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This Month in HIV: A Podcast of Critical News in HIV
  

This Month in HIV: Sex and Dating When You're HIV Positive

June 2007

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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David Salyer: I will say, quite honestly, that in 2001, I was involved with a man for a year. We dated and we were monogamous. We decided, because we were both positive, and we were willing to go the monogamous route, that we would bareback. I don't have any regrets about that and I don't think it had an impact on my health.

Keith?

Keith Green: It's actually where I am in my relationship right now. We are both positive, and he's more newly diagnosed than I am. I have been positive since I was 17. This is kind of new for him. But that's where our conversation is: If we're going to be monogamous, and we understand that neither of us are infected with any other sexually transmissible infections, and we know that my viral load has been undetectable for the past four years, we are leaning more towards the no condom. Sometimes it does happen without condoms. It's not a conscious thing yet. But we're going there. We're going that route, where we will probably not be using condoms in our relationship.

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So I guess this conversation is helpful, even in bringing in some of our dialogue back to him and saying, "Okay, honey. This is what we kind of talked about in this conversation. What do you think about this?"

But he's very informed. We're both very informed. We both have conversations with our doctors, and with each other, about how to proceed. But I am usually of the mind that, unless we're in a committed relationship where we have had this conversation, and we continue to have this conversation about our risks and about our monogamous relationship -- because that's the key, having that open dialogue -- then I am going to be using condoms for the rest of my life.

Perry Halkitis: I think Keith raises a really good point that would be very well taken by not just positive people, but anybody in a relationship. Relationships constantly evolve. They change. They face struggles. They face highs and lows. And there has got to be this constant dialogue between people, not only about their physical health, but about their emotional health, in remaining in these relationships.

Nina, what's your take on all of this?

Nina Martinez: I guess I would kind of go a different route, if I did meet an HIV-positive man. And I guess you could pose the question to me: Would I consider having unprotected sex at any point? I guess I would just say no, and that's probably because I have never had unprotected sex.

"The words, 'negligible risk' kind of ring a sour note with me. Because contracting HIV through blood is said today to be a negligible risk. But if you're the person that it happens to, negligible is of little, little comfort."

-- Nina Martinez

I guess I'm very protective of ... I like to call it my 1980s San Francisco Olympic Gold Medal AIDS. I have read a lot of the research on reinfection and things like that. The words "negligible risk" kind of ring a sour note with me, because contracting HIV through blood is said today to be a negligible risk, but if you're the person that it happens to, negligible is of little, little comfort. I guess that would be my piece in there.

What about transmission of HIV drug resistance, if you're having unprotected sex? How big of a risk is that? Perry, I know I talked to you a little bit about that. Is that similar to superinfection? I.e., that it's more of a risk when you're just getting diagnosed HIV positive? The original transmission could be resistant?

Perry Halkitis: The cases of resistant strain that we have seen transmitted are transmissions that occur from an HIV-positive individual to a negative person. That's what's been documented in the literature. But the literature on the transmission of resistance from one HIV-positive person to another HIV-positive person is all about abstinence. There's not any clear data there.

And my thinking -- not as a microbiologist here, or as a physician -- is that the same susceptibility that a person would encounter early on in the infection of HIV would also pertain, not only to the superinfection possibility, but the possibility of being infected with a resistant strain.

What about other sexually transmitted diseases? Keith, is that why you were talking about monogamy, and once you make the monogamous decision you would possibly go to unprotected sex? Is that about the risk of STDs?

Keith Green: It is, absolutely. And it's a constant conversation of monogamy. And having a really real relationship, and an open relationship -- and not open, where we can sleep with whomever we want to sleep with, but open in the sense that if there's a slip up on either end -- you know, you are somewhere and something happens -- not saying that I want that to happen, or that I'm okay with that happening -- but that you would come home, or that I would come home, and say, "Honey, this is what happened. This is how it happened."

We need to have that conversation together. So that I know, again, it's my right to choose. I need to say, "Okay, dear. We need to go and be tested for STDs together," and figure out, did you acquire something while this was happening. It's about continuing to have an open, honest dialogue with the person that I'm with.

Is it because you feel you just want to be safe from other STDs? Or do you think that for someone who is HIV positive it's more dangerous to get certain STDs?

