Dear Counsellor:

My boyfriend and I are both infected with the HIV virus, what are our concerns? We are both on ARV treatment. Do we still need to use condoms?

Careful Lover

Dear Careful Lover:

Thanks for your letter and these very important questions. When both partners are living with HIV, prevention messages and reasons to practise safer sex sometimes become obscure. A common question among HIV-positive partners is: "If I'm already positive, and my partner is positive, why do we have to practise safer sex?" Simply put, safe sex remains important among positive partners. This is because, in addition to preventing infections as discussed above, other factors place HIV-positive sex partners at risk.

While the issue of reinfection with HIV remains unresolved, increasing evidence shows that it can and does happen. I am aware that both you and your partners are on antiretroviral therapies, but it's important to remember that your partner's viral load is not necessarily associated with the level of HIV in his semen or in your vaginal secretions.

Therefore, be aware that, while viral levels may be below the limit of detection in the blood, they may be present in high or low levels elsewhere. Finally, I strongly recommend that you use condoms every time you have sex, practising safe sex is important to both you and your partner's health.

Practising safer sex also reduces the risk of transmitting or contracting other sexually transmitted infections such as chlamydia, gonorrhea, herpes and hepatitis B. These can be very troublesome with people with weakened immune systems.