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Mixed HIV status relationships

Manuel (not his real name) 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 that is their right. Taking care of yourself and making decisions that are right for you is key.  For most others, though, HIV isn’t a make-or-break issue when it comes to dating and relating.  If the attraction is strong and the chemistry is right, HIV is just another factor that complicates human relationships.

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.

Years ago, HIV was tragic and largely untreatable.  Fortunately, those days are long gone and most people with HIV are lead healthy and fairly normal lives.  Living longer and healthier means more opportunity for relationships.  And compared with years past, the distinction between positive and negative doesn’t always seem so great to many men nowadays, particularly younger men who never experienced the bad old days.

One way HIV makes relationships more difficult is that some guys in mixed couples may find less support from poorly-informed friends or family with out-of-date ideas about HIV.  Since social support is important in relationships, couples need to decide what is best for them.  For some, that means not disclosing private information they know family or friends can’t handle.  For others, dealing with this head-on through frank conversations with family and friends is important, letting others know they expect support and encouragement, not fear or disapproval.

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?

The ability to tolerate ambiguity and make decisions each partner is comfortable with is very helpful in mixed-status relationships.  There is still controversy about whether having an undetectable viral load means sex without condoms is OK for mixed-status couples.  Staying informed, having a supportive medical team and talking things through helps.  What is really important in a meaningful sex life, for instance?  Mixed status couples can have good sex if they are honest about their needs and desires and if they are willing to be creative in bed.  That sounds like what most couples need, doesn’t it?  The twist for mixed-status couples is that talking about anxieties is also important, and about what sexual health looks like to each partner.

While new medical treatments have certainly made life with HIV better, they can also cause new stresses for the couple.  Treatments sometimes affect sexual desire, and usually not for the better. 

Couples may find that they avoid topics that emphasize their differentness from one another.  Talking health concerns 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 HIV.”  Often there is a desire to avoid emotionally charged issues like health care regimens, illness or disability based on a desire to “protect” the other partner from potentially unattractive possibilities.

What couples sometimes overlook is that if any relationship endures – regardless of HIV status – and is truly lifelong, the relationship includes facing the realities of illness and mortality.  If mixed-status couples avoid these topics, they are avoiding a conversation that is an inevitable part of sharing life together.

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 afraid to tell him I was scared.”  Manuel’s partner had his own worries.  They learned they weren’t protecting one another – they were simply avoiding conflict.

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 seeing himself as somehow “damaged.”  He needs to notice if HIV is energizing internalized homophobia.  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.

About John

I have been  licensed by the State of Georgia as a professional counselor for more than 25 years.  My areas of specialty are relationships, intimacy, sexuality, anxiety and depression.  My passion is helping people build happier lives and stronger relationships. 

I know it isn’t always easy to talk about problems.  My approach to counseling is nonjudgmental and compassionate.  If you have questions, I welcome the opportunity to talk with you about working together.

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