on ART.

2 hours ago, PhileasFogg said:

Undetectable = Untransmittable.

For the record, these are two different statements. The fact that he’s on ART does not mean that he's undetectable.

13 hours ago, Trebor said:

What are the risks???

The risks are that you could get a sexually transmitted disease (HPV, HIV, hepatitis, chlamydia, gonorrhea, syphilis,…).
ART and U=U, only applies to one of those diseases.
In fact, we might as well include pregnancy as a risk since we don’t really know much about this whole scenario.

13 hours ago, Vegas_Millennial said:

2.  Negative test results are meaningless if the person has had any sex in the time between when the blood was taken and when you are having sex with him or her.

Minor technical  point, the time of absence actually has to reach back a few weeks before the test was taken.
I agree a negative test isn’t very helpful but I disagree that it’s “meaningless”, if no other reason than the fact that a positive test is meaningful. 

At the end of the day, all sexually active adults have to make decisions about the risks they’re willing to take. I don’t claim to be an angel and I don’t deny that the risks I am willing to take change over time. Life is full of tough choices. I’ll give you the same advice I give to young colleagues who are signing their first contracts. "I don’t care what you sign, as long as you understand what you’re signing."

[pubic_assistance]

14 hours ago, Trebor said:

I’ve got an escort I really want up set but he is HIV positive,  on ART. What are the risks???

The risks are based on your own stats. 

If youre on PreP, youre risks are lower than if not. If youre a bottom, your risks are higher than if youre a top.

 Consult a doctor, not a forum full of gay men who take a LOT of risks to get laid. 

[+ PhileasFogg]

@nycman, I bet you 99.9% of the men over 20 on this forum have HPV.  That’s why there’s no attempt to vaccinate us.  Herpes is a risk that can be mitigated but not cured.  The others can be treated and cured in the short term.

Undetectable = Untransmittable.

This is not disputed by immunologists.  But PrEP and regular testing remain an effective tool to further mitigate theoretical risk.

And @pubic_assistance, I agree with you completely.  But my message to @Trebor is that, I believe that once he’s done his own research, he will find that he has no reason to fear or hesitate. 

[pubic_assistance]

1 hour ago, PhileasFogg said:

Undetectable = Untransmittable.

When you're DATING someone and you KNOW a person's status, you can determine risk based on these ideas.

When you're fucking ( or getting fucked ) by a random escort who you DON'T KNOW. You need to throw away the whole concept of them being "untransmittable" and do your best to make sure that YOU are protected from the chance that they ARE TRANSMITTING hiv to your bloodstream. I would NEVER just assume someone is telling me the truth about their status. This is why I personally ( I know I'm old fashioned ) STILL use condoms for anal sex...and probably why I haven't bottomed in years and years.

[+ SirBillybob]

17 hours ago, Trebor said:

I’ve got an escort I really want up set but he is HIV positive,  on ART. What are the risks???

What exactly are you asking or should be asking your physician? People respond to being upset in many ways. In contrast, specific sexual behaviours are associated with different levels of infection risk.

[Constantine]

2 hours ago, PhileasFogg said:

@nycman, I bet you 99.9% of the men over 20 on this forum have HPV.  That’s why there’s no attempt to vaccinate us.  Herpes is a risk that can be mitigated but not cured.  The others can be treated and cured in the short term.

I got the vaccine when I was still in school. It's a no brainer regardless of your sexual orientation. The Michael Douglas story really raised a lot of awareness on the issue.

[+ PhileasFogg]

1 hour ago, pubic_assistance said:

When you're DATING someone and you KNOW a person's status, you can determine risk based on these ideas.

When you're fucking ( or getting fucked ) by a random escort who you DON'T KNOW. You need to throw away the whole concept of them being "untransmittable" and do your best to make sure that YOU are protected from the chance that they ARE TRANSMITTING hiv to your bloodstream. I would NEVER just assume someone is telling me the truth about their status. This is why I personally ( I know I'm old fashioned ) STILL use condoms for anal sex...and probably why I haven't bottomed in years and years.

Interestingly, we are in violent agreement. I often share (and require) recent proof of status if it’s someone I don’t know well.  If they’re on ART, they have been tested recently and will have it.  But still U=U, truthfulness is a different issue.   You assume they’re lying, I’m simply verifying they’re telling the truth.
 

