Hi, Dr. Bob. You were so kind to answer me last year when I could not believe I had accurately tested positive, since my ex and ex-ex had both said they were negative. One lied. He's in a coma now, and has been for the past 4 months. I don't hate him, I'm sad. I was initially diagnosed at 220 VL and 440 cell count. After 8 months, I finally had the guts to get tested again and tested undetectable and 629 cell count. Very happy about all of that. Have a strong immune system! (My new doctor knows you. He was happy to hear that I had written to you.) My loving partner, however, is still completely fearful about kissing, not to even mention sex. He has stuck with me, says it isn't even important, even though it was, before my diagnosis, the most lovingly incredible sex either of us has ever had. I don't know how to revive this. I am so sad about it, I can hardly bear it. I believe him, that he thinks our other connections are strong enough to withstand or even transcend the loss of sex. I am less sure, and for me, it is a monumental loss. It's as if I have to choose "him," who I love so much, or "sex" which I miss a lot and which became more important to me than ever before in my life when I met him. I want both, of course, because I love him so much. It's so ironic, to have met the love of your life, and then find out you are HIV...and he says, it's okay. I don't want to put him at any risk, but he is so fearful he doesn't even believe a condom will protect, is afraid of my fluids getting on him in case he has an open cut, won't kiss me open mouthed because he has some gum issues and is afraid my saliva will get into his gums. Oy vey. I'm so frustrated. He's so loving...but I'm so frustrated. I haven't been able to find a couples counselor yet, either. I guess I keep thinking that with calm talking, we should be able to work this out ourselves, but perhaps that is stupid/unrealistic thinking. I can't imagine how I would feel if it were he who were positive, anyway. Thank you for being you.

Hello "Sad partner lied/in a coma,"

Yours is a sad and frustrating story all around! Sad, because your ex or ex-ex lied. Sad, because you didn't protect yourself from ex or ex-ex, no matter what they claimed. Sad, because someone is now in a coma, presumably due to lack of good HIV/AIDS care. Sad, because you were too frightened to get routine HIV care for an eight-month period. Frustrating, because your new partner is irrationally fearful of acquiring the virus. Frustrating, because you are sexually frustrated. And frustrating, because you haven't been able to find a way to work through these sad and frustrating issues.

There are some bright spots, however! You now have a "new doctor," who, I hope, will follow you more closely. You have a new partner who is "so loving" and whom you "love so much." So what's your next step? I'd suggest you have your new loving, but frightened, partner come with you to your visits to the HIV specialist. Have him write out a list of his concerns about and fears of contracting the virus while being intimate. Be specific. Include questions about open-mouth kissing, "gum issues," saliva, condoms, vaginal fluids, condom failure, etc. The specialist should help address these largely unwarranted fears and possibly offer additional levels of protections, such as a starter dose of PEP for potential accidental significant exposures. He might even suggest a clinical trial involving PrEP (pre-exposure prophylaxis) in which the negative partner takes a prophylactic dose of anti-HIV medications. The specialist can also work with you to make sure your HIV plasma viral load remains undetectable, which further significantly decreases the risk of transmission. Finally, your specialist should be able to refer you to an HIV-knowledgeable/HIV-sensitive couples counselor for ongoing help in working these issues out to everyone's comfort and "satisfaction."

Good luck.

Dr. Bob