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A Serodiscordant Couple

Dec 21, 2000


I am thinking about getting into a relationship with a man who is HIV+ and I am negative. Besides the use of condoms -- which are safe but not always practical in a long term relationship -- what preventitive measures could I take to keep my negative status?

Response from Mr. Kull

First of all, I suggest that you check out The Body's Mixed-HIV-Status Couples Forum hosted by Robert Remien, PhD. That forum deals with the complex issues that serodiscordant couples face.

There is no single right answer to a question like yours. Serodiscordant couples must negotiate their own limits of safety in order to protect their health and psychological well-being. These decisions can only be made by you and your partner, together.

From a strictly practical standpoint, the less fluids that carry HIV that come into contact with your mucous membranes or blood stream, the better. Fluids with higher concentrations of HIV would be blood, semen, and vaginal/cervical secretions. Saliva and tears carry a small amount of virus. Some couples choose to be extremely cautious about fluid contact by, for example, deciding not to deep kiss (french kiss, open mouth, etc.)and using condoms for all genital contact. Some may even have difficulty engaging in any sexual contact. This approach comes close to a risk-elimination perspective.

Some couples choose to take "acceptable risks." Certain types of sexual contact are very important to these couples and they are willing to engage in activities with each other that are considered to be low-risk. This might involve deep kissing or the negative partner performing oral sex on the positive partner without a barrier (but not to ejaculation or during menstruation). Please refer to Newest Information on Deep Kissing and Oral Sex for more information on these topics.

Some couples have difficulty using condoms, and some decide to forgo condoms altogether for anal or vaginal sex. This would be considered an efficient way to transmit HIV. While antiviral medications that your positive partner may be on could reduce your risk for infection (some studies suggest that a very low or undetectable viral load in the positive partner reduces the risk of transmission), it is not guaranteed. Other recent studies suggest that the virus can "compartmentalize" in genital fluids and remain independent of the viral load in blood. Condoms are still recommended for insertive and receptive vaginal and anal sex. See Serodiscordant male couple anal sex and How long after exposure....

I hope this information helps. Talk with your partner and other people in similar situations to yours about these issues. A lot of couples find that the support from other couples helps to alleviate a lot of the emotional stress they encounter in a serodiscordant relationship.


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