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FAQ: Risk of sex with another HIV-positive person?

for Veterans and the Public

Frequently Asked Questions

Q: Is it safe for an HIV-positive person to have unprotected sex with another HIV-positive person?

There is no clear-cut answer, but here are some things to consider.

First, there are different types or "strains" of the HIV virus. A person who's been infected with one strain can become infected with a second strain when exposed to it (such as through unprotected sex). This is referred to as a second infection or "superinfection." It is not yet clear how often superinfection occurs, but it appears to be quite uncommon. A person whose first HIV infection is relatively recent may be more susceptible to infection with a second strain. Someone may become sicker once the second strain of the virus enters the system. This happens because the new strain may be more difficult for the immune system to control, or because the new strain is resistant to the HIV medications the person is taking. (See resistance testing for an explanation of what it means for the virus to be resistant.)

If an HIV-positive person is taking antiretroviral medicine and has an undetectable viral load, the risk of infecting someone else through sex is much lower than it would be if the viral load is high, but other factors (such as whether one of the partners has an STD) may increase the risk of HIV transmission. Studies are going on right now to try to answer questions about HIV reinfection, but in the meantime, HIV-infected individuals will have to decide whether they are willing to take the risk not only of becoming superinfected, but also of possibly superinfecting someone else.

There are more reasons for two HIV-positive people to avoid unprotected sex. Unprotected sex allows the transmission of other sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, and syphilis. Nearly all STDs are curable, but syphilis can be more complicated to treat if you have HIV. Also, there is a risk of acquiring hepatitis B and hepatitis C through unprotected sex; these can be difficult to treat.