Does protection matter if both people have HIV/AIDS?

Dear Reader, 

Safer sex can be important regardless of someone’s human immunodeficiency virus (HIV) status because of the risk of other sexually transmitted infections (STIs). For people living with HIV, it’s possible to have a co-infection, where the HIV positive person develops another infection on top of their HIV infection. This can make both infections much more difficult  to treat. People with HIV can also develop an HIV superinfection, where they become infected by another strain of the HIV virus that either replaces the original strain or stays in the body with the original one (having two HIV strains at once is considered a dual-infection). Even if the HIV positive person is getting treated for HIV, a superinfection can make them sick faster because the treatment may not be as effective on the new virus. 

Reader, it sounds like you’re trying to help your friend determine when his sexual activity is risky. Sexual activity for individuals with HIV and AIDS is complex and involves different factors you may want to consider, talking with him about: 

• If your friend or his partners have STIs other than HIV, are they getting treated for them? If he or his partner(s) have other untreated STIs, they may transmit that STI and may be more likely to get or transmit HIV. 
• Are your friend and his partner(s) receiving HIV treatment? If they’re taking antiretroviral therapy (ART) and have an undetectable viral load, HIV transmission is very unlikely. On the other hand, if they aren't getting treated, they’re more likely to transmit HIV because of their higher viral loads. However, even if all HIV-positive partners have received treatment, your friend may want to consider using protection if any partner is unsure about their viral load, has a high viral load (defined as 200 copies of HIV per milliliter of blood or more), or is experiencing challenges taking their HIV medicine regularly. 

It’s great that you’re concerned about your friend’s health. Having a discussion with him about these concerns may be useful in helping you understand why he’s making certain decisions. If you’re considering how to communicate your concerns in a way that helps your friend feel supported, you might try: 

• Educating yourself about HIV. Having a good understanding of HIV can help you to speak more confidently about your concerns, encourage the use of protection, and advocate for HIV treatment and treatment adherence. Consider checking out HIV.gov’s HIV Basics pages to find more information. 
• Preparing your talking points ahead of time. To open the conversation, you could mention that you came across information about HIV that made you concerned about their well-being. You might share that information, then ask questions like “Are you or your partner(s) receiving treatment for HIV or other STIs?” “Are you or your partner(s) adhering to the treatment regimen?” to help your friend reflect on the risks of unprotected sex. 
• Practicing effective communication skills during the conversation. Being focused and engaged, withholding judgment, and managing your stress levels can help you listen to your friend and articulate your thoughts in an even-toned manner. Having these communication skills may also help your friend to feel supported and understood rather than judged or attacked. 
• Providing resources. Depending on your friend’s needs, you may want to share HIV.gov’s HIV Testing Sites & Care Services Locator or the Centers for Disease Control and Prevention’s Get Tested resource. Both of these resources may help him find nearby STI testing sites. 

Your friend is lucky to have someone like you by his side. Taking the time to educate yourself so you can then be able to share that information with him can be a great way to show him you care. 

Best of luck in encouraging safe sex,