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Mixed couple advice!!
Aug 29, 2005

For the first time I am in a consitant sexual situation with someone who is not HIV+ although I am. To date I have been the bottom in this scenario and we have always used a condom however, things have been hot and heavy at times with slight penetration. How at risk is my partner in this situation and do you have advice for a "newbie" to help keep both of us safe, sane and happy... sexually and mentally??? Any and all advice would be great!!

Response from Dr. Frascino

Hi,

Welcome to the wonderful world of magnetic couples! I would start by reviewing the information in the archives of this forum and related links pertaining to magnetic (serodiscordant) couples. I'll post just one of many below.

You and your new stud muffin need to firmly establish your own unique safer sex rituals that you both agree are both "safe and safe!" You should do this sometime other than in the midst of a toe-curling, hot-and-heavy session. Once you've agreed on your rituals, stick to them and remember PEP is available for unavoidable/accidental significant exposures. Once this groundwork is set, I'm confident you'll both be both happy and satisfied!

Good luck!

Dr. Bob

Safe sex help.. one magnetic couple to another! posted Dec 13, 2004

Hi Dr. Bob,

Fist off, Id like to thank you for all of the valuable support and information that you and The Body contribute to concerned people such as myself. The issues dealt with here can be quite traumatic its a relief to know there are people like you out there trying to make a difference.

Though Ive done a lot of reading on this site in the last year, Im a first time responder. As I do a LOT of reading about HIV (too much at times), I consider myself fairly well informed on the topic. But now Ive come across a situation that Im struggling with and Im hoping you can help (especially considering your personal situation). Im posting in this category as I would like to make sure and get your take on the subject. It deals with starting a magnetic relationship and as youre in a successful one yourself, Im VERY interested to hear from you.

A little background Last October I was diagnosed HIV positive and according to my doctor (who is luckily both gay and an HIV specialist) it was detected quite early. Id always been quite concerned with contracting HIV so after any risky behavior, I would always follow up with tests and lots of questions. Needless to say, my luck ran out.. but thats a whole different story. Anyway, so he concluded an early infection because my antibody test came back negative and my RNA test came back positive. Then within 2 weeks they both came back positive. After a crash course on HIV and therapy options, I decided to go on HAART (Combivir & Viramune). My Dr. didnt push me into a decision, but said that (at the time) there was an untested theory that drug therapy at such an early stage may have significant benefits down the road (but again thats another subject.. I promise I have a valid question). As for my levels my initial tests were 240,000 viral / 450 T4 and as of my last test my viral is less than 50 and my T4 is 475. Ive been undetectable since January 04 and my T4 has been a rollercoaster between 375-700. Before becoming positive, I was nearly paranoid of HIV and intimate contact with positive people, so you can imagine it was quite an adjustment. I think Im doing well so far and have become much more comfortable and educated. I was also fortunate to have some good friends and a sex buddy who were all negative but experienced with HIV positive people. (The question is coming I promise!) After some adjustment, I started to get back to normal which, for me, included hook-ups. The sex buddy I had at the time helped me get back into the swing of sex and showed me how to do it safely. Once things fizzled with him, I took my newfound knowledge and comfort level and moved on.

