DEAR EMEN8: I’ve been with my amazing boyfriend for many months now and we’re both feeling like we’re ready to ditch the condoms. The thing is, he’s HIV positive and undetectable. He’s suggested I go on PrEP. Do I need to? — UNSURE ABOUT CHOICES, SOMEWHERE IN AUSTRALIA
DEAR UNSURE: You’re certainly not alone — you pose a great question we’ve thought a lot about too. There are a few things to consider and discuss with your partner, so we’ve broken these down in the hope it will give you some insight into deciding what’s best for you both based on your circumstances.
About undetectable viral load
We love that you and your boyfriend are looking to be even more intimate with each other while also thinking about your sexual health. It’s also great that you both know he’s undetectable. Although we’re curious if you know what being undetectable means?
Here’s the deal: if your boyfriend is living with HIV and is using HIV treatment to maintain an undetectable viral load for at least six months, there’s effectively no risk of him transmitting HIV to you — even if you’re not on PrEP and you don’t use condoms.
“How he manages his HIV treatment is something you both might want to talk about.”
We also recognise that using HIV treatment medication regularly is an important factor for him to stay undetectable. Maintaining a regular treatment regime isn’t just beneficial for your wonderful sex life together — it’s essential for him to stay healthy. How he manages his HIV treatment is something you both might want to talk about.
It’s great you’ve mentioned PrEP. It’s been getting a lot of attention lately, especially since it’s now available on the PBS. If you do decide PrEP is right for you, this will help make it affordable and convenient to access wherever you’re based in Australia.
And just in case you didn’t know, PrEP is a daily pill that’s highly effective at keeping you HIV negative. Using PrEP involves taking one pill a day and checking in with a GP every three months for routine HIV and STI tests.
Regardless of your partner’s HIV status, PrEP can do an excellent job keeping you protected against HIV, although it doesn’t protect against STIs.
Who else is involved?
At Emen8 we know monogamy is one type of relationship and there are plenty of others that sometimes involve sex with other people. We love the diversity of these relationships, but it’s up to you guys to agree on what you’ll be doing in yours. If there’s a chance that either or both of you might have sex with other people, it’s worth talking about first.
“If there’s a chance that either or both of you might have sex with other people, it’s worth talking about first.”
Having sex with other people could mean there’s a chance of acquiring STIs outside of your relationship — even when condoms are used every time. Going for regular sexual health tests is important for both of you to help identify and treat any infections early.
How does your boyfriend feel?
Isn’t it wonderful when our loved ones support us and look out for us? If your boyfriend’s suggested you use PrEP even though he’s undetectable, it sounds like he might be really keen to make sure you stay as protected as possible. You might want to consider discussing why he’s suggested PrEP. It might provide some insights into how he’s feeling and what’s important to him.
We don’t know for sure what your boyfriend’s concerns are, but there’s a chance he might have faced some challenging experiences of HIV stigma, affecting the way he feels about himself and sexual safety. If he cherishes you, the thought of you being at risk could be upsetting — and the thought of him being the cause of that risk perhaps even more so.
“Learning to let go of any anxiety and feeling confident to try new things might not happen overnight.”
What’s valuable for you to both know is that while your boyfriend maintains an undetectable viral load, you don’t need PrEP to keep your body safe. He’s already ensuring you’re not at risk from HIV as a result of his treatment helping him to stay undetectable. But we also recognise feelings and emotions sometimes make it tricky to have immediate faith in medical science while we warm to new notions of what safe sex means to each of us.
Although the science and the way we understand the benefits of HIV treatment have progressed rapidly, attitudes towards HIV haven’t advanced quite as fast for everyone. Coming to terms with the fact that your boyfriend won’t pass the virus on to you — even without condoms — might take a little while for both of you to get used to. Learning to let go of any anxiety and feeling confident to try new things might not happen overnight. Being informed as well as patient, caring and supportive of each other will help get you there. We know of plenty of other couples who have.
Sharing the responsibility for your safety
Although you don’t need PrEP to keep your body safe, that shouldn’t stop you from choosing it if you decide that’s what you want. What’s good to know is you can always choose to start PrEP and see how you go. PrEP doesn’t have to be forever; you can decide to stop at any time after consulting with your GP.
In some ways, choosing PrEP might mean you’d be managing HIV in a similar way to your boyfriend. You’d both use safe and effective antiretroviral medication every day, even though one of you lives with HIV and the other one doesn’t. Just remember he isn’t afforded the same opportunity to stop taking his medication without seriously impacting his health. If your boyfriend feels he’s carried the burden of responsibility for protecting you against HIV, PrEP might offer an opportunity for you to share that responsibility with him.
“PrEP doesn’t have to be forever; you can decide to stop at any time after consulting with your GP.”
We hope you can see there are a few important things to consider when making the decision to not use condoms in your relationship. But don’t forget, condoms have and will continue to play a huge part in helping to prevent HIV and STI transmissions for many people. We don’t expect them to disappear from shops or bedrooms any time soon. If anything about your situation changes, you can always consider reintroducing them.
However your shared journey towards connection, pleasure and intimacy develops; what’s wonderful is the opportunity to embark on it together. Learning to navigate through any anxiety presents an opportunity to strengthen bonds; giving each other permission to not worry is a valuable compass for keeping you on track.
Most of all, we really hope that knowing your boyfriend can’t pass on HIV to you, while he’s maintaining an undetectable viral load for six months or more, whether you use PrEP or not is reassuring and nurturing for you both. With knowledge like that, perhaps we can all look forward to building even more loving relationships with each other.