My boyfriend’s viral load is undetectable. can we stop using condoms? Tim

This is a question that a lot of people might wonder about. We asked Dr Robert Finlayson, from Taylor Square Private Clinic who has twenty years experience in HIV and Sexual Health what science tells us about this issue.

It’s been known for years that HIV infectiousness is related to HIV viral load, so that a person with a high viral load will be more infectious when having unprotected sex than someone with a low or “undetectable “ viral load.

“Undetectable” viral load means there are less than 40 copies/ml of HIV* in the plasma (the fluid part of blood), but the virus may still be in some blood cells, and even more often still be in semen (cum) and rectal mucous. This is why there could still be some risk when you have unprotected sex with someone whose viral load is “undetectable”.

The risk of transmitting HIV is much greater if there is any inflammation in the genitals, a sexually transmitted disease or trauma. Also, someone may have been “undetectable” at their last test but not have taken their pills 100% of the time since, so their viral load might be higher than it was when they were tested.

Safer sex is still recommended even if your partner is “undetectable”.

*40 copies/ml is as low as the viral load test can detect.

Condoms are proven to be the safest way to avoid passing on or getting HIV.

In some relationships guys are using undetectable viral load without condoms to reduce their risk of passing on or getting HIV. Much more research still needs to be done on the effectiveness of this practice for gay men.

An undetectable viral load decreases the risk of passing on or getting HIV only if -

• You never miss a treatment dose
• Your viral load has been consistently undetectable over a six month period
• You and your partner do not have an STI

Condoms can take the stress out of all these uncertainties. Keep talking to each other about slip-ups or any sexual risks you take. Editors