Re-infection and Poz-Poz Sex

Many positive gay men sometimes consider sex without condoms. Reasons people choose not to use condoms include:

‘I already have HIV’

‘I am on treatment so I can’t pass on HIV’, and

‘STIs are easily treated’

I Already Have HIV

For some time there has been debate about the risk of acquiring another ‘type’ of HIV through unprotected sex. Seroconverting (becoming HIV positive) with a different ‘strain’ of HIV is called reinfection (also referred to as superinfection*). The term reinfection can also mean acquiring treatment resistance after coming into contact with someone else’s already treatment resistant HIV strain.

Reinfection

The main type of HIV in Australia is subtype B. Subtype B is also the most common type in Western Europe and the United States. Reinfection can occur with a different strain of HIV, or possibly with a similar strain (though this is more difficult to prove). It used to be thought that reinfection was a rare event. It can occur in the early stages of HIV infection, up to several years after infection.

Generally, reinfection doesn’t seem to cause many problems, but occasionally it causes a person’s viral load to rise and their CD4 count to drop.

Condoms and water based lube can help prevent reinfection during anal intercourse. It is also thought that someone taking treatment is less likely to pass on or become reinfected with another strain of HIV, especially if their viral load is undetectable.

What About Passing on Resistance?

‘Treatment resistance’ develops when people on treatment miss doses, or take short breaks from their treatments, resulting in there being insufficient levels of the drug in their body to keep HIV under control. HIV reproduces itself very quickly and in very high amounts. Each individual virus can change or ‘mutate’ and be slightly different in structure to its ‘parent’ virus. If a mutation results in a change to a part of the HIV virus that is targeted by an anti-HIV treatment, then that treatment may no longer work as well against the virus.

Resistance can result in a person needing to change their treatment to a combination that might be more difficult to take, or has a higher risk of side-effects. This is why we hear lots of messages reminding us to take our medication exactly as it’s prescribed by your doctor.

If a person with resistant HIV passes HIV on to a negative partner then the partner will become positive with the same resistant strain of HIV. Studies in Australia suggest that it occurs in approximately 15% of all new cases of HIV infection. This is why resistance testing is recommended before commencing HIV treatments.

If two men with HIV have unprotected anal intercourse and one of them has resistant HIV and the other doesn’t, it is possible for the resistant HIV strain to be passed from the one to the other. This could lead to the partner without resistance developing resistance. Although sexual transmission of resistant HIV has been proven through blood tests it is not clear how often this happens. Researchers believe that the sexual transmission of HIV resistance is more likely to occur in the first three years of being HIV positive and if an STI like syphilis or herpes is present.

Condoms and water based lube prevent the sexual transmission of HIV resistance. Researchers believe that for someone on adequate and regular treatment it is less likely for them to pass on or acquire HIV resistance.

Hep C, Syphilis and Other STIs

Fucking without condoms increases your risk of exposure to other sexually transmissible infections (STIs). Many STIs are asymptomatic (have no symptoms) so you might not know you have one. Even though most STIs are easily treated with medication, if they are left untreated they can cause serious health problems. There is increasing concern about sexual transmission of hepatitis C and syphilis among HIV-positive men. Both can cause serious illness. For more information see our Hepatitis C page.