The Positive and Negatives of a Serodiscordant Relationship

Serodiscordant. That word isn't even in my dictionary. Researchers use "serodiscordant" to describe couples where one individual is HIV-positive and the other is HIV-negative. So what happens when HIV opposites attract? Issues! Challenges! Anxiety! And you thought "Will & Grace" had an arduous relationship.

Most couples of mixed HIV status face similar issues regardless of sexual orientation. Straight or gay, mixed couples usually live with fears about HIV transmission to the negative partner and concerns about maintaining a safe but satisfying sex life. Some encounter a profound lack of support and validation from family and friends, who often question why they're getting into or continuing a relationship full of risks like HIV transmission, illness, dependency and death. Of course, illness, death and dependency can happen in any relationship, but somehow HIV makes them more palpable.

Mixed status heterosexual couples may also struggle with HIV stigma and the "it's a gay disease" myth that continues to proliferate in the minds of clueless Americans and unenlightened healthcare professionals. For gay couples, society's overall lack of support for such unions is noxious enough already, so the reality of positive/negative couplings rarely draws sympathy or understanding. Worse, finding or obtaining social services that address the needs of both partners can be a long, frustrating process. In many areas of the country such services simply don't exist.

From 1985-1995, the Center for AIDS Prevention Studies (University of California, San Francisco) conducted the California Partners Study, following 175 serodiscordant couples in an effort to assess the management of HIV in their relationships. Not surprisingly, researchers found that some were terrified of public exposure of their relationship; many felt unsupported in their relationship by some family members and friends; a lot of the HIV+ partners gave up on sex after testing positive because they either felt safer sex would not be fun or they feared HIV transmission to their negative partner; and even HIV+ participants who consistently practiced safer sex experienced fear and guilt. In addition, couples were frustrated by everchanging HIV "facts," and resentful about the lack of resources for mixed status heterosexual couples.

The Male Couple Study conducted in 1993-1995 at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute found that similar issues existed for mixed status gay male couples. Disturbingly, researchers discovered that the 75 couples in the study showed signs of elevated levels of depression, anxiety, hostility, hopelessness and demoralization, more so than even general psychiatric outpatients and similar samples of uncoupled HIV- and HIV+ gay men. Dr. Robert Remien, a clinical psychologist and Principal Investigator of the Male Couples Study, drew an irrefutable conclusion: "...a lot of gay couples feel that there are very few role models for them, so there's a struggle just to be a couple. Then, on top of that, for some, it's an extra challenge to be of opposite HIV status."

Sadly, if you're negative and date a positive person, a lot of people will assume you already are or will eventually be positive. Some negative people will not date a person they know to be positive out of fear of infection, but also because they don't want others to think they must be infected, too. But some positive folks won't date or have sex with partners they believe to be negative, either.

For me personally, I could probably write a multi-part series called "Grim Moments in Dating."

• Before I was positive:
  I dated and slept with men I knew were positive. Feeling as though I fully understood how to protect myself, it just wasn't a big deal. And I never felt like I was hovering around death's door. There were also a few men who had never been tested for HIV, some who assumed they must be positive based on their sexual history, and still others who skillfully avoided the subject until I brought it up, thus evoking deer-in-the-headlights syndrome. One guy burst into tears when I told him a mutual friend had disclosed his HIV-positive status to me, but then waited three more months to tell me he had herpes and hepatitis B. My trust undermined, I walked.

• After I was positive:
  Men remain reluctant to have the conversation. I disclose before the first date or on the date itself, prior to sexual activity. Only once in over six years has another man brought up the subject before I did. Another time, I disclosed to a man who responded by telling me he understood what I was going through because he lived with a chronic illness, too: diabetes. I felt like any minute we were going to get into some infantile quarrel. "My chronic illness is less manageable than yours, pal!" "Diabetic coma!" "Dementia!" "Frequent urination!" "Projectile diarrhea!"

Okay, so disclosure is hard enough, but have you ever secretly hoped that the object of your infatuation shares your status, even if you're positive? I have. I cling to an irrational belief that Mr. Right might be Mr. Perfect if he's already in the HIV loop. We have something in common! Let's bond! Aside from being one of the most absurd scenarios that ever broke out of one of my brain closets, the fact is that it pretty much discounts one basic fact of life: you can never guess who you're going to fall in love with.

The last five men I dated all claimed to be HIV-. Each one of them had something different to say about what my HIV+ status meant to them. For three of them it really didn't seem to matter all that much. One recoiled as if he'd just encountered the Blair Witch. The last one clearly stated his fears and showed a willingness to communicate and continue dating. Frankly, I thought he was a keeper. But guess what? He was hospitalized after developing symptoms associated with heart disease and has since undergone surgery and started drug therapy. So Mr. Maybe-The-Right-One-Even-Though-He's-Not-Positive has some health issues all his own. He told me he wanted to take some time to adjust to his diagnosis, make some lifestyle changes and be by himself. Been there, done that. Can't fault him. More importantly, this was a timely reminder that it's not all about me and my virus.

As grim as some of the research is regarding serodiscordant couples, remember that very little research actually exists. And research of this nature tends to measure the most negative aspects of positive/negative couplings, telling us primarily how HIV complicates our lives. It tells us very little about the rewards, the discovery of inner strengths, the emotional ties, the opportunities for developing better communication skills, or the joy generated when a mixed status couple does create a happy, strong, fulfilling relationship.

A couple of final suggestions for mixed status couples. First, let's ditch "serodiscordant," since it's a word built solidly around the concept of discord. Try "serodivergent" instead. It's kinder and gentler and will probably make researchers crazy. Then, let's abandon insipid cliches like "love conquers all" because relationships are a work in progress. The password is work, not conquer. HIV can certainly overwhelm a relationship, undermining hope, optimism and sexual intimacy...if we let it.

Looking for further info or support? Try Internet sites like www.thebody.com or http://HIVInSite.ucsf.edu. In the Atlanta area, call the Absolutely Positive organization at 770-642-6646 and ask about their Infected/Affected Support Group.