Get a Little Closer: HIV, Sex and Intimacy
Kara Kingston and Eduardo Flores* had a whirlwind romance, the kind you read about in books: An exotic locale. A kiss. A walk along the South American coast. A flair of passion. “I love you” written on a steamy bathroom mirror. And then a wedding ring and a white dress.
Kingston, an American from California, was dizzy with the speed of it. But for the first time, everything seemed easy. With most guys she had dated there’d been some big bump in the romance. But with Flores, it just flowed.
And then there was a bump. A big one: HIV.
It turned out, unbeknownst to either of them, that Flores had been infected with HIV. No one knew when or how, though they had guesses. Suddenly, his body -- the body Kingston had held and stroked and kissed -- seemed foreign to her. When they had sex again after his diagnosis, Flores could see the fear in Kingston's eyes.
HIV had the potential to tear the newlyweds apart. But as Kingston did research and Flores began taking his medication, a new story emerged. The doctor told Kingston that the flu is easier to get than HIV these days. The more people told them to give up, the more they wanted to prove that their love was greater than HIV.
Maybe they could make it work. Maybe they didn’t have to break up because of it. For Kingston, whose uncle had died from complications due to AIDS, the fear was real. But so were the facts.
“Knowing that he’s undetectable and getting educated on how HIV is today makes me less nervous during sex,” said Kingston. “[Treatment as prevention] is a real game-changer for me. We can enjoy an intimacy that’s at least at a level that’s normal.”
Today, the couple is still married, happily, and living in the States with their newborn and dog.
After decades of fear-mongering, loved ones lost to AIDS-related complications and widespread rejection because of their HIV status, normal intimacy is returning to the lives of people living with HIV. Thanks to effective treatment, which reduces the risk of transmission almost to zero, and more options for effective prevention, the new era of HIV is breaking down barriers between couples and fostering intimacy both inside and outside the bedroom. And while this change is giving individuals and couples unprecedented freedom, there’s still a ways to go before society catches up to the closeness that couples affected by HIV can now enjoy.
The Science of Intimacy
One day last fall, Poppy Morgan* was sitting on a hard wooden bench in a San Francisco City Hall meeting room next to researcher Bob Grant, the chief investigator of the iPrEx study (an HIV prevention study) and a researcher at UC San Francisco’s Gladstone Institutes. Morgan wanted to know: Could she see a molecular photo of her husband’s blood next to her own? She wanted visual evidence of this virus that looms so large in her relationship, and how his HIV-infected blood is different from her own HIV-uninfected blood.
Grant’s answer was that, though HIV looms large in the imagination, there’s nothing to see. That’s because Morgan’s husband's HIV treatment is so effective that one would not be able to find any virus in his blood without concentrating it many times over. That’s what it means when people say their viral load is undetectable.
And that’s what it means for HIV to stop coming between couples. There are three primary advances that are making it easier for HIV-discordant couples -- like Kingston and Flores or Poppy and Ted Morgan* -- to be close, and all are encapsulated, literally, in a few small pills. HIV antiretroviral therapy is a combination of medicines that, when taken together (or combined in one pill), can reduce an infected person’s viral load to undetectable levels. Research has also found that HIV medication, when taken in specific ways by people without HIV, can prevent acquisition more than 90% of the time. That’s called PrEP, or pre-exposure prophylaxis; Truvada (a coformulation of the HIV drugs tenofovir and emtricitabine) is the first medication that has been approved for this use.
And then there’s post-exposure prophylaxis (PEP), a combination treatment that can prevent someone who may have been exposed to HIV from actually contracting the virus, if taken soon after the time of potential infection.
Put them all together, and you have a new view of HIV -- one that doesn’t get between a person and his or her loved ones.
Touched for the Very First Time (Again)
Jeremy Balli, 33, can’t remember ever having sex without the specter of HIV hanging over him. Until last year.
“I feel like doing the whole He-Man ‘I have the power!’ pose,” said Balli, who lives in San Francisco. “This is a peace of mind I’ve never had in my entire life.”
“This” is Truvada, which Balli has been taking to keep him HIV negative. He found out about it during a hookup last year. For a gay man who came out in the middle of an epidemic, sex was always something exciting, yes, but also fraught with doubt. “The moment I heard about HIV, I was scared,” he said.
But now, when he has sex with his longtime partner, who’s negative, or any of his play buddies (Balli and his partner are in an open relationship), he can relax and connect in a way he never has before.
Roger Klorese knows the feeling. Klorese, 59, didn’t hear about HIV -- or gay-related immune deficiency (GRID), as it was called in the early days -- until he was 25 or 26. Suddenly, his entire understanding of sex and intimacy flipped. There was a whole “stop what you’re doing” ethos at the time.
“To go from that threat not being there to suddenly being there is a big thing,” said Klorese, whose use of Truvada has helped him feel unburdened by the specter of HIV. “And to now, for the first time in half your life, get to feel that intimacy again ..."
More Work to Do
But this new era of HIV prevention is not a panacea for other issues. News out of the Conference on Retroviruses and Opportunistic Infections (CROI) this year found that the vast majority of people who transmit HIV don’t know they have it. And with large swathes of people with HIV not on treatment, the full freedom and intimacy promised by the new science of HIV are still far off. Add in HIV criminalization laws, which can be used to control or otherwise target HIV-positive people, and you have a culture that still has a long way to go to catch up to the science.
“The rates of HIV are falling in some cases, but they’re rising in others,” said George Felix Sirls, a longtime survivor who lives in Detroit and runs HIV support groups. “We have PrEP and treatment as prevention, but we also have an old-school thought and education system about HIV. People have not been brought up to date. The laws are archaic. Society hasn’t caught up to the medicine.”
*Kara Kingston, Eduardo Flores, Poppy Morgan and Ted Morgan are pseudonyms.
Heather Boerner is a health care journalist based in San Francisco and author of Positively Negative: Love, Pregnancy and Science's Surprising Victory Over HIV.