This Month in HIV: Sex and Dating When You're HIV Positive
Perry Halkitis: I wonder if I could ask Nina a question. Because Nina, you have been positive for almost the entirety of your life. You came into being as a young woman and an adolescent, and as an emerging adult, living with HIV. I wonder if you think that the difficulty with disclosing, or the difficulty in potentially meeting people would be greater if you were, let's say, a 30-year-old woman who had been negative the majority of her life and then seroconverted. Do you think that your dealing with the virus has an effect on the way you are able to relate to dating?
Nina Martinez: Certainly, certainly. When I go out and speak to college audiences, I encounter a certain amount of difficulty, because I don't know what it's like to be a young adult who is newly diagnosed. It's been an interesting year for me, meeting new people who also disclose.
Other young adults that I have worked with have told me of situations in which they don't disclose. And you have to realize that for all positive people, disclosure is a process that you go through. Some become easier with it earlier on in their natural history with HIV, such as myself, and other people can take a really, really long time.
I've come to realize that, for the positive person to disclose their status, it's somewhat of a double standard. If you have two people in bed, one positive and one negative, there's so much emphasis and burden on the positive person. If they know they are positive, they should tell everyone they're positive. But what about the negative person?
I'm trying to talk to college students about this. What about the negative person? Why isn't the negative person shouting from the rooftops, "I'm HIV negative and I'm proud of it!" And it's just getting people to empower themselves with their own status. I'm positive. It's generally taken for granted that I had an HIV-positive test. But the person who's HIV negative ... you know, other than getting tested, you really have no proof that that person is negative.
I'm just trying to shift the dynamics of the burden of disclosure, not only in positive status, but also negative status, and to get people to think about that.
If things were reversed, and I was diagnosed at 20, 25, I would certainly, I think -- because everyone else has had such a time with it, coming into your sexual prime with an HIV diagnosis -- I think that I would have probably been that way, as well.
Perry Halkitis: I think you're right on the mark. I think what's interesting with negative folks, though, is there's this whole array of negative folks, what I refer to as the truly negative people who test and try to have safer behaviors, and are consistent about their health.
"I wonder if the challenges presented in dating negative folks who are consistently proactive about their health are different from the ones who are not so proactive about their health?"
-- Perry Halkitis
Then there are the mythologically negative people, who are people who have maybe tested three years ago and have had all sorts of behaviors in between, and continue to think that they're negative.
I wonder if the challenges presented in dating negative folks who are consistently proactive about their health are different from the ones [presented in dating those] who are not so proactive about their health?
Keith Green: Well, right up front, if we're going to have the conversation about status, I'm going to ask: When was your last test? How do you know you're negative?
That's going to be an in-depth conversation. It's not going to be really quick and over: "Yes, I'm negative." I want to know how you know that, what do you know about safer sex.
I'm very curious like that. Generally, what has happened is, usually that will lead to the person who identifies as negative being tested within a short time following our conversation. Because most of the time -- not that it's been a whole lot, let's clear this up -- but that person has not been tested recently, or is not tested regularly.
I run into far more people, and not just in my own sexual encounters, but just in the work that I do, I run into lots and lots of those -- what did you call them, again?
Perry Halkitis: Mythologically negative.
Keith Green: Mythologically negative. I run into lots of those people. I'm like, you really don't know your status. You believe you are negative, but based on what you just told me, you can't really know whether you are positive or negative. Interesting.
David Salyer: You know what? I also run into guys who do test for HIV once or twice a year, but they have never been screened for STDs. So that's a completely different conversation.
But I wanted to back up for a second and mention that on Monday of this week, I had a date with a guy who says he's HIV negative. I have a second date with him tomorrow night. What I plan to do in the course of the evening is what Keith said. Ask him about his last test and then get a feel for what is safe for him and what his boundaries are. Because I'm really into him, and I can see this moving forward. So I kind of want to know where he's at. How often does he test? Is it once a year? Or was it in 1999?
David, is that what you usually do? Is that kind of a procedure at this point?
David Salyer: Yes. If someone is negative, if I have a date with a guy who's negative, I'm going to kind of go fishing for a little bit more information about how often they test. I'll probably try to work something into the conversation about STDs. I must be pretty charming, because I typically get away with this!
