Supplement-Safe sex is important for HIV-positive people as well

Some people who have HIV might think it's too late to practice prevention. They may tell themselves something like this: "I have the disease, so what difference does it make now whether I practice safe sex, especially if I'm choosing partners who also have HIV?"

In fact, it makes a huge difference for HIV-positive people to practice safe sex. Here's why: All HIV is not created equal. Worldwide, there are more than 10 different types and subtypes of the human immunodeficiency virus. You are infected with one type (or "strain") of HIV, but your sexual partner might be infected with a different type. If you give your partner a type of HIV that's different from the one he or she already has, your partner could get sick all over again.

Doctors in Canada have seen the first case of an HIV-infected man whose health changed from excellent to poor after he was infected with a second strain of the virus.

"This case means it's quite possible that a person with HIV could be reinfected with a [different] strain of HIV," says William Cameron, MD, a professor of medicine at the University of Ottawa and Ottawa Hospital. Cameron was one of the physicians involved in this case.

The man was a very special case. He had been infected with HIV for more than 10 years, but his viral load remained very low and his immune system was strong, although he wasn't taking any HIV drugs.

"This person was one of those rare people who didn't seem to get sick from HIV," Cameron says.

But this man's rare ability to defeat HIV disappeared after he began to have sex with an HIV-infected partner who had a history of taking anti-HIV drugs, Cameron says.

Suddenly, the man who was not taking medications began to progress rapidly to AIDS. Even worse, his new strain of virus (which doctors called a "superinfection") was resistant to various anti-HIV drugs. Researchers studied blood samples from both men, which showed that the first man had become infected with his partner's HIV strain.

While this was one of the first documented cases of an HIV superinfection, it likely won't be the last. For instance, some research suggests that certain HIV subtypes are 10 to 20 times more likely than subtype B (the most common HIV subtype in the United States) to spread from a woman to a man through heterosexual contact.

Also, research shows that AZT and other HIV drugs might not work as well with some of the different strains. Plus, if you are infected with more than one strain, then the chances increase that you could have a drug-resistant form of HIV, which means some drugs may fail early in your treatment.

Here are some answers to questions you might have about how to prevent spreading HIV to other people and how to prevent yourself from becoming infected with new strains of the virus:

Is it safe to have unprotected sex with one partner who also has HIV?

Unfortunately, no. The HIV case from Ottawa proves that even in a committed relationship between two HIV-positive people, it's possible for the virus to spread, causing a superinfection that harms one or both partners.

If you are HIV-infected and you have unprotected sex with multiple HIV-positive partners, then you are increasing your risk of developing a superinfection with a drug-resistant strain of the virus.

So when you have HIV, the only safe sex is sex that does not involve the exchange of any body fluids. This means you should always use a condom.

Shouldn't my sexual partner protect him/herself? Why should I take responsibility for his/her actions?

Whether or not you are infected with HIV, you should always protect yourself from the possible spread of other sexually transmitted diseases (STDs) and from spreading any disease you have to your partner. Because HIV weakens your immune system, it's a good idea to avoid getting any kind of infection. The more you become infected with STDs or other diseases, the harder it is for your immune system to recover. So safe sex is in your best interest.

Plus, you should tell your partner you have HIV so he or she can take adequate precaution against infection. If you don't tell your partner, he or she might not feel it's necessary to use a condom, which would be risky.

What sort of precaution should I use during vaginal or anal sex?

Don't have sex without using a condom, preferably a latex condom. Women with HIV should use a female condom, inserted in their vagina. This also provides protection against pregnancy and various STDs.

If you use a lubricant during sexual intercourse, stick with a water-based lubricant and avoid petroleum-based jelly, cold cream, baby oils, or other oils that can weaken and break a condom.

Oral sex is safe, isn't it?

No. HIV experts have long thought that HIV can be spread through oral sex in both men and women. Until recently, there were no studies proving that some people are being infected solely through oral sex. Now, the Centers for Disease Control and Prevention (CDC) has published a study showing that among a group of gay and bisexual men, nearly one in 12 were infected with HIV through oral sex.

While unprotected anal sex and vaginal sex still are more likely to spread the virus, clearly this shows that oral sex is a risky behavior as well.

Can I protect myself during oral sex?

Yes. You can use a condom or dental dam, which is a square piece of latex used by dentists. Or, you can use plastic food wrap.

Keep in mind that the only way to prevent spreading HIV is to make sure you do not exchange body fluids with someone else. This includes semen, vaginal secretions, and blood.

Are there other things I should do to prevent spreading HIV?

• You should keep sex toys for your own use and not share them with others.

• You should not share needles or other drug paraphernalia with other people.

• Don't donate blood, plasma, or organs.

• Don't use someone else's razor or toothbrush, and keep your own personal razors and toothbrushes separate from the ones used by other people in your household.

• If you are pregnant, you should see a doctor who can prescribe drugs that will prevent you from infecting your baby with HIV.

• Avoid using drugs like cocaine, ecstasy, crack, poppers, alcohol, and "K" when you visit a nightclub or other place where you might be tempted to have sex with a stranger. Because when you are under the influence of a drug or alcohol, you will be less likely to use a condom and practice safe sex.

Where can I find out more about HIV prevention?

You may contact the CDC National Prevention Informa tion Network, P.O. Box 6003, Rockville, MD 20849-6003. Telephone: (800) 458-5231. Or you may visit the CDC's Web site at www.cdc.gov and click on the links to health information and publications.

The Gay Men's Health Crisis in New York City has brochures and other information about HIV available. You may call their hotline at (212) 807-6655 or call the organization for information about counseling and workshops at (212) 337-3343.