Hello during anal sex a condom broke (Sunday) the individual informed me they were positive and undetectable but I wanted to see if it was too late to go on preventative treatment and where I should go to get on the right medication
Hi there,

Thank you for your inquiry. From what we gather from the question, you were asking about the possibility of HIV transmission from engaging in anal sex in which the condom broke during the act. You also state that your partner is living with HIV and has achieved an undetectable status. 

In regard to the act in which you have described, and with the current health status of your partner; we determine that this scenario is of Negligible Risk (there is no evidence or documented cases of transmission with the scenario provided, however, there is a theoretical possibility). 

Isolating the act itself, anal sex with a broken condom is considered to be of High Risk (transmission is possible in the given scenario). However, due to the undetectable status of your partner, you are at a much lower risk for transmission. 

Partner studies have shown that "individuals with HIV who receive antiretroviral therapy (ART) and have achieved and maintained an undetectable viral load cannot sexually transmit the virus to others" (1). In one partner study of 1166 HIV-discordant couples (meaning one individual was living with HIV and one was not), in which the partner living with HIV was receiving ART and achieved viral suppression (undetectable viral load), it was determined that among 58,000 condomless sexual acts, there were no linked HIV transmissions (1). A second study, conclusively demonstrated that there were no cases of HIV transmission between HIV-discordant MSM (men who have sex with men) partners, despite approximately 77,000 condomless sexual acts, if the partner living with HIV had achieved viral suppression and the partner not living with HIV was not receiving PrEP or PEP (pre/post-exposure prophylaxis) (1). 

We have determined this scenario to be of Negligible Risk due to the marginal chance that there could be discordance between our evaluation of 'undetectable' as defined by the partner study (HIV-RNA viral load of fewer than 200 copies/mL), and the evaluation your partner has received by their healthcare provider. An undetectable status, in this case, may vary from community to community. As such, we evaluate the scenario to be Negligible based on differences in research and given the act of unprotected anal sex having met our criteria for a High Risk encounter. 

Additionally, it is always important to know one's status so that we may protect ourselves and our partners. For this reason, we recommend that you reach out to a healthcare provider to help you make specific choices regarding this scenario. 

If you are continuously engaging in what we would consider High Risk activities (vaginal and anal sex without a condom), we would encourage you to seek out additional methods of protection such as PrEP (Pre-Exposure Prophylaxis) and PEP (Post-Exposure Prophylaxis). These methods may serve as an extra barrier to protect against HIV transmission, ontop of diligent, and proper condom use. 

All the best, 

AIDS Vancouver Online/Helpline, Cody 

Partner Studies (1)

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