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Monday, 21 November 2011

Sex and SeroDiscordancy for Positive People

One of the biggest dilemmas and hurdles facing both newly diagnosed and many long term diagnosed positive people is the question of sex. After all, HIV, in the majority of cases, has been transmitted though some form of sexual contact. As a result I have seen many people go through long periods of celibacy. When I have asked them why they are not having sex any more the answers are invariably one or several of these responses:

1.     I don’t feel very sexy any more
2.     Its sex that got me into this situation in the first place!
3.     I have lost my mojo
4.     I am worried about giving this to somebody else
5.     I am scared of being rejected so its easier to not bother trying
6.     Whose gonna want me now anyway?
7.     I feel dirty and tainted
8.     I don’t want to talk about it

Given the circumstances, most of these responses are pretty understandable. I mean, nobody asks for HIV (Apart from the bug chasers, but that’s a different story), so coming to terms with having a sexually transmittable long term condition is going to, at least in the short term, give you a sense of apprehension and almost phobic response to any sexual activity.

So how do we get over this hurdle?

Because positive people can and do go on to have very healthy sex lives and normal, argumentative, bickering, loving, sharing, monogamous or open, committed, understanding and passionate relationships. The kinds of relationships that they were having before they acquired their little additional passengers.  The difference is that they are on the other side of the equation now. Before hand, it was their responsibility to protect themselves from acquiring any STI’s. Whereas now, they have the additional responsibility of not passing on the one we which know we have. The prospect of infecting somebody that we love, a soulmate, a life partner or a spouse can become such a burden for some. But what we forget is that it is not just our responsibility to try and prevent the spread of HIV. It is everybody’s, and that includes our partners, though this little fact does not always help or seem apparent. Being in a relationship with a HIV negative partner therefore can be strained to say the least. This dynamic is called “Sero-Discordancy”. In an earlier blog I talked about SeroSorting and how some positive people choose to only have sex with other positive people.  This decision is not always quite so easy or straightforward. What if you find  “The One”? What if you meet that person who presses all the right buttons, makes you want to hold them all night, fuck them senseless all day. Makes you laugh and feel totally at ease with yourself and accepts you for the person that you are.

What if that person is HIV negative?

At what point do you tell them that you are positive. Will this ruin the relationship?
At what point will your discordancy of status start to cause problems in the relationship?
At what point will you give them the virus, infect the person you love?
At what point will you start to get ill and will they have to watch you die?
At what point did you become so worried about what if’s and maybe’s?

We can drive ourselves insane trying to think of all the possibilities and eventualities. The simple fact of the matter is, if you love each other no obstacle is great enough and no hurdle is high enough for you to deal with. If you are right for each other then the fact that one of you is HIV positive is besides the point. Having HIV does not make you any more or less of a person. It does not make you a different species. It does not make you any less human. The only thing that should matter is that you trust each other and understand the boundaries that you are both going to set and the risks that you are both prepared to take, as a couple. This way you are both going into the relationship with your eyes wide open and with a shared sense of responsibility for the possibility that the negative partner may at some point acquire the virus. Of course, how you manage the risk is between the two of you.

Transmission risk is not the same for all sexual activities. The most successful approach to date is to always use a condom, but there is still the risk of the condom failing or the “Drunken/off your face, OMG we fucked without a condom” scenario. The risk of transmission is also different dependent on if you are a top or a bottom (Of course straight couples don’t really get much of a choice in this decision). Whilst penetrative sex is a high risk activity whether you are a top or a bottom, the risk of transmission is greater for the receptive partner if he is negative and the top is positive. Don’t go thinking that you are free from risk if you only Top, your bell end is capable of directly absorbing the virus! All I am saying is that the risk of you getting the virus by topping is lower. This risk is significantly reduced even further if the Positive partner is on anti-retroviral meds, is adherent and has a sustained undetectable viral load (the amount of virus floating about in his body). However, there are still studies going on to determine if there is a correlation between blood viral load and the viral load of other bodily fluids such as Semen for example. Of course, sex doesn’t just have to be about the pokey bum fun though does it. There are plenty of other things which are even lower risk or risk free for HIV transmission that a serodiscordant couple can get up to. There is  oral sex and fisting, which both carry a massively reduced risk but in addition I am not going to go into a big list of non-penetrative role playing and BDSM activities. I’m sure you all have a pretty good imagination. The point I am making here is that there are many ways you can continue to have a very healthy and active sex life as a HIV positive person with a HIV negative partner (S).  Be that through safe sex or through managed risk, Don’t become a Monk or  a Nun just because you are poz, lifes too short and just think of all the great sex you will be missing out on!