[NOTE: This article was written before PrEP. I’ve been a gay men’s specialist therapist and blogger for a VERY long time…]
You’re on your third date with someone who very well could be Mr. Right. You’re impressed that you got him to go to your favorite restaurant when you weren’t sure he would like it. You’re staring across the candle-lit table at those beautiful green eyes of his. He pauses and then takes a deep breath, a little sigh, and says, “So… I guess I should tell you that I’m HIV-positive.” (Now you know why he wanted the table in the corner with no one else around.) You swallow the lump in your throat and try to get air into your lungs, and manage to say, “Wow. Thank you for telling me.” You try not to glance down at your watch to calculate how fast you can end this date. You want to run screaming from the room, but you can’t, because the waiter just arrived with the entrees and you’re not giving up your favorite dish quite so fast.
Which is exactly the point: Don’t give up so fast – on dinner, or on him. Just because he’s HIV-positive and you’re HIV-negative doesn’t mean that a good relationship isn’t possible. Then what does it mean? How does an HIV-negative guy cope with hearing the news that his Mr. Right is positive?
First, you think about what this means for you. With current treatments, Mr. Right is very likely NOT going to die prematurely and leave you alone and abandoned, nor waste away like in the horrific days of the height of the AIDS crisis. Odds are, with consistent access to good medical care, he’s probably going to be fine, health-wise — very fine — for a very long time, and he might ultimately outlive you. What it does mean, however, is that you have to take some precautions to avoid becoming infected. If you’re generally a bottom, he won’t be able to penetrate you unprotected or cum inside you without significant risk. Michael Carter, writing for www.harmredux.org, citing the May 31, 2007 edition of the academic journal AIDS, describes how researchers at the University of California put the risk of an HIV-positive guy transmitting HIV to you during unprotected sex as 1 in 10,000 if he’s symptom-free and on medication to reduce his blood’s viral load; 7 in 10,000 if he’s symptom-free and off medication; and 36 in 10,000 in those with symptoms. Despite these low odds, unprotected sex between people of different serostatus, particularly with the poz guy on top, is still considered very risky. If you’re really into bottoming raw, this guy might not be right for you. But these researchers also found that guys who “thought” and “said” they were negative but actually had recent HIV infection found that their risk of transmission was 82 in 10,000 – the highest risk yet. So, the current (2005 and beyond, actually) fad of “serosorting” – only having unprotected sex with other guys who say they’re negative – while having some statistical validity for HIV prevention in some recent studies in San Francisco — only works if the guy you’re with is really and truly negative – which is hard to know at any given time. (For a fuller discussion of all the volatile issues involved in bareback sex, see the comprehensive new book, Without Condoms, by Michael Shernoff, LCSW, a legendary gay psychotherapist and HIV expert in New York for over 30 years.)
If you’re a top, there is still risk involved with a negative top penetrating a positive bottom unprotected, especially if there is any blood in the area (blood is the human fluid with the most concentration of HIV, and therefore the most infectious) and certainly top guys have been infected this way. While some negative tops do this frequently without blood present and stay negative, it is still considered risky sexual behavior. If you’re OK with using condoms, Mr. Right’s confession should have less impact. People sometimes cite horror stories about transmission when “the condom broke,” but this is a very rare means of transmission. If this does happen, post-exposure prophylaxis (PEP – taking HIV medications for approximately 30 days) available through your doctor within approximately 24-48 hours of the sexual accident could prevent you from becoming positive (“seroconverting”). Latex and polyurethane condoms are factory-tested for reliability, and over 20 years of clinical study data from around the world shows that if they are used properly and with a condom-safe (water-based) lubricant, are extremely effective in preventing HIV transmission – even while having sex with someone poz.
Like all issues couples face, communication is key. So when Mr. Right makes his confession, ask him questions. Tell him your fears. Get information and support. But don’t run away – and bon apetit.
(In Part II of this article, I will describe how some real-life poz-neg couples have overcome their challenges to achieve their own version of Domestic Bliss.)
Get some support and answers to your relationship questions by scheduling a session for you and/or your partner. Email me at Ken@GayTherapyLA.com, or call/text 310-339-5778.