We’re Both HIV-Positive. Can We Be Reinfected?

Hi! Hope is ok for you that I contact you this way… First of all, excuse my english, is not my first language.

So, I have doubts concerning the security of me and my boyfriend (we both are hiv positive) The thing is, we want to enjoy of each others cum, but we are afraid of reinfecting ourselves… Our count is undetectable, but here in Cuba, the doctors says is not safe to get in contact with our semen. So, what can you sugest about it.

I read your articles about undetectable=untransmisible, but still, I have doubts… Thanks!

BTW, I love to read you… Thank you for that, really…

I’m not a doctor, so in most cases, I defer to what doctors say — but I think your doctor is wrong.

From The Lancet, a peer-reviewed medical journal, February 2019:

This finding reinforces existing consensus by WHO and more than [990 other organizations] worldwide that people whose HIV viral load is stably suppressed cannot sexually transmit the virus. With evidence supporting undetectable=untransmittable (U=U) now overwhelming, providers should be routinely communicating the message to all of their patients living with HIV.

From JAMA, the Journal of the American Medical Association, January 2019:

U = U signifies that individuals with HIV who receive antiretroviral therapy (ART) and have achieved and maintained an undetectable viral load cannot sexually transmit the virus to others. This concept, based on strong scientific evidence, has broad implications for the treatment of HIV infection from a scientific and public health standpoint, for the self-esteem of individuals by reducing the stigma associated with HIV, and for certain legal aspects of HIV criminalization.

From the CDC, the Centers for Disease Control and Prevention, September 2017:

People who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.

Undetectable = untransmittable — period. If you have an undetectable viral load, achieved through successful ART (antiretroviral therapy), you can’t transmit HIV to your boyfriend, or to anyone else. That is a fact.

Your doctor is uninformed (or does not accept the available data). U=U has not exactly been shouted from the rooftops as a medical breakthrough. If anything, it was hushed, avoided, and met with resistance from major medical establishments when my friend Bruce Richman started the Prevention Access Campaign and made it his mission to bring the medically-proven fact of U = U into the spotlight.

Browse the Prevention Access Campaign’s website. It includes links, articles, and helpful information — which, if you want to keep your doctor, you should refer them to.

The sluggish endorsement of U = U came from the fear that it would spur those who are not undetectable (or unaware that they are not undetectable) to forego condoms and, in doing so, put others at risk. (Never mind that people who want to engage in sexually risky behavior will do so regardless of what any medical institution says.) Also, to be wrong about such a statement would be a travesty and bring lawsuits, so hesitation was borne simply of an overabundance of caution and an absence of verified and accessible information that U = U is true, including various extensive studies and their results. The Prevention Access Campaign compiled and promoted these studies and urged major medical establishments to assert that U = U is, in fact, true. To date, all major ones have.

Let’s move on to your fears of reinfection, dual infection, or “superinfection”, which is such a ridiculous scare word that I’m tempted to roll my eyes. All of these terms describe the same thing. Reinfection with a drug-resistant strain of HIV is a concern if the person fucking you can transmit HIV. If your boyfriend is undetectable, he can’t. Here’s a screenshot from Terrence Higgins Trust, a British HIV/AIDS charity organization:

Screen Shot 2020-05-28 at 4.16.53 AM

If you’re both undetectable, this isn’t something to worry about. If at any point one of you is not undetectable, you can only get reinfected (or “superinfected”) if your boyfriend has a different strain of HIV than you do, and as far as we can tell, this would only be a problem if his strain is resistant to the meds you’re currently taking (or may want to take in the future).

There are dozens of different, naturally replicating strains of HIV out there, but since you both live in the same place, he probably has the same strain you do.  Regardless if he has the same strain of HIV as you do, his strain will only become resistant to his drugs if his adherence to medication is poor.

Reinfection is something I’ve truly never worried about, not once, and I never use condoms. But I’m also not the paragon of responsibility, so I decided to seek credible information. Your question made me do some research and here’s what I’ve found: After more than fifty years battling AIDS worldwide, nobody seems to know anything conclusive about dual infection. Besides the risk of catching a strain that is medication-resistant, there is no incontestable evidence that a person having two different strains of HIV causes a significant change in their symptoms or in the progression of the disease.

The term “superinfection” was coined in 2002 when investigators at the Massachusetts General Hospital showed that a patient with previously well-controlled HIV infection and robust T-cell responses later developed accelerated disease progression after infection with a new strain of HIV. But here’s a critical detail: the report of this patient could not address whether or not their dual infection was associated with poorer clinical outcomes compared to infection with a single virus.

When you do your own research — and you should — here’s some help. When I seek out credible information about HIV — information which I know is edited and vetted by diligent, sex-positive editors and written in language I can understand (journals for medical professionals and actual medical reports are usually too dense with medical jargon for me to understand) — I look to Plus and TheBody. I trust these sources because I’ve written for them and know their staff. But even in these outlets, a smattering of headlines show that there are ample doubts and inconsistencies in what we know about dual infection: “AIDS Expert Questions the Threat of HIV ‘Superinfection’” in 2003, “Study Finds No Sign of Superinfection” in 2004, “Is HIV Superinfection Unhealthy?” in 2014, and, most recently, “Whatever Happened to HIV Superinfection?” in April 2020, which helpfully explains the reality of natural different strains of HIV (called HIV subtypes):

Screen Shot 2020-05-28 at 4.55.07 AM

Simply put, there are more than 37 million people living with HIV/AIDS in the world, so the fact that we know so little about dual infection shows it’s not significant enough to be a major source of stress. Drug-resistant strains are real, but so too is our proliferation of new drugs. And again, if your boyfriend is verifiably undetectable, you’re not going to get infected with his strain, no matter what it is.

None of this means that bareback sex is free of risk. We haven’t addressed the risk posed by other sexually transmitted infections like gonorrhea and syphilis. And you could always be unlucky — your boyfriend may be lax about taking his meds, he may not truly be undetectable, his virus may become resistant to his drugs, and you may get infected with a strain of HIV that is resistant to your medication. There’s always that risk. Every time I get fucked without a condom by someone who I believe in HIV-positive and undetectable, there’s always that risk for me, too. There’s always some percentage of health risk no matter what we do sexually, so you have to be willing to gamble a little bit, research the facts, and take informed risks without sacrificing pleasure.

This is one instance in which I think the pleasure payoff — enjoying your boyfriend’s cum — is worth the very small risk that you’ll have complications from a dual infection. I can’t make that decision for you — but if I were you, I’d get loaded up by my undetectable boyfriend tomorrow. Or tonight. Or right-fucking-now.

As with all posts involving medical science, I have to say that I’m not a doctor and you should consult a professional — but in this case, I suggest consulting a different professional. If you can, get a new doctor, ideally one who specializes in HIV care.

Love, Beastly

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