Keith Green: I think it's just, I want to be safe. I'm not sure if I feel it's more dangerous. I'm a pretty healthy guy. So I don't think it's more dangerous than it is for an HIV-negative person. It's just the fact that I don't want to walk into my doctor's office, who I have this wonderful relationship with, and he knows what I do and how I do it, and say, "Hey, Doc, I think I'm dripping. There's a little burn here." I don't want to have to experience that.

So, David, is it similar for you?

David Salyer: Yes. And what I know about STDs is that the symptoms don't always show up. So you could carry it for a long time and just not know.

Keith Green: Sure. Sure. I'm regularly tested for syphilis. Like, every doctor's visit, I'm tested. I'm peeing in a cup. We look for those every time I'm tested, although I don't feel like I'm putting myself necessarily at risk. I'm not sleeping with a million people; I'm not sleeping with several people, even. But I still am cautious.

Perry Halkitis: I think that's a very good point, and I think any M.D. who is worth their while is testing any gay man on a consistent basis for STDs, including syphilis -- and [testing] anybody who's sexually active for these diseases.

"The fact that we have gone to Tier II level to treat gonorrhea -- and that's the standard right now in the United States, because there's so much resistant gonorrhea out there -- indicates to me that people, one, need to be careful about these things, but physicians need to be really aware that they have to be watching people for STIs [sexually transmitted infections], other than HIV, itself."

-- Perry Halkitis

The fact that we have gone to Tier II level to treat gonorrhea -- and that's the standard right now in the United States, because there's so much resistant gonorrhea out there -- indicates to me that people, one, need to be careful about these things, but physicians need to be really aware that they have to be watching people for STIs [sexually transmitted infections], other than HIV, itself. [For more on current treatment for gonorrhea, click here.]

It's not discussed enough. I'm glad the conversation is focused a little bit on that. Because I think people just say, oh, whatever. It's gonorrhea, who cares? It's treatable with one dose. And the fact of the matter is, after this second tier of medications that is available is depleted, there's nothing in the pipeline at the FDA [U.S. Food and Drug Administration] for the next level of treatment for gonorrhea.

David Salyer: I would also suggest that people find a doctor with whom they can discuss their sex life.

Why?

David Salyer: Because I want to be able to tell the doctor the activities that I'm engaging in. I don't want him or her to freak out about it. I want to be able to have that conversation about rimming, or anal intercourse.

Keith Green: For me, that relationship is so important. If something were to go wrong, or if something were to happen -- you know, "I have got some stomach trouble I've been having for several days I can't get rid of" -- for my doctor to understand that rimming is something that I enjoy, that gives him an idea of something to look for.

And what kind of thing would he be testing for, for instance?

Keith Green: Parasites, Giardia [an organism that can cause stomach and intestinal illness], things of that nature. I agree: A relationship with your doctor is so critical. And having a doctor you can openly and honestly discuss whatever your sex life looks like with is priceless.

I was wondering what kind of advice you guys would give to someone who is newly diagnosed and is thinking about facing the dating world. How do they proceed? Nina, what would you tell them?

Nina Martinez: I would tell them to, I guess, reach a point with themselves that they could become comfortable with their diagnosis, before they even venture into dating. Because I think it will be hard, when you're trying to seek approval from other people, and you're HIV positive, and yet you don't have that approval for yourself. I think that opens a big door into emotional stress and things like that, when you're starting to take rejection more personally than you should.

"I know that if I were to tell somebody that I was HIV positive, and he decides that he doesn't want to deal with it, that's his choice. I don't take that very personally for me, as a person. He's rejecting HIV; he's not rejecting me.

-- Nina Martinez

I know that if I were to tell somebody that I was HIV positive, and he decides that he doesn't want to deal with it, that's his choice. I don't take that very personally for me, as a person. He's rejecting HIV; he's not rejecting me. Because I think I'm a great person. But, again, I think I'm comfortable with my diagnosis. So I think that would be very good to tell someone who's newly diagnosed: Reach a point where they can be comfortable with their diagnosis, and I think dating will become easier for them.

David?

David Salyer: I completely agree with Nina. You have got to get comfortable with your diagnosis. You have to accept what's happened to you. Also I would say, kind of think about your presentation skills. Because this doesn't need to be a melodramatic disclosure, when you're talking to somebody. That's where I think a lot of people go wrong; it's in the way they deliver this information.

