Can HIV+ Gay Men Practice Safe Sex without a Condom?

We all know how safe sex works; we’ve been through the exhaustive classes at school and the awkward lectures in the doctor’s office, after blood tests. But despite the warnings, sometimes we just don’t use a condom – sometimes it’s because we want to feel closer to our partners, and at others it’s just because, it feels better. Either way the decision to go condom-less, can have a pretty huge impact on you and your partner’s wellbeing, even if it doesn’t seem like it in the moment. This is especially true if either of you are HIV+.

A study conducted by the UNSW in 2014 showed decreasing condom use across all demographics in Australia, a statistic which had led to a comparable increase in STI rates across the country, with transmissions of gonorrhoea and chlamydia both increasing. While gay men are, by and large, more aware of sexual risk and take some precautions to mitigate it, they can still be vulnerable to transmission.

Enter Antiretroviral Treatments

Advances in HIV treatment have yielded a new breed of medicines known as (ART). Consistent use of these therapies work to reduce the amount of HIV replicating immune cells present in the body to below a threshold level, usually under 50. If, through treatment, an HIV positive person is able to maintain their status at below this level, they are described as having an “undetectable viral load” (UVL).

Trials conducted in both Switzerland and South Africa have shown no documented cases of HIV transmission among couples with an HIV positive partner. This was true, even in the many instances where no condoms or other prophylactics were being used. The findings were so definitive that the head of the South African HIV Clinicians Society declared,

No other intervention beyond abstinence shows such a level of protection. It’s probably even safer than condoms because things often go wrong with condoms.’€

While neither study came right out and said that ART was a strategy for effective safe sex, the conclusion is easy to draw on your own.

PReP and PEP

For HIV negative individuals, the introduction of preventive medical treatments such as Truvada have mean that they no longer have to rely on their partners word to practice safe, condom-less sex. While the drug is still not available under insurer coverage in Australia, the treatment works in much the same way as a traditional ART preventing HIV transmission with an efficacy of up to 99%, just as effective as using condoms.

In addition, retroactive treatments such as PEP are available for gay men who suspect they’ve been involved in risky sex with HIV positive individuals. While not 100% effective, this medicinal course can greatly reduce your chances of infection as long as they’re started within 72 hours of intercourse.

It is an established fact that anal sex is the most HIV sensitive form of sexual contact. This puts many gay men right at the top of the list for risk of transmission, a statistic that’s unfortunately been borne out across the years. However, with new treatments coming to the fore, it might well be possible that in the years to come, gay men can enjoy safe sexual relations without resorting to condoms at all.

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