My name is Bonnie Goldman and I'm editorial director of The Body. I'd like to welcome you to This Month in HIV. This month's subject? Dating when you're HIV positive. Dating when you're HIV negative is a challenge. Dating when you're HIV positive is doubly, maybe triply, so. After all, dating usually requires some strategizing. It's like a promotional campaign: You try to emphasize your strong points and play down any weaknesses.
What does this mean if you have HIV? How do you get back into the dating game after your diagnosis? How -- and more importantly, when -- do you tell someone you are dating that you are HIV positive? There are so many questions about sex, dating and HIV that the whole idea can seem overwhelming. That's why, today, we've brought together four people to help make sense of it all.
Our first guest is Perry Halkitis, Ph.D. Dr. Halkitis directs the Center for Health, Identity, Behavior and Prevention Studies at New York University. He is one of the United States' leading authorities on HIV prevention. His research examines the relationships between drug use, mental health, social issues and risky behavior. Welcome Perry!
Our next guest is Keith Green. Keith is an associate editor at Positively Aware and works as a community activist in Chicago, Ill. As an African-American gay man with HIV, Keith feels called to combat the virus in communities of color, especially among black gay men. He's 30 years old and single. His story and articles can be found on our site. Welcome Keith!
U.S. Dating Sites for HIV-Positive Gays or Straights
Our next guest is 24-year-old Nina Martinez. Nina was infected with HIV from a blood transfusion as an infant. Originally from Washington, D.C., she's currently at Emory University in Atlanta, Ga., studying public health. Nina works for the Hope Clinic of the Emory Vaccine Center, where she helps educate the public about HIV vaccine trials. She's heterosexual and single. Welcome Nina!
Last, but not least, is David Salyer. David is an HIV-positive journalist, educator and activist living in Atlanta, Ga. He has developed and led safer sex and disclosure presentations and workshops for people with HIV since 1994. He's also a peer counselor. He's been writing for years about living with HIV and his wise and witty articles can be found on our our site. He's a 40-something gay, single man. Welcome David!
My first question is -- and I guess we'll start with you, David -- how did you get back into the dating game when you were first diagnosed?
David Salyer: Well, I can't say that it slowed me down. I was actually already dating somebody. I just went to him and said, "This is what's happened. I've tested positive." As it turned out, he got tested, and he was positive as well. I know he wasn't the person that infected me. So we just traveled down that road together, for six years.
After that, I left that relationship. So that's when I reentered the dating world again, and I have dated negative men and positive men. There are difficulties either way, really.
Keith, how did you get back into the dating game when you were first diagnosed? What were some of the issues for you?
Keith Green: I'm kind of with David. I never really slowed down. In the beginning, it was really difficult. It was very, very difficult in the beginning. I dated, and did not disclose. I'm bisexual, so I dated both men and women. One thing that happened was I feel I was pushed more towards being a gay man, if you will, because I found it a lot easier to disclose my status to other gay men, or other men, than I did to disclose to women.
It was really, really challenging in the beginning, until I really got comfortable with my own status, and with the fact that this was something I was going to have to live with and go through for the rest of my life.
Why do you think there is such a big difference between disclosing to men and to women? Keith Green: Well, because you can't disclose the HIV piece, really, without the question about sexuality coming up, especially for black women. I'm not sure what it is, and I can only speak for black women, but even my straight black female friends and my mother are all very, very ... you know, it's not even really about the HIV thing. It's knowing that the person that they are with, or about to engage in sexual activity with, has been with another man. There's something about that that does not sit well with black women.
-- Keith Green
So it was more that disclosing my HIV status would mean disclosing that I also have sex with men, and that just became such a big challenge that I didn't, couldn't, deal with it at that time.
Perry Halkitis: I think, Keith, what you're saying is really great, and I think it points to one of the issues that we should probably talk about a little bit here. Which is, when we're talking about dating and being an HIV-positive person, HIV is not the only thing that's in the mix, right? There are issues of sexuality; there are issues of culture; there are issues of gender identity. All those things are difficult enough, for anybody, even without HIV. HIV is just another element in a very complex array of things that people have to balance.
I can't agree more. Nina, your situation is different from that of anyone else here. Because you always knew you were positive, when you began dating.
Nina Martinez: Yes. I was diagnosed when I was 8 years old, and as a result, I never learned to be uncomfortable with talking about my status, because you don't really ask an 8-year-old to keep a secret. And, because I didn't understand what HIV was, I just never learned to keep it a secret.
So I have always been very comfortable talking about my status, and I think that my comfortability makes it easier for people to be more at ease with my status.
