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Safety Research, Risk, and Activity

Dear Dr.,
I am a white heterosexual female that recently tested negative on my annual STI screening. I have been dating a male friend after casual contact for many months. At the end of our first date, after kissing goodbye (more than 'social' or 'casual' kissing), he told me that he has been HIV+ for 10 years, has been 'healthy' (no serious infections), and has been on ARV therapy for a year. I began to research levels of risk and safe activities for us that exclude sex (penetrative or oral-- we've agreed to keep sex off the table). We have been seeing each other routinely for 2 weeks.
I first discovered that "deep kissing" is not considered a mode of transmission by many medical experts, but that there are certain government (US and UK) websites that address this as "low risk." He and I have engaged in deep kissing, and neither of us have sores, cuts, or wounds in our mouths. Can you please clarify the risk in this since I have found conflicting information? Next, after learning that mutual masturbation is not considered risky, we decided to try that. Continued research however, again because of conflicting information, confused me about risk here as well. I kept my panties on during the episode, in which he brought me to climax through rubbing over my panties. Because neither he not I have open cuts or sores on our bodies (including hands), he did not wear a condom while I provided a hand job. My question relates to precum-- my panties remained in place during the episode, but his hands, which may have had precum on them, briefly brushed my vulva twice as his fingers slipped under my panties. Can you please describe the risk involved here, (the frequently noted point that "HIV does not live long outside the body" is rather vague), and suggest how to reduce risk during mutual masturbation in the future?  I am trying to be as safe as possible, and would like to know if I need to get tested. A respectful thank you for your time.
1 Responses
936016 tn?1332765604
Hello and thanks for your post.

Treated HIV positive people aim to have viral load = the amount of circulating virus per one ml of body fluid - as low as possible and ideally and usually we aim to get this to undetectable levels. The lower point of detection in most HIV treatment units will be around 20 to 50 copies of virus per ml of blood.

New HIV infection will often result in immediate levels of greater than 10 million copies per ml so you can see that the treatments work well nd are effective at collapsing the amount of virus.

In addition, most new HIV positive people will experience a massive and natural reduction in their virus levels within say a few months. So the initial millions of copies will naturally reduce to perhaps 50,000 to say 100,000 copies. Again, a very sizeable reduction but generally not as good as the treated group.

Most HIV positive people will within 10 years require and be started on effective treatment.

So in the situation you describe it is likely that your man has undetectable viral load and consequently will not be infectious in any realistic way.

In any event, kissing and deep kissing present no risk.

Mutual masturbation presents no risk.

Mutual masturbation with pre-cum on fingers in my view presents no risk. Bear in mind that the calculated risk of HIV acquisition via unprotected vaginal sex with ejaculation with an HIV positive male is of the order of 0.001% per episode - ie 1 in 1000. In you reduce this risk to near inconsequential by use of anti HIV medicines then you can see that the prospect for infection via fingering with pre-cum is vanishingly small.

There is no further information beyond what you have regarding how long HIV survives outside the body.

I think all of what you have described is fine.

kind regards, Sean
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