Is it OK to use PrEP instead of condoms if my partner's HIV-positive?
Dr Tlaleng Mofokeng answers your questions about sexual health
Q: Can my partner and I use PrEP instead of condoms, given that one of us is HIV-positive?
A: PrEP is an antiretroviral drug in tablet form for use by people who are HIV-negative to decrease the risk of HIV acquisition. PrEP has to be taken daily and can reduce a patient's chances of contracting HIV by more than 90%, according to the US Centers for Disease Control.
The clinical scenario you describe, where one of you is HIV-positive and the other HIV-negative, is referred to as HIV-serodiscordant and is common.
PrEP is recommended for use as there is an increased risk of exposure to HIV through sexual contact. It is also indicated in those who may, for other reasons, not be in a position to negotiate condom use every time.
Other groups deemed to be at increased risk include young women, sex workers and men having sex with men. PrEP has a significant impact in reducing the risks of HIV transmission, and thus can contribute to a more pleasurable sexual experience.
However, PrEP does not prevent pregnancy or protect against other sexually transmissible infections (STIs) like gonorrhoea, syphilis and chlamydia.
In some cases, certain STIs can be more damaging to the reproductive organs than HIV. Gonorrhoea and chlamydia, for instance, can lead to scarring of the Fallopian tubes, and cause infertility and chronic pelvic pain. This is another reason to continue using condoms during sex, even if you're on PrEP.
The use of a contraceptive method, specifically one that works well to prevent pregnancy, is a good idea. It is important that the partner who has HIV is receiving treatment to ensure that their viral load is undetectable because this means there will be a low risk of HIV transmission.
Conception options will depend on the technology available and overall wellness of the couple. The pregnancy journey and foetal health will be of a more positive outcome when there is honesty, communication, adherence to treatment and planned unprotected sex for conception. Prevention of mother-to-child options can be discussed under the guidance of a health-care provider.
• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.
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