My ex has tested HIV positive and we’ve been having bareback sex
Dear Dr Laura,
This is a very painful email for me to write. I’m 24 years old and I’ve been in a relationship with Mark for two years. We love each other loads. He works in retail and I work for the Civil Service. We moved in together about a year ago and it’s been going really well. Mark, who is also 24, thinks it’s monogamous. But I had a boyfriend before Mark called Anthony. He was my first boyfriend and about 6 years older than me, so he’s about 30. We lived together for about four years. The trouble is whenever we meet which is about once every two months for a catch up, we always get drunk, take a line of coke and have really rough, wild unsafe sex at his house. Now Anthony’s just rung me and told me has just been diagnosed HIV. And I’m at my wit’s end because Mark thinks we are in a monogamous relationship and we tested at the beginning of the relationship (so we could ditch the condoms) and again about six months ago. I know I need to go and get tested but I am just so scared that I am HIV positive from Anthony and I have no idea how to tell Mark – and he could be too! I think it could end our relationship. Please help.
Hi Toby and thank you for your letter. The first thing you need to do is get an HIV test – this will determine which actions you need to take immediately. The timing of the test depends on when you last had sex with Anthony – if it was at least 2 months ago then a test now will give you a definitive answer. Make sure it’s a ‘4th generation’ test as these detect HIV sooner than some of the rapid fingerprick/saliva tests. If it was less than 2 months ago you should still test but you will need a repeat test later on to be certain – the clinic can advise you about timelines.
I’d recommend a full check-up for sexually transmitted infections (STIs) too. You should not have condomless sex with Mark until you are certain you have not acquired HIV from Anthony. One key question was the timing of your last HIV test. I’m assuming that, as it was your second test within your relationship with Mark, that it’s not possible you had early HIV which may have been missed by the test, and the only person who could have passed HIV to you, is Anthony. If you have had sex with Anthony within the last 72 hours then you can take post-exposure prophylaxis (PEP) – a one-month course of HIV medication that you can access from Sexual Health Services or Emergency Departments.
If you test HIV-positive you will need to tell Mark so he can get tested too. It’s likely you’ll be offered HIV treatment very quickly and, once your viral load (the amount of HIV in your blood) has been confirmed as ‘undetectable’ (meaning the drugs have suppressed the virus to very low levels) then you cannot pass HIV on to your partners. However, there will be a period of time when you could have passed HIV on and Mark needs a test for that reason. If you are worried about telling Mark most clinics can offer some extra support; at the Mortimer Market Centre we have expert Health Advisors who can see you both together to discuss your result.
If you test HIV-negative (and negative for other STIs) then you need to talk to Mark but the urgency, and nature, of that conversation will differ. Obviously, its not fair on Mark for him to be making decisions about his sexual health that aren’t based on the full story, so it’s definitely a conversation you need to have. There are lots of website that can offer advice:
The relationship service Relate has been around a long time but they have a lot of sensible advice and you may find this page on their website helpful: relate.org.uk/relationship-help/help-relationships/affairs/ive-had-affair-how-do-i-tell-my-partner.
Another website worth looking at is from GMFA (the gay men’s health project); they have an interesting summary of a survey they did about relationships and communication: gmfa.org.uk/fs158-the-issue-with-break-ups.
Terrence Higgins Trust offer low-cost couples counselling: tht.org.uk/our-services/head-office/connect-counselling/couples-counselling
The outcome for your relationship is, of course, impossible to predict and very much down to the two of you. You’re right, it may mean the end, but Mark may understand, and support you. All I can advise is that you do it somewhere private, where he has space to yell or swear or cry, and you time it away from important commitments – maybe at a weekend? And prepare to be told where to go. If you live together you may want to plan somewhere else to stay for a few days! If you test negative and decide to continue things with Anthony then you can go on PrEP until he is undetectable on treatment – see the iwantprepnow website.
Finally, there’s a little alarm bell ringing in the back of my head about your relationship with Anthony. My maths tell me you were pretty young when you first met Anthony and though drink, drugs and hard sex may all be your choice, please consider whether this is all 100% consensual? If you have ever felt pressured into anything, or felt unable to say no, that’s not consensual and you may want to talk to a sexual health service or your GP for some advice.
ACTIONS TO TAKE AWAY
1. If you’ve had condomless sex with someone with HIV when you don’t know for certain they have an undetectable blood viral load on treatment, ask about PEP
2. If you are having condomless sex with people who don’t know their HIV status or are living with HIV but you are not certain they have an undetectable blood viral load on treatment, ask about PrEP
3. Get the right HIV test ASAP and repeat it at the appropriate time: the clinic will advise you or you can read more here: i-base.info/guides/testing/what-is-the-window-period
4. Tell Mark the truth in a calm, honest way – the urgency will depend on the outcome of your HIV test
5. Seek expert advice about your relationship if Mark is happy to and think about the impact of drink and drugs on your ability to consent.
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every month in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org