Speaking of negative partners, I know a lot of positive people who argue that maybe they should stay away from negative people. It's not worth it. Maybe they should just date positive people, because at least there's this great understanding. What are your feelings about it? David?
David Salyer: I can tell you, honestly. A couple of years ago I was sitting in my therapist's office, and I said, "You know what? I just don't want to date any more HIV-negative guys. I just want to date other positive men. It will just be easier."
"As it turns out, I usually meet HIV-negative men, and that's where the chemistry is. I haven't been so lucky with positive guys yet."
-- David Salyer
And that is great, except it would be foolish of me to think the universe was going to cooperate with me. Love doesn't work that way. Sexual attraction doesn't work that way. As it turns out, I usually meet HIV-negative men, and that's where the chemistry is. I haven't been so lucky with positive guys yet.
Keith Green: I'm open. I'm definitely open. But I do feel more comfortable dating positive guys. And I have to back up a little bit. When you started out, you mentioned that I was single. But I'm actually not. I've been in a relationship now for ... it will be a year at the end of the month, the end of June.
Keith Green: That's okay. In case he hears this, I want to make sure I'm not advertising. But generally, I tend to be more prone to date positive guys, because the negotiation thing, in terms of what we'll do and how we'll do it, becomes tricky for me.
Keith Green: Because sexually, I am equally versatile. So I love being the assertive partner, and I love being the receptive partner, equally. But I'm very fearful -- if I'm with someone who's negative -- of a condom slip. And we have to have those conversations. It's really, really detailed.
Like, I know that my viral load right now is undetectable and so that helps to minimize the risk. So then we use a condom and that helps even further, blah, blah, blah.
But mentally, I'm uncomfortable, and a lot of times, will have a difficult time keeping an upright penis, because my mind is thinking about what ifs.
And are you as nervous as the other person?
Keith Green: I don't think I am. I don't think I have been. No. I think I'm more nervous than the other person is. ... I think ... I don't know. I couldn't really say what's going on in his mind. But I think that I'm usually more nervous and cautious than the other person is. Then I will try to compromise and relegate myself to the receptive position. But that's not me. I enjoy all of it. So I want to enjoy it, and not have that worry.
"I've never dated any positive men. I wouldn't rule it out. I think it's kind of an artificial distinction, because you fall in love with whomever you fall in love with."
-- Nina Martinez
Nina Martinez: I've never dated any positive men. I wouldn't rule it out. I think it's kind of an artificial distinction, because you fall in love with whomever you fall in love with. And I think also that straight, HIV-positive men, in general -- because I've never met one -- I tend to think that maybe they don't exist. So I've only had relationships with -- and I'll say it -- mythologically negative men. It could be easier to date a positive man; I don't really know. I also think that, because I'm so out there with my status, if there are any straight, positive men out there -- and this could be an advertisement, don't get me wrong -- because I'm so out there with my status, maybe if they aren't, that could probably make things a little difficult. Generally, my relationships have always been with negative men.
Nina, could you talk a little bit about what Keith mentioned? Some of the sexual negotiation? Are there things that negative men will do or not do? Is it you who is more nervous than they?
Nina Martinez: They basically have to tell me what they are comfortable with. I don't suggest anything new, or anything like that. It's basically up to them. I think, because, again, it goes along with them choosing what risks they will or will not take. We have to remember the whole high-risk and low-risk behaviors. Those are based from population numbers. And it's a population context. It doesn't tell you what happened to an individual, because their chances of getting HIV are either zero or one. There's no in between. I let the guy decide what it is that he is or is not comfortable with.
Do you find that people are very comfortable, somewhat comfortable, not comfortable?
Nina Martinez: They're very comfortable, because they get all the say. They get to decide. And men like to decide.
David? Can you weigh in on this?
David Salyer: Actually, something that came up for me while Nina was speaking, and having listened to Keith, as well: I meet a lot of positive African-American women. And they tell me that African-American men don't seem to believe that they can get HIV from them.
So they don't want to use protection?
David Salyer: Yes.
Keith Green: I agree. I so agree. I just did a really big article on serodiscordance. And all of the women I talked to: that was kind of the thing, that lots of African-American men don't really believe that they can get HIV from them.
Then the women end up in these relationships where they kind of are at the mercy of these men. Because, like Nina talked about earlier, the men will kind of throw out, "Well, you know nobody else is going to want you because you're positive," and blah, blah, blah. There's a really interesting dynamic that I heard from the women that interviewed for that story.
