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Op-Ed

HIV-positive and wants to bareback

An HIV-positive Filipino asks if it’s okay to have unprotected sex with another HIV-positive person; and Dr. Jose Narciso Melchor Sescon answers.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.

Dear Doc,

I am HIV-positive, and I prefer hooking up with other HIV-positive guys because I find it more comfortable – we don’t have to hide our status from each other.

A few days ago, one HIV-positive person invited me for bareback sex. He said that we can do this as long as: 1) We have the same strain; 2) We have the same ARVs; and 3) We have undetectable viral load.

Is the guy correct?

Poz guy who is considering

Generally, HIV-positive individuals are more comfortable hooking up with their peers (same HIV status) as there is no shame, guilt nor fear in openly discussing among themselves almost anything. Having peers around you makes life more meaningful, important for you to live on and live productively. Peers are effective in making life situations realistic because of shared commonalities.

With the recent advances in HIV and AIDS treatment, we now see HIV as manageable, just like any other chronic diseases like diabetes and hypertension. We have seen PLHIV become productive as they return to work, just as they also now have longer life expectancy.

But in the case you mentioned above, bareback sex (anal sex without condom) is still not recommended. This is for the simple reason that we want both partners to practice “responsible” sex at all times, and this means using latex or polyethylene condoms and water based lubricants for anal sex. Doing this is still the best evidence-based move that lowers the risk of HIV infection, HIV transmission, or STI infection.

Although the criteria mentioned (e.g. same strain, on consistent ARV treatment, undetectable viral load) could point to a lesser risk, you are still risking impinging your immune system for various reasons.

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Good if the persons involved have the same HIV strain. However, in resource constraint settings, this HIV genotyping (determining HIV strains) is not routinely done because of logistic reasons. Also, if ever done at all, it is usually for research purposes only. The last HIV genotyping done in the Philippines was close to two decades ago, and at that time, PLHIV already had more than one HIV strain.

Note that one PLHIV can have two or more HIV strains in their bodies. HIV strains are further categorized or classified geographically (where they commonly abound), and also according to activity (either as “fast” progressors and “slow” progressors).

We have read about PLHIV in rich and developed countries who are “confident” and are complacent to do barebacking, and yet they kept their status quo. But this cannot be said for those in developing countries such as ours, where times have evolved, and where ARV treatment failures and drug resistances issues abound.  So every sexual encounter should always be protected.

It’s not just with condom use; the issue I want to highlight is the practice of responsible sex. Practice safe sex; no barebacking please!

At the end of the day, whatever the decision is of the couple/partners, the decision they made is to be respected. But on our end, full information based on available evidence-based information has been provided for them to make a conscientious decision. If at the end of the day they still choose to bareback, then they are consenting adults knowing the levels of risks that they want to practice, and that are acceptable to both.

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