HIV/AIDS

Q: I am HIV positive, and I take HIV medications. My partner is HIV negative. Should he/she start pre-exposure prophylaxis (PrEP) medication to protect him/herself from becoming infected?

If you take your HIV medications every day and your HIV viral load always is "undetectable" (so low that it is not detected on lab tests), the chances of infecting your partner are very, very low, so low that experts say there is "effectively no risk" of sexual transmission to a partner. But, if you sometimes forget to take your HIV medicines, or your HIV viral load sometimes is not undetectable, we recommend that you as a couple take additional steps to prevent the HIV-negative partner from becoming infected. And your partner may want to use his/her own prevention method, regardless of your HIV viral load. Preventative methods could include using PrEP, using condoms, and/or avoiding riskier forms of sex.

PrEP refers to a medicine (Truvada^®) that is taken by HIV-negative people to reduce their risk of becoming infected. PrEP is highly effective if it is taken correctly and consistently, every day. The U.S. Centers for Disease Control and Prevention (CDC) recommends that we consider PrEP for anyone who has a sex partner or injection-drug-using partner who is HIV positive. So, this would apply to your partner. We do not yet have scientific data to tell us whether PrEP will add extra protection if the positive partner's HIV viral load is continuously "undetectable" on HIV meds, but we should know more in the next few years. Certainly, if your partner has other partners (that is, if you do not have a monogamous relationship), PrEP will decrease his/her risk of getting HIV from those other partners. Your partner should speak with his/her health care provider about PrEP and get expert advice on whether PrEP would be a good HIV prevention method for him/her.

Q: I am HIV positive, and I do not take HIV medications. My partner is HIV negative. Should he/she start PrEP to protect him/herself from becoming infected?

If your HIV virus is not suppressed by consistently taking HIV medications (antiretrovirals, or ARVs), the risk of your partner becoming infected through sex or through sharing drug injecting equipment is quite high, unless you as a couple take measures to reduce this risk. Pre-exposure prophylaxis (PrEP) is medication (Truvada^®) that is taken every day by an HIV-negative person to prevent HIV infection. PrEP can be highly effective if it is taken correctly and consistently, especially if it is used in conjunction with other methods of reducing HIV risk (such as using condoms or sterile injection drug equipment).

The U.S. Centers for Disease Control and Prevention (CDC) recommends that we consider PrEP for anyone who has a sex partner or injection-drug-using partner who is HIV positive. So, your partner definitely should think about whether PrEP would be a good prevention method for him/her. He or she should speak with a health care provider to learn more about PrEP and other HIV prevention practices.

Coming back to you, I am very concerned that you are not taking HIV medications. We have a great deal of scientific data proving that people live longer and healthier lives if their HIV is controlled with medications, no matter what their CD4 counts are or how well they feel at any one moment. And, we know that your risk of infecting another person is extremely low if you are on HIV meds. So, please consider taking HIV medications -- for your own health as well as to prevent transmission to others.

Q: I am HIV positive. My partner is HIV negative and is taking PrEP. Do we still need to use condoms?

PrEP is highly effective at preventing HIV infection if it is used correctly and consistently, every day. But it is not 100% effective. Since you are HIV positive and your partner is HIV negative, it is recommended that you as a couple use additional methods of reducing HIV risk such as condoms while your partner uses PrEP. And, remember that consistent and correct use of condoms can prevent sexually transmitted diseases, and pregnancy. You, as the partner with HIV, should start HIV medications (ART) if you are not already on meds. HIV treatment is good for your health, and it also enormously reduces the risk of infecting HIV-negative partners.