Jay
How high the risk is if I had unprotected anal sex with someone on prep?
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helpline-volunteer
Hi there,

Thank you for your inquiry. From what we gather from your question, you are asking about the possibility of HIV transmission after engaging in unprotected sex with someone currently on PrEP. In the case that this was someone of unknown HIV status/not receiving PrEP, this would be considered a High Risk scenario; however, given that the individual is currently on PrEP, the risk assessment is a bit more complex, which I will explain below.


In order for transmission to occur, a number of requirements must be met (see below). 

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HIV transmission requires the presence of HIV positive fluid (such as semen, vaginal fluid, pre-cum, rectal fluid, breastmilk, etc), coupled with a High, Low, or Negligible Risk activity, that provides the virus direct access to the bloodstream. 

Engaging in unprotected sex is considered a High Risk activity as there is the possibility of HIV positive fluid having direct access to the bloodstream. There are a few strategies that help to minimize the risk of HIV transmission, including consistent and correct use of condoms, and PrEP (1). Given that this individual is currently on PrEP (and assuming they are taking it consistently and correctly), their risk of HIV transmission can be considered very low. Therefore, while the activity you engaged in is still considered a High Risk activity, the risk of transmission is very low in this case, as it is unlikely the individual taking PrEP currently has HIV. Given the limited information provided and the inability to assess this individual's compliance to their PrEP, I recommend referring to a healthcare provider for HIV testing.

Additionally, if you are planning on engaging in unprotected sex regularly, I encourage you to consider PrEP treatment yourself to further lower your risk of HIV transmission, as opposed to relying on your partner to take their treatment consistently and correctly.

Recommendation: 
Refer to a health care provider for HIV testing.

Regards,

AIDS Vancouver Helpline/Online, Ashley

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Additional Resources:
PrEP and HIV transmission (1)

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