Sex and the Negative Guy

June 5, 2012 10:04 AM

Dear MetaFilter: I need advice on serodiscordant dating. (That is, when a HIV- guy starts seeing a HIV+ guy.)

This is a new relationship, and we haven't gone farther than kissing yet. I'm familiar with safe sex practices, but I'd hoping to find advice and/or narratives from a serodiscordant couple. This guy is great. I want to stay HIV-, and I don't want to be needlessly fearful. But quite honestly, the only person I've known with experience in this situation told me he wouldn't do it again. Help.

Your friend,

[e-mail]

posted by anonymous to human relations (10 answers total)

My understanding is that, as a result of modern drug cocktails and such, the risk of transmission is much lower than in the past. If he is taking his meds and you're both practising safer sex, that's about all that you can do.¹

I know you don't want to be needlessly fearful, but I think you have to acknowledge that there is always going to be a risk that you may be infected, however small it may be. If that is not something that you're willing to risk, it's probably best to end the relationship before it gets too serious.

I don't have personal experience in this area, and the one person I know who has (limited) experience refuses to ever get involved in such a relationship because she experienced the deaths of a few close friends as a result of AIDS back in the '80s.

_{1. Note that I am not a medical expert by any means, and I am relying mostly on anecdotal evidence. DO NOT TAKE MY COMMENTS AS ACCURATE MEDICAL ADVICE.}
posted by asnider at 10:18 AM on June 5, 2012

Your local LGBT or HIV services group can answer all of your questions. They exist in part as a resource for people in your situation. You can go by yourself but I would also recommend going as a couple when you get there.

I am not sure if you have experiences with such a group, but it is free of judgement, no one will know you were there. They are fantastic.
posted by munchingzombie at 10:32 AM on June 5, 2012 [1 favorite]

A lot of larger hospitals have HIV-specific counseling and testing for serodiscordant couples. Not necessarily medical advice, but I also came to recommend this article:

http://www.theatlantic.com/health/archive/2012/03/odd-blood-serodiscordancy-or-life-with-an-hiv-positive-partner/255091/
posted by allymusiqua at 10:35 AM on June 5, 2012

(IANAD, this is not expert advice, disclaimer, etc.)
There's a lot to think about here, so this is by no means complete.

I'm sure you can find better anecdotes on the web than I can provide, so I'll skip that for now.
You are not being needlessly fearful; engaging in any kind of serodiscordant sexual relationship is going to be inherently risky to some degree.

The HPTN052 study, among others, supports the idea that if your HIV+ partner has an undetectable viral load and is on stable ART treatment, especially if they started relatively early, then the risk of transmission was significantly reduced. Obviously condoms also help, though they are not a foolproof solution.

Pre-exposure prophylaxis is another option, although possibly less useful if you engage in sex frequently, and it is possible you'll run into resistance from care providers to keep prescribing it.

A few other things to consider, which may or may not matter depending on your situation:
1) How much do you trust this person, really? I don't mean to say we should all be ultra-cynical paranoids, but it's naive to pretend that there's not a lot of baggage tied to this issue. Do you know they take their meds regularly? Do you know their viral load is supressed? If they miss a few doses, for whatever innocous reason, will they be up front about it?

2)How long-term do you see this being? HIV/AIDS treatment has come a long way, and people can have great quality of life for decades, but the disease remains, for now, uncurable. AIDS, or complications from AIDS, will get them in the end (if something else doesn't first). Are you prepared to someday be a long-term caregiver?

3) Connected with 2, be aware that while money problems can creep into any relationship, HIV introduces unique problems. HIV care can be expensive. It creates insurance complications. It can create guilt on both sides about who's paying for what.
posted by Wretch729 at 10:38 AM on June 5, 2012 [2 favorites]

Oh and the other one I forgot (may be super obvious but just in case) MAKE SURE you are both on the same page about when/where/to whom it is OK to disclose HIV status. This is not always obvious ("oh Grandma A is totally cool with everything, but don't say a word to Grandpa A").
posted by Wretch729 at 10:53 AM on June 5, 2012

[As per usual if you think you're saying something that makes you sound like an asshole, consider not saying it here, thank you.]
posted by jessamyn at 12:57 PM on June 5, 2012 [3 favorites]

There are tons of HIV- people who have sex with people with HIV. They do not need to take pre-exposure antiretrovirals to not contract HIV.

So, from my personal experience—which is pretty vast on this topic: I spent years in a long-term serodiscordant relationship, have had several shorter ones, and am HIV- and have slept with lots and lots of HIV+ guys, including one of the first guys I ever slept with—there's a few different issues here.

You must, and can only do, what you are comfortable with.

Condoms, when used for fucking, are extremely effective. That doesn't mean you're going to feel that they're as safe as they are. (Somewhat, sort of similarly: not all of us feel like airplanes are safe!)

So everyone's mileage on this is different. I have met people who won't perform blowjobs without a condom on the genitalia in question. You know what? That's fine! That's how they feel safe. I would never consider that necessary but that only matters for me. It's not about what you're doing in bed, but how you feel about it.

You cannot enjoy having sex with someone if you are going to lay in bed anxious all night after.

