Some Reflections on Relationships and Sexual Intimacy for Gay Men with AIDS/HIV
The European Judeo-Christian heritage has a well documented history of sex-negativity, erotophobia, and sexual violence. Discomfort with sex in general, widespread disapproval of sexual pleasure outside of traditional marriage, and intolerance of sexual differences has resulted in legislation prohibiting sex education in schools, limited access to birth control and abortion, and violence against lesbians, gay men, drag queens and women. These narrow-minded attitudes have unfortunately had a powerful influence in shaping contemporary American thought and responses to sexual diversity and sexual health.
The current efforts to impede, at the cost of human lives, sexually explicit AIDS education and prevention programs that are based on sound public health principles is but one example of American schizophrenia around sex and sexuality. This directly translates into some people feeling that others deserve to die for being sexual in ways that they do not approve of. The fact that there are politicians and religious leaders who have actually publicly stated that people infected with HIV deserve to become sick and die, and are only paying for their sins, lust, or perversions, is a clear indication that many members of our society believe that certain forms of consenting sexual behaviors between adults are bad and must be curbed or punished.
Any adult who has developed a healthy and well-integrated sexual component of him/herself has had to do so despite strong messages to curtail positive sexual expression. Certainly this is the case with lesbian, gay or bisexual people who have developed as self-actualized individuals and who have refused to allow rampant homophobia to continue to cripple them.
Thus, it is completely understandable that people who have full blown AIDS or who are infected with HIV may have a variety of feelings, that often include shame and/or low self-esteem, arising out of being HIV seropositive or having AlDS. Learning that you have been exposed to HIV or being diagnosed with an AlDS-related medical condition is almost certain to affect your sex life, at least temporarily. One initial reaction to the shock, fear, anxiety or depression is to completely shut down sexually. Another reaction to the onset of a personal health crisis is to become extremely sexually active, either with one partner or many. Other people find that, at least initially, there is no change in the way they function sexually. There are many reasons why a person may choose to become celibate as a result of an AIDS/HIV diagnosis. As someone becomes increasingly symptomatic, it is not uncommon for his interest in having sex to decrease and eventually disappear. And yet this does not happen to all people with HIV illness.
There has always been a variety of ways that gay men expressed their sexuality. Some people coupled up in long-term monogamous relationships, while others had long-term relationships that were not sexually exclusive. There was a segment of the gay male community that preferred tricking, i.e., one night stands or brief affairs, to anything long-term or permanent. There were always some gay men who chose to be celibate, at least for some period of their lives. Our sexual tastes went from leather, S/M, or kinky to vanilla; from preppie to gender fuck and drag. This diversity has always been one of the strengths of the community and an expression of our differences. There is no reason why we have to let AIDS stop us from celebrating ourselves as sexual beings, as long as each of us continually reinforces our commitment to safe sex.
ConsiderationsAIDS has certainly cast a dark shadow over sexual play. As one man I know put it, "Cum used to be love juice for me, but now I think of a as the bearer of death, and honey, that's not a turn on, but it's what I think of every time I'm about to put a dick into my mouth!" Concerns about possibly spreading HIV have appropriately inhibited some forms of sexual play, and reduced spontaneity as condoms must be put on and taken off.
There are many reasons why a person may choose to become celibate as a result of an AIDS/HIV diagnosis. As someone becomes increasingly symptomatic, it is not uncommon for his interest in having sex to decrease and eventually disappear. And yet this does not happen to all people with HIV illness.
For people in a relationship where sex had been a valued aspect, one partner's loss of sexual desire can cause problems. For couples who may be experiencing stress as a result of this problem, it is crucial for both people to discuss their needs and be honest about their feelings regarding this change in their relationship. There are numerous ways of dealing with this. Just because one person is not feeling sexual usually does not mean that he does not still want to be physically affectionate with his partner.
The partner who still has a desire to be sexual has several options for meeting these needs. This is certainly an opportunity for creative problem solving to address both partners' needs. Perhaps the man who does not have any sexual desire is amenable to participating in certain sexual acts where he isn't expected to have an erection, be penetrated or reach an orgasm, but is willing to help his lover achieve sexual satisfaction. Some couples agree that at this point in their relationship it is acceptable for the partner who desires sex to have sexual contacts outside of the relationship. Other couples find this too threatening to even consider. What is important is that both parties communicate honestly about their feelings.
