Is it Ever OK to Have Sex Without a Condom?

Can an HIV-positive person ever have sex without a condom again?
The answer is yes, but with a very large asterisk, says Dr. Gary Cohan. With better antiretroviral treatment and PrEP, it is possible to conceive of a situation where couples could have sex without a condom with a small risk of transmission. In the PARTNER study of serodiscordant couples, preliminary results show that among more than 700 couples, that no HIV-positive person with a viral load of less than 200 copies per milliliter of blood transmitted the virus to their uninfected partner. But these results come two years into a five-year study. Cohan cautions to follow the Centers for Disease Control and Prevention guidelines for using pre-exposure prophylaxis, or PrEP, which emphasizes using condoms in conjunction because they prevent not only the spread of HIV but also other sexually transmitted infections.

“Many HIV-positive people have falsely conflated the term ‘undetectable’ with ‘noninfectious,’” says Cohan (although some other doctors, like Robert Grant, below, do use such terminology). “This is not yet proven to be true and has created lots of confusion and risk taking by sexually active people.” “Undetectable” means that a person’s viral load is below a quantifiable level, but it is not the same as HIV having been completely eliminated. “Many HIV-negative patients have shared with me situations in which HIV-positive people have stated to them, ‘I’m positive but undetectable, so you can’t get HIV from me.’ Simply not unequivocally proven — yet,” Cohan says.

So can a person with HIV ever have sex without a condom again? “[It] completely depends on each sex partner’s appetite for risk — risk of HIV transmission to the negative partner, whether the HIV-positive person is on effective antiviral therapy (i.e. ‘undetectable’ viral load), whether the negative partner is on daily PrEP, and whether everyone understands the risk of acquiring and transmitting HIV and other STDs like syphilis, gonorrhea, chlamydia, herpes, hepatitis C, etc.,” says Cohan.