So you only do what you feel like you can and should do. I have... how can I say this in a not-super-graphic way? I have seen people recoil in horror from the... bodily emissions of HIV+ sex partners. (Literally! It was like someone was throwing boiling acid at them!) This is a person who is going to regret having someone ejaculate near him. He should have identified that as a boundary. Instead, everyone just felt weird: and he felt anxious. And everyone's going to have a different moment of anxiety.

You don't have to get HIV.

Good news! It's not that easy to get. But while that's true, the problem is that there aren't really "odds" you can play. It's not like you can say "well I can give 43 blowjobs and have 155 acts of condom penetration and have him ejaculate on this cut on my hand 4 times and I'll be fine, because the odds of geting HIV from that are .0035%." Life and math don't work like that.

And to be fair, I still have some friends who literally have no idea how they got HIV. And I have a larger number of friends who can't believe they didn't get it, and feel like they "should have." (Of course they shouldn't have! No one should! But what that means is that they were performing a "risk calculation" in their heads—and they shouldn't have been doing that. They should have been doing what they felt okay about.)

You have to talk about this with him.

It's fine to be like "Listen, I know you have lots of experience in this realm, but I don't, so you're gonna have to bear with me. And I know that's not really fair, but here we are." If he can handle this and treat you right, great. If he can't engage in this, you shouldn't be fucking him. As much or as little as you need. Maybe you don't want to talk about it with him! Maybe that's not fun or romantic or whatever. But you need to at least make sure you're on the same page.

Oh and: learn how to use condoms correctly.

You'd think that goes without saying, BUT IT DOESN'T. Bodies are weird, sex is complicated, and this stuff takes practice. Take it slow, take it easy, buy correct lube and good condoms (experiment with the right ones for you) and leave some lights on so you can see what's going on.

On a personal level, let me say that I think people who exclude people from their dating pool are stupid. Yes. I actually think that! And I know that's an incredibly judgmental and terrible thing to say, and probably a WRONG thing to say, so I usually keep that to myself. Because some people can't emotionally handle dating or even sexing someone with HIV. I guess.

But guess what! We're all going to die, and also everyone's going to have SOMETHING "wrong" with them. If you marry someone, guess what! Someday they'll have diabetes, or cancer, or whatever. At least in this instance, you know one thing that you're getting right up front. Life is full of surprises, including terrible ones.

Please feel free to make contact with me if you'd like to talk about this.
posted by RJ Reynolds at 2:32 PM on June 5, 2012 [22 favorites]

RJ Reynolds has good advice.

I don't know how helpful this is, but I'm an HIV-negative woman who was in a relationship for several years with an HIV-positive woman. There was (and still is) little data about woman-to-woman transmission risks, so be happy you don't have to deal with that. We had to do some talking and some negotiating to decide what we we both comfortable with. She had more experience talking about this with partners, which was helpful to me.

I would have no objection (based on serostatus) to being in a relationship with someone who was positive, but I also feel comfortable with my knowledge level about how to prevent HIV transmission. Don't do anything you personally don't feel comfortable with. I work on HIV issues and have a lot of people with HIV in my life in various ways, so it's a topic and reality that's very familiar to me. I know that's not everyone's reality.
posted by gingerbeer at 5:03 PM on June 5, 2012 [1 favorite]

I don't know if this will help, but here's my experience for what it's worth:

I am HIV- and my partner is HIV+. We are both age 50+. He has been HIV+ since at least the early 1980s. He is a survivor. We met in 2000 at a bar and went home to his apartment. He had to take an insulin injection due to his Type 1 diabetes and, out of curiosity, I asked "How's your health?" He assumed I was asking about his HIV status, so we ended up having "the talk" right before our first night together.

I never felt any anxiety about it with him, having already worked through those feelings over many years. I had reached the point where I assumed that any man I met as a sexual propect was probably HIV+, and I had to come to terms with that. At times it was very scary to me, perhaps sort of like what you feel now. Or perhaps it was different, since some of my friends and sex partners had died. As one who came out in the 1980s, the first thing you learned is "sex is dangerous." It took a long time for me to learn how to live with that idea and still have a life, so to speak.

The way I did this was to understand that I can't eliminate risk. All I can do is manage it. I can decide what level of risk I can tolerate, take steps to meet that goal, and then try to let go of fear and anxiety. That applies just as much to driving down the highway (Will I get hit by a Bimbo Bread Truck?) to my finances (Will my job disappear next month or next year?) to my sex life (Will I contract HIV?). Clearly I don't want to be in a car wreck or what not, and I do the practical things I can to manage the risk, but I still have to get where I need to go.

RJ Reynolds has the good practical advice, and you can get more from your local HIV/AIDS and LGBT resources. Ultimately, it's up to you to decide what level of risk you can live with.

About my partner and me, he's actually disabled and in very poor health now, mostly from the diabetes and various conditions partly caused by that. Although we cannot be sexual with each other now, we're still family together. The techniques I learned about managing risk and fear over the years have proved very useful as I confront my feelings about his health and our future.
posted by Robert Angelo at 6:37 PM on June 5, 2012 [8 favorites]

You might find the Youtube series Queer as Fuck helpful. Its a sitcom/soap opera, but its intended as a sexual health education resource, backed by the Victorian AIDS Council.

The show features a serodiscordant couple from Season 3 episode 7 onwards.
posted by PercyByssheShelley at 10:11 PM on June 7, 2012