From my view, as a top, the data is out there showing that the risk of a top getting HIV from a + bottom is still very low. Plus I have prep, doxy (which I’ve never been inclined to use yet), and I’m picky (I’m not professing pickiness is reliable though)

[Luv2play]

3 hours ago, pubic_assistance said:

The risks are based on your own stats. 

If youre on PreP, youre risks are lower than if not. If youre a bottom, your risks are higher than if youre a top.

 Consult a doctor, not a forum full of gay men who take a LOT of risks to get laid. 

You don’t think straight women don’t take a lot of risks to get laid. And vice versa as well. Life is full of risk taking. And for the strong of mind. 

[+ SirBillybob]

21 minutes ago, PhileasFogg said:

From my view, as a top, the data is out there showing that the risk of a top getting HIV from a + bottom is still very low. Plus I have prep, doxy (which I’ve never been inclined to use yet), and I’m picky (I’m not professing pickiness is reliable though)

I’ve always explained to patients that the risk from unprotected insertive anal is lower than from receptive anal but depends on the more elusive variable of how much of a debt is owed to past good luck because the cumulative risk events for a top can be equivalent in probability of infection to that of a bottom with lesser number of events in which infection from a poz person with unsuppressed virus is evaded. This concept of the past catching up is as relevant as the idea of prospective encounters in terms of the decision to PrEP or not. 

[pubic_assistance]

1 hour ago, PhileasFogg said:

You assume they’re lying, I’m simply verifying they’re telling the truth.

I assume everyone is HIV positive and act accordingly.

 

[Luv2play]

24 minutes ago, pubic_assistance said:

I assume everyone is HIV positive and act accordingly.

 

That’s a very un-nuanced approach. 

[+ PhileasFogg]

2 hours ago, SirBillybob said:

I’ve always explained to patients that the risk from unprotected insertive anal is lower than from receptive anal but depends on the more elusive variable of how much of a debt is owed to past good luck because the cumulative risk events for a top can be equivalent in probability of infection to that of a bottom with lesser number of events in which infection from a poz person with unsuppressed virus is evaded. This concept of the past catching up is as relevant as the idea of prospective encounters in terms of the decision to PrEP or not. 

I don’t think it works that way.
The per-act risk doesn’t simply accumulate linearly — probabilities compound differently, and repeated exposures don’t guarantee infection even though the overall risk increases. Not all probabilities are cumulative in the way you describe.

[+ SirBillybob]

1 hour ago, PhileasFogg said:

I don’t think it works that way.
The per-act risk doesn’t simply accumulate linearly — probabilities compound differently, and repeated exposures don’t guarantee infection even though the overall risk increases. Not all probabilities are cumulative in the way you describe.

Per-act risk accumulates nonlinearly and repeated exposures compound differently because the number of risk acts is applied as an exponent to the probability of non-infection. This doesn’t mean that you cannot take an arbitrary probability of infection and calculate the number of insertive acts that it takes to achieve risk equivalency to the number of receptive acts. That there is no absolute guarantee of infection is an artefact of the impossibility of non-infection probability reaching zero because there is no exponent applied to either .9862 or to .9989 that can yield absolute 0. It just makes sense to round up to 100% probability of infection for high cumulative amounts of risk acts because the inverse of none is not none … one or more. Of course, in this context one is all it takes and more is superfluous unless re-infection complicates the clinical picture.

Edited August 28 by SirBillybob

[pubic_assistance]

3 hours ago, Luv2play said:

That’s a very un-nuanced approach. 

YES. But I fucked my brains out with thousands of people over the past 30-some years...and never caught one STD. 

So...I would say mission accomplished.

[+ PhileasFogg]

1 hour ago, SirBillybob said:

Per-act risk accumulates nonlinearly and repeated exposures compound differently because the number of risk acts is applied as an exponent to the probability of non-infection. This doesn’t mean that you cannot take an arbitrary probability of infection and calculate the number of insertive acts that it takes to achieve risk equivalency to the number of receptive acts. That there is no absolute guarantee of infection is an artefact of the impossibility of non-infection probability reaching zero because there is no exponent applied to either .9862 or to .9989 that can yield absolute 0. It just makes sense to round up to 100% probability of infection for high cumulative amounts of risk acts because the inverse of none is not none … one or more. Of course, in this context one is all it takes and more is superfluous unless re-infection complicates the clinical picture.

