I am an internist and frequently confronted witha situation where one spouse is HIV infected.They need advice on how safe it is to have sex if they follow advice on condomes etc.In some situations the non-infected partner insists on abstinence and seeks sexual pleasure elsewhere leading to breakup of marriages.What advice can be given?

While it is not fool-proof, consistent and correct condom use in HIV serodiscordant couples is a highly effective strategy for reducing risk of HIV transmission. Of course, both members of such couples need to feel comfortable about sexual intimacy. Besides having the basic information which health care providers can give them, I suggest that couples trying to cope with all of the issues related to being a "Serodiscordant Couple" seek couples counseling from a therapist who is familiar with the issues.