At least once a week, I am asked by one of my HIV-a

At least once a week, I am asked by one of my HIV-infected patients whether they need to continue to practice safe sex if they are in a monogamous (one mate only) relationship with an HIV-infected partner. Put another way, since both partners already have HIV, what's the harm of unprotected sex? Actually, this is not an easy question to answer fully. My belief, however, is that the best approach is to provide as much information as possible; emphasizing what is known versus what is uncertain. Such a complete disclosure is the only way I can remain credible while allowing the patient to make a fully informed decision.

My response to this question generally begins by telling the patient what is known about the risks of unsafe (unprotected) sex between HIV-infected partners. First of all, we know that in this situation, the spread of other sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, syphilis, and herpes remains a risk, as usual. What's more, these so-called traditional STDs are well known to be associated with serious complications.

Both gonorrhea and chlamydia initially can cause infections of the urethra (urethritis) and anus, or rectum (proctitis). Subsequently, these infections can progress to serious complications in these areas and even spread to other parts of the body. In addition, in women, gonorrhea and chlamydia are associated with increased risks of infertility and ectopic pregnancy, which at times can be life-threatening. (An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus; for example, in the tubes.)

Viewed from another perspective, however, in a monogamous relationship between HIV-infected partners, with good diagnostic screening, the problems of gonorrhea and chlamydia are usually not insurmountable. Thus, when diagnosed, these diseases are generally curable. The same holds true for syphilis, except that it can be difficult to treat. Finally, herpes disease, although manageable, is never cured, and once acquired, results in life-long infection.