The other thing I would say is something I talked about earlier. Don't do this in the bedroom. Don't wait until you've gotten naked and you're crawling into bed with somebody to bring this up. That's just the worst time. I can't think of anything that would feel worse than getting thrown out of somebody's bedroom, naked.

When you were talking about delivery: Can you give me an example of what would be a nice way to deliver this news?

David Salyer: I would say try to do it kind of casually. Again, don't go, "I have something really important that I have to tell you." Don't preface it like that. Just try to work it casually into the conversation. You might mention that you have been to a workshop recently for people living with HIV or AIDS. Or you even might say something about, you've got to pick up your prescription for your medications. Very often it will just lead into the conversation. Just find a way to work it in casually.

Do you find that people have a better reaction that way?

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David Salyer: Yes, I think so. I think, rather than sitting them down, like you're on a daytime soap opera, and turning it into this really heightened conversation ...

So you mean, that might make them act dramatically, if you deliver this dramatic information?

David Salyer: I think, absolutely. If you present yourself like you're damaged, very often the reaction is going to be: Okay, you're a damaged person. You have got to come at it from a place of strength. You have to look and feel confident about what you're telling them.

Keith?

Keith Green: I would have to agree with everything that was just said. It is about your own comfort level, you being comfortable with your status. And to be educated. Because a lot of the rejection is out of ignorance. So, if you come across as strong and informed and knowledgeable ... In situations where I was disclosing to someone who is negative who is kind of unsure, I think that my confidence and my ability to stress to them that we will do everything possible to keep your HIV-negative status intact, it gives them some assurance. It makes the whole thing a lot lighter and a lot easier to deal with.

Actually, I guess this is kind of a shameless plug, in a sense, but not really, we [Test Positive Aware Network] just developed this video called "Pause, Rewind, Talk, Don't Stop." Basically it lays out like that.

There's a guy and a girl, and a guy with another guy. You see them interacting and meeting, and all of that and as the camera angles change, it goes from being a guy to a girl. But this guy's bisexual. But it basically goes through the whole motion of pausing to have this conversation, rewinding, talking, but not stopping. You know, keep going. Do what you do. Have fun. Enjoy it. But make sure that you throw the conversation in, and take some time to really just have dialogue.

So, in a way, you're saying, don't tell people, "Here's a reason to reject me." But just sort of mention it, like, "This is my life," kind of.

Keith Green: Absolutely.

That's interesting. Because I think people have problems with the language. They have problems coming up with what to say. They haven't seen it in the movies. We've learned all our lines in the movies. And so we don't know. How do we do this? How do you do it without drama?

So do you think that an HIV-positive person can find happiness in the dating world? Keith, you seem to have found a partner. Because some people say it's impossible. It's just impossible. And they give up. I don't know if it's a function of their difficulty with relationships or whether it is really hard, if you're HIV positive, to find somebody.

David Salyer: I say, for me personally, I'm actually happy being single. There are lots of worse things that can happen to you than being single. But I also enjoy dating, because I like to just put myself out there and interact with people.

It's not that bad, you're saying.

David Salyer: I don't experience it as being bad. Although, I'm telling you: The Bravo network needs to follow me around with a camera. Because when I think that talking about my HIV status in my life is going to be the highlight of the conversation, guys always surprise me with what they deliver.

Keith Green: Yes. Yes!

What do you mean? Do you have any specific examples?

I don't know if the first date is the best time for you to tell me that you're diabetic and that you were adopted, and that your mother killed your father with a shoe. ... Yet, sometimes, it just opens the floodgate. When you tell them something very personal about yourself, like, 'I've been living with HIV for 14 years,' it's almost like they have to match you with something.

-- David Salyer

David Salyer: Well, I don't know if the first date is the best time for you to tell me that you're diabetic and that you were adopted, and that your mother killed your father with a shoe. I don't know that I need to hear that, the first time I meet you. Yet, sometimes, it just opens the floodgate. When you tell them something very personal about yourself, like, "I've been living with HIV for 14 years," it's almost like they have to match you with something.

Keith Green: I wonder, though. I wonder if that's because you're an educator and because you have this dialogue often. I've wondered, is that because we just kind of have that social worker kind of feel thing about us, that people feel the need to just dump? Or does it happen to everybody who's HIV positive who discloses?

