I am falling in love with a woman I know is HIV positive. We are great companions but there is also always an underlying sexual tension. I feel like I am playing with fire. What in the world should I do?
— Burning, but not consumed
Dear Burning, but not consumed,
Seeking out information is a good start! And the fact that your partner has been open with you about her status also gets you off on the right foot. So fret not; while there are a few issues that a sero-discordant couple (where one person is HIV positive and the other is not) ought to consider, know that this can be a workable situation and that many couples before you have traversed this landscape. There are three primary considerations that you'll likely be navigating as a couple: Keeping the HIV negative person uninfected, managing potential power differences, and the psychological/emotional impact of life-threatening illness.
Following safer sex guidelines are of prime importance. These include:
- If the HIV positive partner regularly takes her or his prescriptions and medications, it helps keep the viral load in the body lower, which decreases the chances that the virus will spread to an intimate other.
- When having vaginal, anal, or oral sex, condoms, dental dams, and lube should be used. Always.
- Mutual masturbation can be practiced without latex barriers as long as one is certain there are no open sores or injuries on ones hands.
- If toys of any kind are used, always wash them with soap and water after each use. Silicone toys are often the easiest to clean — they can be boiled or tossed in the dishwasher.
- If S&M activities that involve drawing blood will take place, make sure all equipment is washed and disinfected afterwards. Equipment should not be shared.
- Know that if either partner has any other type of STI such as Chlamydia or herpes, HIV transmission risk increases.
Secondly, be aware of problematic power dynamics that can emerge in the sero-discordant relationship if one partner is exercising power and control over another in an abusive manner. In these situations, the HIV negative partner might intentionally make the positive partner feel (financially or otherwise) indebted to her or him for being in the relationship, may exploit the status of the partner to gain access to resources, or may be even disrupt the positive partner's medication regimen, endangering her or his health. The reverse can also occur if the HIV positive person behaves abusively towards the negative partner, using their status as a means to control her or him. In this type of situation, the positive partner might try to make the negative partner feel guilty for being uninfected and may even threaten to expose the partner by insisting on having unsafe sex, for example.
However, in the overwhelming majority of situations, power dynamics emerge unintentionally. The stigma that HIV carries can make the HIV positive person feel a range of emotions about their desirability. She or he may feel undeserving of a loving relationship, may feel guilty about their status, and may compromise too much or over-conform to her or his partner's notions of how the relationship is meant to look. As the HIV negative half of the relationship, being aware of the potential for these feelings and inviting communication about them or about the potential for them to arise, can be a powerful first step in working through them. Check out Healthy vs. unhealthy relationships for more information on dynamics of healthy relationships.
Lastly, an HIV negative person may struggle with the possibility that their positive partner may have a shorter lifespan. Awareness of such a possibility can have a significant impact and a range of different feelings can arise as ones feelings for her or his partner deepen. Balancing this awareness with the knowledge that many people (especially those who consistently take their medications), live long lives with HIV may be helpful in working through these feelings. Seeing a counselor can also help one cope with fears about their partner's death.
Your willingness to communicate about these issues will serve you well in creating and maintaining a healthy relationship with your HIV-positive partner.