A large part of sex has to do with body image. As people lose weight, have skin problems,
develop KS lesions or have a Hickman catheter installed, they may no longer like the way their
body looks or feels. Thus when they no longer feel attractive or desirable, some people with
AIDS avoid sex because they don't believe that anyone could find them attractive. Often when a
PWA expresses this during couples therapy, the partner acknowledges the changes in his lover's
appearance, but usually shares that for him at this point in their life together, sexual attraction is
no longer primarily based upon looks, even if it had once been the focus of their intimacy.
"Read On"All right, I can hear some of you thinking to yourselves, "What he's discussed so far is all well and good for those people lucky enough to have the luxury of negotiating sex within a relationship that predated their diagnosis, but when are you going to begin to talk about the concerns of the numerous single people who are HIV seropositive or with AIDS who still wish to be sexual or even begin a relationship?" Read on.
Being seropositive or having AIDS does not mean that anyone's chances for beginning a relationship are over. Obviously, AIDS/HIV can complicate things and make the process of meeting people and dating seem more difficult. Today, health status certainly heightens many people's anxieties about meeting people, sex and dating.
In conversations with single patients and friends who have HIV, I have heard many different opinions regarding the kind of person being sought as a boyfriend or lover. There are the men who only want to go out with other men who are also HlV seropositive, feeling that this will make things less complicated. There are those who only want to me someone who is not seropositive, as in case they get sick their boyfriend will be able to take care of them.
Several people have shared with me that they simply do not want to deal with telling people about being seropositive or having AIDS and risking possible rejection so when they feel horny they simply go to one of the safe sex clubs and play safe or go out, pick someone up, go home and have conservative and very safe sex. This raises the issue of when is the appropriate time to tell a prospective sex partner that you have been exposed to HIV or have "it"? Some people feel that as long as they do not do anything to place either themselves or their partner(s) at risk of spreading HIV, they do not have to discuss HIV. Yet if you meet someone, go home, have safe sex, don't talk about HIV, have a real great time and want to see each other again, won't it become increasingly difficult to tell your new friend about your health status?
For this very reason many people with HIV decide not to have sex with someone they just meet. They go out on a few dates that do not end up in bed, and get to know each other. This way they can decide if they feel they like and trust the other person enough to disclose their HIV status to him. Some people will choose not to continue dating person who has HIV, and will be greatly relieved that the two of you never went to bed. This can be disappointing or even painful, but not nearly as painful as being rejected once you had sex and had your feelings as well as your hormones are stirred up. Since what is considered safe sex is still not absolute, and there are very gray areas about oral sex, two people may have different definitions about what is safe and what they are willing to do. A story told to me by a friend with AIDS who dated someone for a few weeks before he told him about his diagnosis illustrates how difficult this can be. My friend said he and his boyfriend had been having what he considers to be safe sex that included cocksucking without either person cumming in someone's mouth. After telling his friend that he had AIDS, my friend's friend said he wouldn't have gone down on him without a condom if he had known he had AIDS. "You let me suck on your dick all those times without telling me you had AIDS?" his boyfriend asked, hurt and bewildered. My friend said he felt badly, but not guilty.
In addition to all the issues surrounding body image already discussed, there is the question of self-image in regard to having a possibly life-threatening illness. Many single people with HIV think of themselves as "damaged goods" and thus not people whom anybody would ever find suitable to begin a relationship with. This expression of low self-esteem usually rekindles internalized homophobic feelings that had been dormant or even resolved for many years. Feeling vulnerable about health status, compounded with vulnerability about desires for intimacy, often makes even the most self-assured individual hesitate to put himself out there in dating situations.
This article has obviously only scratched the surface of very complex and difficult issues that deeply affect many of us. In order to create a forum where issues of sex, dating and intimacy for seropositive or gay men with AIDS can safely be discussed in some depth, a group of people from the PWA Coalition and GMHC have gotten together and revised the existing GMHC workshop on sex, dating and intimacy. Call the GMHC Hotline at (212) 807-6655 for more information.
©1991 Michael Shernoff
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It is a part of the publication People With AIDS Newsline.