You are discounting the impact of exercising care and vetting partners.  The probability of transmission between an undetectable partner abd a partner not on prep is 0.  So as Jethro Bodine would say “naught times naught is naught” 😉

But even if you assume some incremental risk, say .5%, the cumulative non linear risk is tiny.  Sorry I’m on a plane without a calculator.

I’m not disputing what you say.  It looks like a lot over time when you use 1%, but when you use the actual probability, it’s infinitesimally small 

[+ SirBillybob]

1 hour ago, PhileasFogg said:

You are discounting the impact of exercising care and vetting partners.  The probability of transmission between an undetectable partner abd a partner not on prep is 0.  So as Jethro Bodine would say “naught times naught is naught” 😉

But even if you assume some incremental risk, say .5%, the cumulative non linear risk is tiny.  Sorry I’m on a plane without a calculator.

I’m not disputing what you say.  It looks like a lot over time when you use 1%, but when you use the actual probability, it’s infinitesimally small 

Use a condom if you’re mile-high.

No, I’m not discounting anything. I am only applying the concept to the actuality of unprotected sexual intercourse with one or more partners HIV-positive with unsuppressed viremia, using those risk metrics. Believe it or not, that is how insertive partners are seroconverting, acquiring infection, even today in a world where better prevention options in combination nevertheless exist. If he had fucked 100 times over any previous period his cumulative risk of infection will already have been 10.4%. Another 100 added prospectively … 19.8%. 

I had applied it to a scenario of evaluating the appropriateness of PrEP when working with an inquiring patient whose sexual position was insertive, where he might assume that past experiences in which he evaded infection did not count towards cumulative risk due to false assumptions of a risk reset to 1/909. Those experiences could include time frames prior to the widespread clinical option of PrEP and the concept of TasP. But in my scenario the idea of TasP is irrelevant because, yes, the best estimate of transmission is zero (while mathematically > 0) due to sustained undetectability.

The cumulative experiences with a poz partner with unsuppressed viral load are not precisely quantifiable unless one knows every partner’s viral load status, but the risk ratios are measurable if you compare tops and bottoms using each respective stationary setpoint of event risk and assuming the same proportions of partners’ categorical viremia status. 

Edited August 29 by SirBillybob

[+ nycman]

5 hours ago, Luv2play said:

That’s a very un-nuanced approach. 

And a very smart one. 

Btw, do you honestly think U=U is nuanced?….come on!….pot…kettle….black. 

Honestly, I find the militancy of the "U=U" crowd to be frightening. You do you. Just don’t try to talk others into taking unnecessary risks. There is no benefit in not protecting yourself. Again, I don’t care what risks anyone takes, as long as they understand the risks. And yes, I’m aware this is a broken record, and we’ve all made our points multiple times. Pass around the pizza menu please. My order is still pepperoni with mushrooms. 

[+ SirBillybob]

It doesn’t really matter what assumptions about partners back the application of infection prevention options. Many people employ maximum protection, short of abstinence, in spite of assuming it won’t always have been necessary. To assert that they are incapable of measured nuance is absurd. 

Edited August 29 by SirBillybob

[CuriousByNature]

2 hours ago, SirBillybob said:

It doesn’t really matter what assumptions about partners back the application of infection prevention options. Many people employ maximum protection, short of abstinence, in spite of assuming it won’t always have been necessary. To assert that they are incapable of measured nuance is absurd. 

Any idea what the HIV infection risk would be if a person is on PreP and using condoms?

[CuriousByNature]

13 hours ago, PhileasFogg said:

I bet you 99.9% of the men over 20 on this forum have HPV.  

I'm in the 0.1% cohort.  Yay to being a virgin at 52!   LOL

[BuffaloKyle]

27 minutes ago, CuriousByNature said:

Any idea what the HIV infection risk would be if a person is on PreP and using condoms?

If you are on PreP and use a condom and have sex with an HIV+ person the chances of getting infected is so low it's not even worth worrying about. Also if they're undetectable it's pretty much impossible. Not saying no chance on earth for the one time it would happen but again not worth even worrying about.

Edited August 29 by BuffaloKyle