Expert: Terry B - 3/29/2007

Question
A few questions. I have rejoined with my x after 10 years apart and have found she is HIV positive now. She has a very low virtual load and is very aggressive with her medications. However I am a very sexually active person.

1. We engage in a lot of oral both giving and receiving. I am very aggressive and lick and lap like a German Shepard. Probably a stupid question but what are my chances of infection with or without mouth sores?

2. I am confused as to why oral is not as risky as intercourse. How can one form of sex be less risky than another? I love sex with her and will on occasion have unprotected sex with her. I guess this is risky and it is just a chance I take I guess.

I assume that these are stupid questions as no one really knows what your chances are and sex with a positive person puts you at risk…duhhh.  Guess I should just get my will updated and go for it. I am not really interested in living with out her anyway.

Answer
Dear Steve:

Peace and all good things to you and yours.  I am amazed by your letter - "No greater love..."  Your questions are not stupid in the least.  There are, however, some things you may want to consider.  

Part of caring for another means not endangering them needlessly (or burdening them with guilt).  What are her thoughts about the risk of you becoming infected (if you are not already)?  It is worth a conversation.

Also, should you become infected, the action of HIV and its mutations is such that variations can hasten death for the both of you. HIV is like a bad copying machine.  About half of the copies are so poor that they cannot replicate; a quarter of the copies are exact duplicates of the original, and another quarter are close but not exact copies - these are mutations which may have developed resistance to available medications.  Because the mutation and replication process goes on throughout the course of the disease at a very high rate, in a person undiagnosed or untreated, the variation of these mutations is tremendous, increasing chances that a resistant variation will survive and become dominant.  

For two people who are infected and exchanging fluids, the effect is a continual reintroduction of HIV variants - speeding medication resistance, further impacting the immune system, and hastening illness and death for both.  From what you write, I would think you would seek to prevent, alleviate, or postpone the illness, suffering, and debilitation of your partner.

One can engage in expression of love and passion while at the same time modifying behaviors toward a tolerable balance between excitement and protection.  A web search should help you find others in similar situations where you can share your experiences, concerns, and tips on safer erotic living.  I encourage you to seek these out - www.thebody.com might be a good place to start.

As for your specific questions:  Blood, semen, vaginal secretions and breast milk are the fluids that transmit HIV.  If you come in contact with these fluids from an infected person you are "exposed" to HIV.  

As with all illnesses, "exposure" does not necessarily lead to becoming infected.  The factors which contribute to an exposure becoming an infection include the Route, Frequency, Amount, Area, Duration, and Concentration of Virus.  Impacting any of these reduces risk.

Regarding Route:  Skin and mucous membranes are the body's barrier against pathogens (germs).  A break in these (a cut, a sore) makes it easier for a pathogen such as HIV to find entry into the body - and access to the cells it needs to replicate.  Unprotected receptive anal sex is also dangerous because the fluids can be absorbed through the intestinal wall.

RE: Frequency - the more times exposed, the greater the risk.

RE: Amount - the more fluid to which you are exposed, the greater the risk.

RE: Area - the greater the area (amount of skin or mucous membrane exposed) the greater the risk.  This may account for why persons who are receptive, uncircumcised males and persons who douche after intercourse are at higher risk.

RE: Duration - the longer you are exposed, the greater the risk.  Again, persons who are receptive to the fluids of another during a sex act are at greater risk.

RE: Concentration of Virus - Viral (not "virtual") load (how many particles of virus per mm3 of fluid) is highest during initial infection and at life end, when the body is unable to suppress HIV.  While a person on medication therapies with a low or 'undetectable' viral load is less likely to infect, understand also that those viral particles present may have survived because they are resistant to available medications.  This means that if you (or she) become infected or reinfect it may be with resistant viral strains (see note above about hastening to illness and death).

If you have read this far, I hope I have captured your attention and provided you with some information that will enhance not only your sex but your love for each other.  Oral sex with a non-permeable barrier (some cellophane wraps, latex), consistent condom use, and other tips you might find should help you find the balance between caring for each other's health and still enjoying your relationship.

Again, I thank you for your letter, your excellent questions, and an opportunity to address an issue not often brought up in this forum.

Sincerely,

Terry B