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Couple (one +, one not!)
Aug 22, 2006

Dear Robert, I just discovered this site by chance while browsing from Rome, Italy, and I am impressed with your kindness, sense of humour and - even if i am not the best person to say it - with your professionality. I am 29, HIV + since 2004, not treated (yet). My bf is a (french) doctor, he is negative; we met 7 months ago and everything is ok between us. He has been the most comprehensive guy ever when i told him about my HIV status, and he is the sweetest guy ever. Nevertheless, i am a bit worried about his health, probably more than he is: we have, of course, safe anal sex, but he tends to have unprotected oral sex (in both roles). He says that the risk is very low since I don't have any (visible) loss of pre-cum, and that he checks his mouth before doing it. Still... I fear his love for me is bringing him to underestimate the risks. On the other side, he's a doctor working with HIV infected people! I know the responsability is completely ours, but could you just tell me a few words to encourage me to stop this or, on the contrary, to make me trust his "professional" opinion a little bit more? Thank you so much for your kind attention. Alessandro

Response from Dr. Frascino

Hi,

An Italian Stallion named Alessandro and a French doctor . . . . Hmmm . . . hot combination. I think I saw a coupling like that in a porno flick a few years back. Caliente!

The issue you and your mec bien monté are facing is one all magnetic couples need to grapple with. How safe is safe and what level of safety (or risk) are we willing to accept. We all take calculated risk every day driving a car in Rome is a risk, driving a care in Naples's Zona Industriale is a bigger risk; flying in a plane is a risk, flying with "snakes on a plane" is a bigger risk, etc. When it comes to magnetic-couple sex, communication is key. You both need to understand the risks of various sexual activities and then mutually agree on what you both feel is safe enough. This is called negotiated risk (or negotiated safety) and it means you create sexual rituals you both are completely comfortable with. That way there is no confusion about going too far.

I suggest you and your French Connection take a read through the archives of this forum. There is a whole section on magnetic couples. I'll repost a few responses from those archives below, but I suggest you take advantage of the wealth of information in the complete archives and on related links. You'll even find information about my magnetic coupling with Steve (Dr. Steve, the expert in The Body's Tratamientos Forum). Hopefully our personal experience with these very issues will help you and your beau.

Stay well, Boys, and remember opposites attract.

Dr. Bob

Dr. Bob: Mixed Status Gay Couple and Oral Sex

Jul 3, 2003

Dr. Bob -

Thank you for sharing that your partner is both negative and supportive. I tested positive in August 2002, and my partner (who is negative) and I will be celebrating 9 years together this summer. We have come to the decision that it is within our risk tolerance for me to perform oral sex on him without a condom. Are we whistling past the graveyard? I love him very much, and do not want to infect him by accident, through ignorance, or through willful disregard for the true risks involved.

In short, is it OK for me to go down on him without feeling guilty or fearful?

Thank you! Also, without prying into your personal life, how long have your partner and you been having sex safely, without his seroconverting?

I appreciate you!!!

Best,

- D.

Response from Dr. Frascino

Hello D,

Nine years together? Congratulations! (In straight years, youd be celebrating your golden wedding anniversary right? . . . . that is if we are ever allowed to get married in the first place.) OK, on to your question. Are you whistling past the graveyard? No. You "do not want to infect your partner by accident, through ignorance, or through willful disregard for the true risks involved." Being in the exact same situation as you, I couldnt agree more! You and your partner have decided that it is within your "risk tolerance" for you to go down on him without a condom. What you have just decided is what we now refer to as negotiated safety (or negotiated risk).

Let me start with some basic concepts:

1. One of the great things about being alive is having sex. 2. Sex is as important to seropositives as it is to seronegatives. 3. A healthy expression of sexuality is an integral part of general health.

OK, what about your specific decision? Well, we know that the risk of contracting HIV from any type of oral sex is extremely low. The risk for the insertive partner is even lower than that for the receptive partner. Several recent studies have found no recent seroconverters despite unprotected oral sex with HIV-positive partners. However, this does not mean there is absolutely no risk, as these studies were not large enough to make that type of absolute assertion. What the studies do indicate is that the risk is even lower than what we originally thought. We know folks engage in a calculated risk analysis all day, every day. Do I drive above the speed limit, try to sneak through a yellow light, smoke a cigarette, fly in an airplane, date Mike Tyson . . . ? Magnetic couples need to discuss what feels safe or unsafe based on their individual comfort levels and the medical facts. The facts are we cant say that insertive oral sex is absolutely risk-free for HIV, but all recent evidence is indicating that whatever risk there might be must be extremely, extremely low.

