Serodiscordant Relationships

"Serodiscordant couples raise the thorniest set of issues, because they must face major concerns about both transmission and care-giving."

What Is a Serodiscordant Relationship?

A serodiscordant couple is made up of one person who is HIV negative and one who is HIV positive.

The term serodiscordant originates from the word "seroconversion", which is the medical term for becoming HIV positive, and the word "discordant", which means "at odds".

Some people don't like the term serodiscordant and may use other terms to describe their relationship. Some of these terms are:

• magnetic
• sero-divergent
• inter-viral
• positive-negative
• mixed sero-status
• mixed status.

The challenges that you may experience while in a serodiscordant relationship may not have much to do with how you or your partner got infected with HIV. The challenges are based on the fact that HIV is present in your relationship.

"Accept the reality that your serostatus is 'opposite' and talk about what a positive and negative identity mean to you. Neither experience is more legitimate. Both deserve respect."

Things You or Your Partner May Be Worried About ...

• rejection or abandonment
• losing your partner
• infecting your partner or being infected
• practising safer sex
• health issues and illness
• following treatment plans (treatment adherence)
• effects of treatment or illness on body image and energy levels
• loss of sex drive or sexual desire
• caregiving responsibilities
• family planning or financial planning for the future
• disclosure and privacy issues in talking to others about your relationship and HIV status.

Communication Is the Key ...

Relationships of any kind need good communication strategies in order to stay healthy.

All couples face conflict and compromise -- issues about sex, household chores, financial matters, and family dynamics are common. Because of HIV, serodiscordant couples face added fears and anxieties. For example, worries about transmitting the infection to the HIV-negative partner can lead to sexual problems and emotional withdrawal. And body changes like lipodystrophy (fat redistribution, which is a side effect of medication) can result in depression and cause the HIV-positive partner to feel less attractive.

Communication is the key to resolving conflict, reducing stress and keeping your relationship strong.

Try to be open about your feelings with your partner. Talk about:

• your feelings of grief, anger or fear
• your concerns about providing care in times of illness
• what sexual practices you feel comfortable with
• your needs in terms of support and information.

Ask questions about anything you don't understand.

Just like other couples, those who are dealing with HIV need to respect each other's decisions, and validate each other's feelings.

You may find it helpful to seek professional support for the issues that you and your partner have the most difficulty working out.

"Many members of mixed-status couples avoid discussing their mutual HIV-related concerns in order to 'protect' their partner from these potentially troubling thoughts and feelings."

Points of Discussion for Serodiscordant Couples ...

Silence and secrecy in any relationship can be disastrous. In serodiscordant relationships, not discussing things can lead to risky behaviours and greater anxiety. As difficult as it may be, it is important to discuss very personal issues. By exploring difficult and painful topics, you take away their power to interfere in your relationship.

Emotional health. Talk about your fears of illness and loss. Discuss the feelings you have about grief and death, and explore your ideas about "survivor guilt" (the guilt one may feel about being the HIV-negative partner). Identify areas where you feel the need for more support or information.

Sex talk. Discuss your worries about infecting your partner or being infected by your partner. Decide together what precautions and risks you are willing to take in your sexual relationship. Talk about your likes and dislikes, and identify your concerns about body image, sexual drive and desire.

Medical treatments. Be open about your feelings around treatment issues such as compliance, side effects, and drug trials. Get the information you need and respect the decisions that are made about what treatment options are right for the HIV-positive partner.

Caregiving. Talk about the stress that the HIV-negative partner may feel about becoming the caregiver for the HIV-positive partner. Discuss the concerns that the HIV-positive partner may have about getting sick and needing care.

Family planning. Make decisions about family matters together. If you want to have children, talk about the possibilities of transmission (to partner or to child). Discuss the pros and cons of options such as alternative insemination and adoption. If you already have children, discuss the potential of one partner being a single parent if serious illness or death occurs.

Future planning. Explore any differing attitudes about financial issues. Discuss concerns about saving for the future versus desires to spend in the short term. As hard as it may be, it is important to talk about end-of-life preparation for both partners, including difficult subjects like palliative care, power of attorney, and funeral arrangement preferences.

"If either person does not want to engage in an activity, that person has the final say."

Disclosure. Talk about issues related to disclosing HIV status to others outside the relationship. Discuss the possibilities of not disclosing in order to protect your privacy and avoid discrimination, while examining the option of disclosure in order to gain support and reduce isolation. Keep in mind that, except for emergency situations, the HIV-positive person is ultimately the only person who can decide when, how and with whom the information is shared.

Negotiating Safer Sex in Serodiscordant Relationships ...

Together, you can work out strategies by staying away from blame, shame, anger, and guilt.

Try these strategies for negotiating safer sex:

• Listen to each other -- both partners must have a say in what activities you are going to engage in.
• Seek clarification if you don't know which behaviours are risky for transmission and which are safer.
• Become familiar with the options you have when choosing condoms or dental dams.
• Know that HIV transmission isn't the only risk: be aware of and protect each other from other illnesses and sexually transmitted infections.
• Communicate your fears -- talk about your concerns.
• Share your ideas for creative alternatives for sex play.
• Establish guidelines with each other that you can both accept. These guidelines should not only be about the protection of the HIV-negative partner; they need to include strategies for addressing desirability and gratification too.

Getting on With Living ...

Serodiscordant couples, like all couples with special challenges, need to look for ways to live as normal a life as possible. Of course, what is "normal" for one couple might not feel right for another. Remember that you are a unique couple, and that you love each other. Together, you can use your love and attraction to your advantage and enjoy a healthy relationship.

Some community health or AIDS service organizations provide services for people living with and affected by HIV/AIDS, and may offer support for serodiscordant couples.