Mixed HIV status relationships

John R. Ballew, M.S., L.P.C.

Manuel is healthy and happy and living well with HIV. When he found out he was positive several years ago, he decided it would keep things simple if he only dated other poz guys. He soon found out that his heart didn’t share that agenda. “I’ve been with John for three years; he’s negative,” he told me. “I didn’t expect this. Most of the time I don’t think it makes any difference. But sometimes….”

Some men are just too worried about the possibility of infection to get involved with someone whose HIV status is different from their own. And men who really need to take a partner’s cum inside them are generally going to need to stick with someone of the same HIV status. For others, though, HIV isn’t a make-or-break issue when it comes to dating and relating.

We don’t have good language to talk about couples where one partner has HIV and the other does not. “Sero-discordant” is the official terminology. I think that’s obnoxious language; relationships are difficult enough without labeling one “discordant.” “Sero-different” seems like a step in the right direction. Some people prefer “magnetic couples,” as in one is positive and the other negative. Whatever.

Ten years ago, HIV seemed like a death sentence to many gay men. Now, more and more men with HIV are living healthy, and relatively normal lives. Living longer and healthier means more opportunity for relationships. And compared with years past, the distinction between positive and negative doesn’t seem so great to many men nowadays.

Too many couples still don’t have role models for healthy male-male relationships. And mixed-HIV status couples? Fewer models still, unless you count the tragedies and melodramas that seem as out-of-date as “Love Story.”

Sure, the experience of living with HIV is different for each couple, but researchers have found some common threads.

One way HIV makes relationships more difficult is that some guys in mixed couples find less support from friends and family – either out of fear for the uninfected partner or concern that the positive guy is going to be abandoned if the going gets rough. Since social support is important in most relationships, couples need to find ways to deal with this head-on by being frank with family and friends: they expect support and encouragement, not judgment or attitude.

In fact, HIV can have a positive impact in relationships if it causes people to maintain a focus on what is most important in life. HIV can push partners to live in the present moment – not because there is no future, but because the future may be uncertain. That’s true for all people, but living with HIV can underscore that ambiguity.

It’s probably no surprise that sex is the area of intimate relationships that is most directly impacted by HIV. Someone unwilling to take any risks at all is going to find it tricky to be in a mixed-status relationship, but how do the guys involved decide what is safe for them – or what risks they are willing to tolerate?

Talking things through helps. How important is anal sex, for instance? What kinds of things does each partner absolutely have to do in order to have the kind of sex life that’s important to him? Couples who want to fuck and who want the HIV negative guy to stay that way are going to need to accept condoms as a permanent part of their sex lives.

Mixed status couples can have great sex if they are honest about their needs and desires and if they are willing to be creative in bed.

Some couples find that they avoid topics that emphasize their differentness from one another. Talking about things like retirement, aging or even changing jobs may feel awkward for the HIV negative partner. Similarly, the positive partner may hold back in talking about their anxieties, symptoms or medical problems for fear of seeming like they are “always talking about AIDS.” Often there is a desire to avoid emotionally charged issues like health care regimens, illness, disability or death based on a desire to “protect” the other partner from potentially ugly reality.

Manuel and his partner found themselves avoiding any talk about HIV. They got into couples counseling for something unrelated. “We found out that we each were avoiding talking about it to protect the other guy” he said. “How stupid was that? I mean, there were times when I really could have used his support, but I was too chickenshit to tell him I was scared.” Manuel’s partner had his own fears. They learned they weren’t protecting one another – they were simply avoiding conflict.

While new medical treatments have certainly made life with HIV better, they can also cause new stresses for the couple. The regimens can be complicated, and side effects are sometimes nasty. Treatments affect sexual desire differently, and usually not for the better. And there is both more hope and more uncertainty about living with HIV than ever before. The uncertainty can increase stress around issues related to future life together.

It is important for mixed-status couples to not let HIV become the sole guiding concern in making decisions about moving, financial planning, changing jobs, having children or anything else. The HIV-positive partner may need to let go of anxieties or guilt about being a burden or victim. And if the HIV-negative partner has codependent fantasies of being the rescuer or savior, he’s going to have to get rid of them as well. It’s important to find ways to express hopes and fears with the other partner in a way that lowers barriers and builds intimacy. Talking about things helps – maybe talking things over with a counselor.

Life is difficult. Life with HIV is more difficult. There is no need to choose between living with HIV and living with love.

John Ballew, M.S., is a licensed professional counselor in private practice in Atlanta. He can be reached through his website at www.bodymindsoul.org.