I’ve run into an old girlfriend and would like to get involved, but now she has HIV. She’s on medication and says her viral load is undetectable. I know it’s hard for women to give HIV to men. So why does she insist on using condoms?
Your old girlfriend is showing great respect for you and herself by being truthful and stressing that you use condoms. You are correct that it is more difficult for a woman to infect a man through sexual contact than vice versa.
In the U.S., a man with HIV is eight times more likely to infect a woman during intercourse than a woman is to infect a man. Still, the risk exists. The presence of sexually transmitted infections (STIs)—which many people unknowingly have—increases the odds. STIs depress the immune system and can cause microscopic breaks in the skin in and around the genitals through which HIV in semen or vaginal secretions can enter the partner’s bloodstream, causing infection.
Therefore, you should both be tested and treated for STIs, and you should be tested for HIV, if you haven’t been already. On top of the risk you face, accidentally giving her an STI (or infecting her with a different strain of HIV) could compromise her immune system, possibly jeopardizing her well-being.
The likelihood that your partner will infect you with HIV increases as her viral load (the amount of virus in her system) rises. Her undetectable status means the virus is present at very low levels; it does not mean it is absent. I recommend that the two of you meet with an HIV specialist to discuss the risk of specific behaviors.
Use male or female condoms each time you have sex, and get tested and treated for STIs and HIV every six months. This frees you to concentrate on your relationship. If her insistence upon using condoms reflects her feelings for you, then you have a special lady.
Ask the Sexpert
Gail Wyatt, PhD, director of the sexual health program and associate director of the AIDS Institute at UCLA, assists us between the sheets