"Isn't it in fact true, especially for women who are HIV positive, and who are on antivirals, because of the way heterosexual sex works, the mechanics of it, that, in fact, the transmission of HIV from women to straight men may be at a much lower level than it is, for example, let's say from a gay man having sex with another man through anal intercourse?"
-- Perry Halkitis
Perry Halkitis: But let's stay with this for a second, and let's play the transmission game for a second. Isn't it in fact true, especially for women who are HIV positive, and who are on antivirals, because of the way heterosexual sex works, the mechanics of it, that, in fact, the transmission of HIV from women to straight men may be at a much lower level than it is, for example, let's say from a gay man having sex with another man through anal intercourse? Isn't there some truth to that?
David Salyer: Yes, absolutely. The female-to-male transmission rate, some people might use the word "negligible" to describe it. So, yes. That is true.
But it's not zero.
Perry Halkitis: No, it's not zero. Absolutely not.
It's just eight times less risky than the other, male to female. But we don't know what that means.
Perry Halkitis: No. We absolutely don't know what that means. But we also know how human beings operate. And how human beings operate is along a continuum of risk. And there are risks they are willing to take. I think what may be the case for some women, and for some men, is that their understanding is that the risk is almost negligible. As a result of that, that's a risk that they are willing to take just in that very parallel way that I think that our research here at my center shows consistently with gay men, that oral sex is just a risk they are willing to take.
David Salyer: Absolutely. I can tell you. I have been standing in front of groups since 1994, waving flavored condoms ... and nobody wants them.
Keith Green: Yes.
Perry Halkitis: Right.
Keith Green: Yeah. Nobody wants those.
Perry Halkitis: I would ask the group: Is that okay? You make an ethical decision at some point in your life, about what you're willing to do and what you're not willing to do. We definitely want to educate people to be safe as often as they can.
But ultimately, people need to live their lives. And if it's a very clear, and negligible, small risk, is it not okay for people to be taking this risk, if they are willing to do it?
David Salyer: I think it's okay as long as I have had a conversation with them about their oral health and the things that could lead to transmission orally.
Keith Green: As long as they are clear on what the risks are and what the precautions are, I think people have the right to do whatever they want to do.
We talked about mixed-status relationships. What about same-status relationships? If you decide to date only HIV-positive people, do you guys feel you can safely have unprotected sex? David?
David Salyer: Why did I know you were going to come to me on that question? I think there's a negotiation there, as well. I have to say, quite honestly, because I identify in my online personal ads as being HIV positive, I get a lot of offers from other positive men to bareback. And, yes, I'm just going to be truthful and say that I have, under a couple of circumstances, done that with other positive men. But it was after I had a long discussion about what that could mean for us.
Yes. And I confess, I'm a little bit uncomfortable talking about it. But yes, I have.
Why do you feel uncomfortable?
David Salyer: I guess, as an educator, I want people to know that some of the most recent research implies that you could be reinfected with HIV. But I, personally, don't see that as a risk to me.
David Salyer: I just don't believe that. Well, actually, I don't believe that it would be any worse for me.
"I think if the fact was that reinfection and superinfection was so highly possible, we would be seeing a lot more of that in the positive population."
-- Perry Halkitis
Perry Halkitis: I think a good point is raised here. And I think it's one that positive people struggle with all the time, this reinfection thing, this superinfection thing, right? And the data are pretty inconsistent here. I think if the fact was that reinfection and superinfection was so highly possible, we would be seeing a lot more of that in the positive population, clinically. It would be manifesting itself.
I think some of the most recent data that has actually come out of the conferences, the retroviral conference [14th Conference on Retroviruses and Opportunistic Infections (CROI 2007)], indicate that sure, it's possible. But the probability of that really decreases when somebody becomes more chronically infected with the virus. So maybe at the early stages of the disease, when somebody's been infected for less than a year, for a short period of time, superinfection is possible. But ultimately that sort of wanes over time.
This is my personal belief -- based per my understanding of the literature -- that we're not seeing a lot of this going on in the population.
David, I definitely hear what you're saying. I definitely understand the struggle with this whole issue. But how about two positive men who have talked about this, and feel comfortable with it, and they just decide to bareback with each other? Is that ultimately such a bad thing?
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This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
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