I ended up hooking up with a new guy several times without disclosing my status. I was under the impression (at that time) that as long as I kept things on the safe side, that it was okay not to disclose. My reasoning behind that was rather complex and I wont delve into it here, but what is important is that as I got to know him, I realized that I should have told him from the start. Ive since sat down with him and explained my status and all it entails and answered all his questions. It turns out that he was quite like me before I was positive in that hes terrified of HIV and intimate contact with a positive person. It also doesnt help that an HIV infection would seriously hinder the future of his life-long profession (for privacy reasons youll just have to trust me on that one). He was upset, but weve managed to work through a lot of the issues. I took him to see my specialist and hes passed 2 RNA tests and an antibody test. Also, I think its noteworthy that all of our sexual encounters fall under safer sex (condoms, no semen in the mouth/ass, etc.). Since I told him, we have restrained from any sexual activity that isnt considered extremely safe (ie mutual masturbation, kissing) As gay relationships can often be a bit unconventional sometimes, were now doing the whole getting to know you thing and have taken quite well to each other. Weve literally talked for hours on end nearly every day for over a month and are very open and clear. Hes made sure to clarify that it is the HIV that he is afraid of and not me as a person. Weve also mutually agreed that minus the HIV issue, wed be interested in starting a relationship. My question is this What exactly is considered safe sex? I have a few particular situations Id like to run past you regarding discordant or magnetic couples because it seems there either really isnt a lot of information out there pertaining to our situation or that its all conflicting. We have both read so much on the topic that our brains are about to burst, and weve gained very little helpful knowledge. Besides asking my specialist, Im not quite sure where to turn with this. I very much like this guy which says a lot as Im usually quite picky. Were compatible in every way I can think of so far, and its rather aggrevating that something that seems out of my control is whats standing in the way. Heres our situation Hes negative and a total top, Im positive and 99% bottom. So there would be no problems with sticking to those roles, and were both fine with using condoms. He likes to occasionally suck me (without ejaculate) and I would be interested in regularly sucking him sometimes with ejaculate (swallowing). Considering our roles, Im finding very little information on the insertive partner being negative and what risks are posed to him with a positive receptive partner. According to posts Ive read from you, the porous condom theory is false. So is it advisable to assume that there its safe for him to penetrate me with proper condom usage? If so, then does style or thickness of the condom factor in? I of course only use undamaged, unexpired name brand condoms, but Ive never seen data on thickness. And not to doubt you, but there seems to be a lot of talk about condoms being porous, but even in that talk its all focused on a positive top with a negative bottom. It seems no one talks about the risk of HIV passing from the bottom to the top during protected anal intercourse. Reason would tell me that under normal anal sex (no blood) the risk to a negative top from a positive bottom would be signifigantly less than if the roles were reversed. Also, all the data on oral sex Im reading focuses on positive insertive partners and never touches on the exposure risks involved in a positive person giving a negative person head. Again I would assume that the risks in our situation would much less as saliva is a very weak conductor of the virus. Ive also found very conflicting information regarding the risks of rimming (both ways). Basically the only thing considered safe that we can find evidence to back up is mutual masturbation and kissing, and its even iffy on the kissing topic. Recently my partner has had a throat infection which left him with a raw throat and tonsils. All the data were finding on HIV in saliva and kissing risks is all over the board. Were both agreed that we can be somewhat flexible sexually and are just looking for some concrete data to base our decisions on. I knew going into a relationship with HIV on the table would be difficult and require a lot of talking and mutual guidelines, but its proving to be quite maddening. I fear that before were ever able to find information that were comfortable making our safe sex decisions with, that well get so frustrated (mentally and sexually) that well be forced to give up. I would VERY much appreciate your input on the topic, especially given your experience with a magnetic relationship. Ive been asking friends, reading on the internet, and searching for books on the subject and were both planning on asking extensive questions on our next Dr.s appointments. Weve even considered trying to find a counselor on the subject, but it seems the Bush-era has pulled the rug out from under our citys major HIV organization.

I thought the hard part of a relationship involving HIV would be being open and honest (which was difficult at first), but what has proved harder is finding information that I can trust to make an informed decision.

I really hope youre able to help and that your advice can not only help us, but help the many other discordant couples that must exist out there! This guy is awesome and has been AMAZING with dealing with and helping me deal with HIV in our relationship. I refuse to let a lack of information on HIV get in our way.

Lastly, as I find your input valuable, I do not discredit Dr. Remien and would also be pleased to hear his input on the subject. Its just that (as it often is with traumatic situations) I also want to hear the voice of someone who is going through the same thing.

Sorry for the HUGE email, but like with this relationship I feel that openness and clarity are paramount.

Sincerely,

Frustrated

Response from Dr. Frascino

Hi Frustrated,

Dude, we've got to work on editing and focusing your comments and questions. When I saw the length of your post, I started searching Amazon.com for a Cliff Notes' version . . . .

First off, I suggest you do some searching too. Search the archives of this forum, as I've written many times about magnetic couples, risk and many of the subjects you pose in your question. Neither my opinions nor the scientific facts supporting them have changed. Now "briefly" turning to your direct questions:

1. What is safe? I suggest you review the information on Safer Sex at the HIV InSite Knowledge Base Chapter that can be found at http://hivinsite.UCSF.edu/InSite?page=kb-07-02-02.

With this information, you and your partner will need to realistically draw boundaries for your individual sexual rituals. This is called negotiated safety (or negotiated risk), and involves an analysis weighing what you both believe is safe based on individual comfort level and the medical facts. Communication is key.

2. HIV transmission risk is always greater for the receptive partner.

3. HIV cannot pass through intact latex with "proper condom usage," no matter who is on top. I have not seen scientific data that "style or thickness" of the latex condom really offer significant advantages as far as HIV transmission is concerned. However, if you feel better with the maximum strength/maximum thickness varieties, you should use them.

4. Regarding condoms being porous, let me reassure you that HIV cannot pass through intact latex.

5. Yes, the Bush Era is having disastrous consequences on HIV prevention education. Your local HIV specialist should be able to give you some leads on local HIV-competent and compassionate counselors.

6. Remember PEP is an option in case there is an accidental significant exposure. Also watch for information and results from a clinical trial using a single anti-retroviral agent as a form of prophylaxis against infection.

Finally regarding your "HUGE" e-mail, just in case you write back, remember sometimes less really is more.

Good luck.

Dr. Bob



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