David Salyer: I would say, do your dates ever feel like a peer counseling session?

Keith Green: All the time!

David Salyer: Absolutely. I mean, it drives me crazy.

Keith Green: It does. It does.

Nina, does this ring true for you, as well?

Nina Martinez: I just feel like HIV or not, we all have things that we're uncomfortable talking about. So maybe it's just a way to put the positive person at ease, to bring up something that's equally ... it's kind of a show of camaraderie [whether] the other person [is] negative or positive. It's a way for people to relate to each other.

For me, personally, because HIV encompasses so many things that we don't like talking about, it's kind of a litmus paper test, that you go and you interact with these different people, and you get a sense of how they feel.

When you get a sense of how they feel about HIV, you get a sense of all these other subjects -- where they might stand on these kinds of subjects, like sex, safer sex, poverty, politics. I hope you guys understand. All those. Because HIV is so complex. When you do find the one person -- or more than one, hopefully -- that can easily talk about HIV, to me that just makes all the waiting for the right person kind of worth it.

I use HIV as a litmus test. I guess that's how I would put that. I'll get other people that will tell me stories, too, of hardship and things like that. I think it's their way to put me at ease, so that we're kind of on the same playing field.

Keith Green: I hear you. I don't know if that's the case in my ... I think it's just, for whatever reason, it becomes a -- and you said it best, David -- relationships become sort of counseling relationships. Am I dating you? Are you my boyfriend? Or are you a client?

I'll get weird phone calls. It's just weird. Not that relationships aren't, in some way, counseling sessions. We're supposed to be there for each other. You're supposed to be able to lean on and tell your partner anything.

But again, like you said: The first date, you are telling me your life story, and how you were abused. And it just becomes this whole thing because I said, "Hey, I'm HIV positive." It's interesting. It's very, very interesting.

Perry, you could probably add to this a lot. But don't you think it's because dating is generally artificial? And if you don't have anything like that to reveal, you could keep it artificial for a very long time. You could keep it like a little promo of how wonderful you are. You know, just trying to impress people. And it could go date after date of you impressing them, and them impressing you, etc. And no one's revealing anything. It's like a game.

Perry Halkitis: Yes. I feel like when you are an HIV-positive person, you are in some ways forced to think about the dating game a little bit more, and don't rely on the games.

I would never want to be 16 years old again and dating. To me, that was the most miserable time, ever, and all the angsts that were associated with that.

So I think you're right. I think, in some ways, positive people are more evolved in their thinking about dating because they have this virus in their bodies. They have to think about what that means, in terms of sex with their partners. So in some ways, there's a much more evolved thought process around the whole dating thing that causes perhaps a more open, honest discussion with potential partners.

Right. And it might be very refreshing for a negative person. Like, oh, wow. This is like a real person who's talking to me. No one ever talks to me. You know, we just do this fake game playing. And then maybe we have sex, and then that's it. Whereas here, you're disclosing something personal about yourself. And people are, like, "Wow. Oh, you know? I have problems, too. No one has ever asked." So maybe that's what happens. It becomes a real communication, and not just a date.

Perry Halkitis: And then if it's going to turn into a relationship, that's what the basis has to be, ultimately. Right? So if you can start there, you're off to a really good start.

Right. You're just fast forwarding. It takes most people 20 dates to get real.

Perry Halkitis: Or never.

Or never.

Keith Green: Or never. Good point. Or never.

David Salyer: Yes, that's a good point. That it's kind of a fast forward for a date, when you reveal. Because typically, I'll go on a date and they already know I'm positive. But there may be some other information about it, like the fact that I kind of do work in that field. I can see what everybody is saying; it can open up a deeper conversation, and it puts the date on fast forward.

Well, I guess we've run out of time now. So thank you very much, everybody. I think this has been great. I think people will learn a lot from it. So, thanks for being there, and thanks for sharing your stories.

For some dating resources, click here.

To read more about Perry Halkitis, click here. To contact Perry, click here.

To read more about Keith Green, click here. To contact Keith, click here.

To read more about Nina Martinez, click here. To contact Nina, click here.

To read David Salyer's columns, click here. To contact David, click here.

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Copyright © 2007 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


  

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