Dear Dr Remien: I just sent you the question about having a negative partner but playing with positive men as well, and being guilt-ridden both ways.

I just read your answer to a man in a similar situation, whose boyfriend wanted unsafe sex. You told him there is "no reason [they] can't have satisfying sex". Well, that's not how I feel. I have unprotected sex with other poz men, and we know the risks. There is one man in particular who I feel very close to, who I have very intense, passionate, unprotected sex with. This isn't something I can do with my partner. So my choices are: (a) enjoy the passion outside my relationship, and the guilt that comes with that; (b) do it with my partner too, and infect him; (c) deny myself the pleasure and passion I know I can have, and on some level resent it. Not really a great scenario any way I look at it. Meanwhile my partner keeps pressing for "bare" sex and I don't know how to withstand all the stress and pressure and conflict. Help?

While the mixed feelings you have about all of this are understandable and not uncommon, it doesn't need to be that way. Further, I believe you have more options than the ones you described. First off, you didn't mention whether you and your partner have a mutual understanding about having sex outside of your relationship. If you do, then I wonder why there is "guilt" associated with the sex outside of the relationship. If you do not have a mutual understanding on this issue, I suggest that you discuss this with your partner and see where it leads you.

In regard to your partner's "pressing for bare sex," I think that he needs to be seriously challenged on this. It is very unfair of him to place such pressure on you, since as you well know, HIV is not something to be taken lightly, and most people living with HIV do not want to pass it on to others. What is his understanding of the risk and consequences of becoming HIV infected? Is he engaging in unprotected sex with other partners, putting himself at risk in a variety of circumstances? While some would say that everyone has the right to take whatever risks they want for themselves, he would not be the only one affected if he were to become positive.

Also, I don't think that having passionate sex outside of a relationship and also having passionate sex within a relationship are mutually exclusive things. There are many people in relationships who achieve both - although it doesn't work for all people or for all couples. I also don't believe that passionate and satisfying sex cannot be achieved while also protecting oneself and one's partner from sexually transmitted diseases. While "protected" sex and "raw" sex are not the same, many people are able to feel passionate and satisfied when using protection.

Finally, since you say you and your poz partners are aware of the risks, I will not say a lot about this, except to remind you and other readers of this Forum that HIV is not the only sexually transmitted disease that poz people need to be concerned about in terms of their own and their partners' health.

Take care.