Many magnetic couples (one I know very well) have a very successful and satisfying sexual relationship. The need for touch, pleasure, intimacy, and hot sex does not decline with your CD4 count, nor should it! For magnetic couples (and couples in general, for that matter), communication is key. I know HIV-positives feel better when HIV negatives share the worry of possible infection. Accepting each other as different is also important. I think the bottom line is that sex is not a luxury we can easily do without. There is no reasonable substitute that is anywhere near to being as pleasurable. Celibacy generally, is not a viable option and can lead to a sense of deprivation, frustration, and ultimately, acting out (just look at the Catholic church!). Besides, I tend to think life-long celibacy, because of fear of infection (giving or receiving), is analogous to never crossing a city street for fear of being hit by a car. Common sense and negotiating risk (safety) are as practical and potentially life saving as looking both ways before crossing a busy intersection. Chances of disaster striking increase in either case, if you tightly close your eyes and just forge ahead. I think you and your partner have your eyes wide open, have looked both ways, and have weighed potential risks accurately. I see no reason for guilt or undue fears if you want to "cross the street". If you are both comfortable with your decision (which I think is reasonable, medically speaking), then enjoy sex for what it is wonderful! Steve and I have you two beat by a year. Weve been together for 10 years. I seroconverted in 1991. If you two have even half as much fun as we do, you are one very lucky couple!

Stay well D. Give your honey a hug from me.

Dr. Bob

how safe is safe with poz boyfriend??

Oct 13, 2003

My boyfriend of 3 months is positive and I am negative as of last week. We are consistantly using condoms and I do not perform oral sex on him. Still, after sex I have paranoid feelings. Can I touch his precum/semen and infect myself somehow? How much risk is involved? What about broken rubbers? It never happened but could. All these nagging fears are taking a toll on my enjoyment of our sex life.

Response from Dr. Frascino

Hello,

You and your boyfriend need to have a serious discussion about sex and risk. We all take risks every day accelerating through that yellow light, walking in a rainstorm holding an umbrella (possible target for lightening), eating your mother-in-law's cooking, etc., etc., etc. We choose what level of risk we are willing to take. We all must do the same thing with sex. What were you comfortable doing with your boyfriend before you found out he was positive and you were negative? Ideally, we should all assume our sex partners are (or could be) HIV-positive, and take the appropriate precautions each and every time. By that logic, our behaviors really shouldn't change, even if one person is found to be positive and the other is not. Right? That's the ideal world. In the real world, now you know he's positive and you're not and suddenly "nagging fears" are hindering sex. Magnetic couples (one poz, one neg) need to decide together what level of risk they are willing to accept, agree to these rituals and limitations, and stick to them. This is called "negotiated risk" or "negotiated safety." You and your boyfriend need to review all the safe sex and risk info found on this site and related links, and then decide what level of risk both you and he are willing to accept, just as you would decide on the risk of going whitewater rafting or bungee jumping or on a date with O.J. Simpson. Others magnetic couples may decide they want to minimize even extremely small risks, so they may use condoms for oral sex. Communication is key. Once you both agree to the level of risk, and both agree to follow your rules each and every time, the "nagging fears" will go away. By the way, your boyfriend could be having "nagging fears" of possibly placing you at risk, just as you are having "nagging fears" about becoming HIV-positive. What about broken rubbers? Since you know your partner is HIV-positive, if a condom fails and there is significant potential exposure, then PEP (post-exposure prophylaxis) would be warranted. Your doctor or your boyfriend's HIV specialist should be able to prescribe this for you. Start it as soon as possible, and no later than 72 hours, for it to have the best chance of working. Finally, my lover and the center of my universe is HIV-negative (Dr. Steve Natterstad, The Body's expert in the Tratamientos Forum). I am positive. We're celebrating our 10th anniversary on World AIDS Day December 1, 2003. I'm sure we would qualify for an entire documentary on "The Joys of Magnetic Couple Coupling!" (Yes, it would get an NC-17). Hope this helps.

Dr. Bob

Neg. male wants info on preventing HIV with pos partner

Aug 10, 2005

I am an HIV- man who is in a new relationship with a man who is HIV pos. We haven't had sex yet due to our concerns about HIV transmission. Because I am a "bottom", I'm looking for information on the best way to prevent infection. My partner's viral load is undetectable. Does that reduce my risk of infection? Thank you in advance for your answer.

Response from Dr. Frascino

Hello,

Congratulations on your new relationship!

Regarding the HIV transmission risk for "magnetic couples" (one poz, one neggie), please review the information in the archives. Yes, a nondetectable viral load does reduce, but not eliminate, HIV transmission risk. Safer sex practices remain essential. Also familiarize yourself with PEP (post exposure prophylaxis) in case of a significant accidental exposure.

I'll re-post one of the questions from the archives that address your concerns.

Good luck. I do hope your magnet coupling is as successful, loving and satisfying as mine with Dr Steve (the expert on the Body's Tratamientos (En Español) forum.

Dr. Bob

Safe sex help.. one magnetic couple to another! 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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