Can a person contract Human Immunodeficiency Virus (HIV) from a one-minute condom break, then engage in unprotected sex and ejaculate inside their partner, and still have their partner test negative for HIV after one year?

From the Guidelines

Yes, it is possible for someone to have been exposed to HIV through a condom break, later enter a long-term relationship with unprotected sex, and have their partner test negative after a year. However, this scenario suggests you likely did not contract HIV from the initial exposure. If you had acquired HIV from the condom break incident, and then had regular unprotected sex with your partner for a year, there would be a high probability of transmission to your partner. HIV transmission rates per act of unprotected receptive vaginal intercourse range from 0.08% to 0.19%, but over multiple exposures across a year, the cumulative risk becomes substantial 1. The fact that your partner tested negative after a year of unprotected sex strongly indicates you are likely HIV-negative yourself.

Key Considerations

• The most effective means of preventing HIV infection is preventing exposure, and antiretroviral therapy cannot replace behaviors that help avoid HIV exposure 1.
• For complete certainty, you should get tested, as modern HIV tests are highly accurate after 45-90 days post-exposure.
• If you have concerns about HIV or other STIs, both partners should get comprehensive testing before having unprotected sex in any new relationship 1.
• A history of the specific sexual behaviors that might have led to, or modified, a risk for acquiring HIV infection should be taken, and eliciting a complete description of the exposure and information about the HIV status of the partner(s) can substantially lower or increase the estimate of risk for HIV transmission resulting from a specific exposure 1.
• The U.S. Department of Health and Human Services recommends a 28-day course of highly active antiretroviral therapy (HAART) for persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission 1.

Recommendations

• Get tested for HIV and other STIs to confirm your status.
• Practice safe sex, such as using condoms consistently and correctly, to reduce the risk of HIV transmission.
• Consider pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) if you are at high risk of HIV exposure 1.

From the Research

HIV Transmission and PrEP Efficacy

• The provided studies do not directly address the scenario of HIV transmission through a one-minute condom break, but they do discuss the efficacy of Pre-Exposure Prophylaxis (PrEP) in preventing HIV infection 2, 3, 4, 5, 6.
• PrEP has been shown to be highly effective in preventing new HIV infections when medication adherence is high, with studies demonstrating its efficacy in men who have sex with men and HIV-serodiscordant heterosexual couples 2, 5.

PrEP and HIV Transmission

• While PrEP is highly effective, it is not 100% effective, and there have been cases of HIV acquisition in individuals who are adherent to PrEP, including against the transmission of drug-resistant HIV strains 4, 6.
• The risk of HIV transmission through a one-minute condom break is not directly addressed in the provided studies, but it is known that HIV transmission can occur through unprotected sex, even if the exposure is brief.

Long-term Relationship and Unprotected Sex

• If an individual has contracted HIV through a one-minute condom break and then engages in unprotected sex with a partner, there is a risk of transmitting the virus to the partner, especially if the individual has a high viral load.
• However, if the individual is on effective antiretroviral therapy (ART) and has an undetectable viral load, the risk of transmission is significantly reduced.
• The provided studies do not directly address the scenario of an individual contracting HIV and then starting a long-term relationship with someone, but they do discuss the importance of adherence to PrEP and ART in preventing HIV transmission 2, 3, 4, 5, 6.

HIV Testing and Diagnosis

• If an individual's partner tests negative for HIV after a year of being together, it does not necessarily mean that the individual did not transmit the virus to their partner, as HIV testing may not always detect early infection.
• It is essential for individuals to get regularly tested for HIV and to discuss their HIV status and any potential risks with their partner 6.