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Condomphobia in a Serodiscordant Relationship
Mar 9, 2014

Dear David

I'm 36, been positive since November 2009, and I am now in a serodiscordant relationship since October last year. Our feelings for each other are very loving, supportive, caring, and genuine. Yet, the sexual part is usually very 'pedestrian' and vanilla. I know that my boy friend (29) is more or less secretly longing for the type of promiscuous and unprotected sex that he used to have before our relationship, as I see him jump online on hook-up sites for bareback sex. He says he's just chatting on there when he gets bored, but whether he does hook up or not, it obviously indicates that he has a deeper desire that I don't know how to fulfil. I have tried various times to top him with a condom, but he suffers from what I'd call condomphobia. He has developed this irrational psychosis that the sensation of the condom in him is destroying all sexual intimacy and he cannot enjoy getting fucked by me as a result. So we usually revert to oral sex, but I can sense that neither of us is being satisfied in the long term, and the relationship suffers as a result. He even told me that he's not afraid of being infected, as he wants to spend the rest of his life with me, so he says he doesn't care if we are both positive. However, I don't want to infect him on purpose.

Do you have any advice for us? I briefly mentioned Pre-Exposure Prophylaxis (PrEP) to him, but he is very health conscious otherwise (ironic, huh?) and does not like the idea of taking any extra tablets or pills in addition to the vitamins and supplements he does take.

I have checked other forums such as the HIV Prevention forum for answers before asking you for advice, but all I could find usually revolves around the simple suggestion to use condoms.

Response from Dr. Fawcett

Hi,

Thanks for writing. You raise some issues that many people in serodiscordant relationships face. Sadly, there are not enough resources for such couples to assist in addressing them. One of the most important things you can do is be certain you are adherent to your medications and that your viral load is undetectable. This minimizes the risk of transmission should there be an accident with the condom.

Many couples find it hard to understand that there is a risk continuum of safer sex and the risk tolerance for each individual will vary. Many people want black and white answers about what to do (the only safe option being not having sex in the first place). I would suggest both of you meeting with your heathcare provider to be certain you are both fully informed.

That said, it seems that the current situation of foregoing certain sexual behaviors is probably not sustainable. I suspect your partner's feelings about condoms probably represent more psychological resistance than actual experience. I recommend getting some couples counseling to talk about this (preferably someone with knowledge of HIV). Communication of feelings and needs, along with trust, are essential for you both right now. I really like a kind of couple's therapy called Imago therapy, which focuses on these issues and skills. You can look for a therapist with this kind of training here. Here is resource page from TheBody about serodiscordant relationships.

There may be something there that is useful for you.

I wish the best for you and your partner,

David



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