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Unprotected HIV+ & HIV-

Nov 22, 2001

Mr Shernoff,

My partner was diagnosed + earlier this year and currently is not on medications---numbers are pretty good. I am writing because I feel out of control sexually. I can not seem to have protected sex even though while we are being sexually active we both know what could happen we still have unprotected sex. I always am the insertive partner which I assume lowers my risk, but the risk is still there. I honestly can not stop this behavior---I have tried. I love him very much and we are in a long term committed relationship, but I don't want to be HIV+, nor do I want to stop the sex we have. Do you have any suggestions...what is making us do this even though we know we shouldn't be. What do we, especially myself, to change this feels like I am trying to kick smoking or stop some bad drug habit...

Response from Mr. Shernoff

I think that it is not only you who is responsible here. It is essential that both you and your partner share responsibility for not having protected sex and explicitly talk about this and all of the potential emotional as well as physical ramifications.

While what you are doing is obviously not totally safe, it is a behavior that many mixed antibody status couples engage in knowing that it does increase the risk of the uninfected partner becoming infected. Have you and your partner both discussed this in great detail, exploring all of the feelings that both of you have about the potential for you to become infected? Obviously unprotected anal sex without a condom feel enormously more pleasurable, is more spontaneous and even more intimate than using a condom. But are these benefits really worth your possibly becoming infected? ThHe answer to this question is not obvious. Some people choose to prioritze the intensity and quality of their sexual experiences over the possibility that how they are having sex puts them at risk for contracting HIV. There is no right or wrong way to look at this issue. It is a something that must seriously be wrestled with by each individual as long as he or she is willing to accept the potential for serious long term consequences.

If you have not already done so ask your partner how he would feel if you did seroconvert and is that a risk that he is willing to live with and how would he feel about himself if that came to pass? How would you feel about yourself, him and the relationship if you seroconverted?

While you say that you do not want to get HIV, that is propbably only true on the conscious level. On some unconscious level you must either want to become infected, don't care strongly enough about yourself to do everything in your power to prevent yourself from becoming infected, or think that today with the various medications available that it is no big deal to have HIV. Or perhaps unconsciously you are simply ambivalent about whether or not you remain HIV negative. These are just possible hunches about why you are engaging in this potentially self destructive behavior. Not knowing you and not having spent hours exploring your psyche with you it is impossible for me to do any more than just guess at how come you are doing it. As you so well know this is a very emotionally fraught and complex issue. The power of very hot, connected and intimate sex is not something to be minimized, and this combination itself may be all that is motivating you to continue it. Perhaps since you say that you do not want to change how you are having sex that you try to make peace with the reality that you are playing Russian Roulette.

I don't know if any of what I have just said is helpful, but perhaps it will casue you to think about this issue a bit differently or talk about it with your partner in different ways than you hopefully have already done.

Michael Shernoff, MSW

Is it me or the drugs?

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