I think -- especially when you're dating -- people can pick up on your insecurities, and if HIV is one of them, it makes it easier for them to kind of count you off the market. In terms of when I'm wanting to date, and things like that, the men in my life already know my status. So I feel like it's more my choice of whether to date them, rather than their choice of wanting to date me.
David Salyer: That's big.
How do they know your status already?
Nina Martinez: I think I bring it up casually in conversation. I think that's really important. Because if you just bring it out, point-blank, you might shock some people. But, generally, if people ask me where I work -- and I work at HIV vaccine trials -- it generally comes up as a side note, and people don't even think twice about what I've just said. It's a, "Wow. You wouldn't even know by looking at her." I have not really had a problem with that.
Do you have any terrific or any bad stories about disclosing?
Nina Martinez: Well, my first relationship ended with kind of a bang. He told me that I was going to kill everyone I ever loved. I'd definitely say that was quite the send off! But certainly, if somebody's going to tell me that, then that's somebody that I don't want to be with, anyway. But that was definitely very hard for me to take, because nobody had ever said anything like that to me before.
Did that have anything to do with HIV, or just anger about a breakup?
Nina Martinez: I think it was anger about the breakup, and it was kind of a way for him to tell me that nobody else would want me, that I was lucky that he wanted me, or something. I was 19 at the time that somebody said this to me. You know, you're going into your early 20s, and you're not really sure what you want. It's easier to settle with someone who will have you, and has had you, than to venture off. I think that was a large part of why I never moved on from that unhealthy relationship, why I stayed in it for two years -- because I didn't think anybody else would want me. It was pretty tough.
David, I know you have pretty funny stories about disclosing. You had written that you wanted to have a reality show about your dating experiences.
David Salyer: Really, honestly, I can't believe the Bravo network hasn't contacted me. Because I think that being gay and HIV positive, and being in your 40s ... I think there's a terrific reality show there. I've been single, now, five and a half years, so I have been on more than my fair share of dates.
And frankly, disclosing to people ... I think I have found the best way for me, personally. I was never really comfortable meeting guys in a bar and trying to have that conversation over loud disco music. So thank God for the Internet. Because now you can go online, and you can post a profile of yourself, with pictures, and you can write a paragraph. So right up there in the first paragraph about myself, I'm going to disclose that I'm HIV positive. And that tends to weed people out. If they can't deal with it, then they're really not going to contact you, and if they're okay with it, then they will.
What I get a lot of the time, actually, are responses from guys all over the country who will just say hello to me because I have my status right there in the profile. They'll tell me they are positive, but they are just not willing to put it in there. For some reason, they think it's so courageous of me just to be honest about it. I don't really see it that way. I just think it's what works for me. It's the way I live my life.
So, when I do go out on dates, typically they know already. It's been a long time since I showed up for a date and then had to disclose over coffee, or over dinner. But that has happened, and it's really funny.
The funniest story I can think of is, one time I was doing a workshop and there was a new volunteer who was working behind the scenes. I had done a safer sex presentation, and after this workshop, a guy came up to me and asked me out on a date. I said, "Sure." I just figured that he must have gotten that I was positive. But he didn't.
So there I was, on the date with him, and I had to disclose. He just ... he had this look on his face like it hadn't actually occurred to him. The funny thing was, I actually think he had pity sex with me later, just to kind of make me feel better about it. Then I never heard from him again.
So it was kind of funny. But, no. Typically they know already, and I don't have to disclose on a date. The most interesting conversation for me is when I go out with somebody who is HIV negative, and I just ask them point-blank, "Why would you be willing to go down this road with me?"
And what do they say?
David Salyer: Typically, I'll get a response that goes something like this: "Well, I've known people who were positive; it's just not a big deal for me."
-- Keith Green
Keith Green: I've heard that one, too. I've also heard that, especially amongst black men, that the pool of men to date is really small. So if you factor in the fact that possibly 46 percent of us, or one out of every two of us, is HIV positive, that makes the dating pool even smaller for somebody who is negative, who's looking for other negative men. So I have heard people actually say, "Well, the dating pool is small, I can't afford to really exclude positive men," which is just an interesting statement for me, in and of itself.
Keith, have you had any interesting disclosure stories that you care to share?
Keith Green: Sure. Sure. The most interesting [one] was actually with a female. She was a friend of mine. We met and started this kind of friendship that had these kinds of undertones to it. One night, one thing led to another and we had sex. I didn't disclose. We used protection. I felt really, really terrible about it afterwards, and I disclosed to her.
She literally just freaked out. Freaked out! And this was somebody -- we had been building this friendship for probably almost a year, and I hadn't been able to tell her that I was positive. She knew that I was bisexual, but she didn't know that I was positive.
So, when I disclosed that to her, she just really, really ... It basically cost us, for some time, our friendship. It was a very long time before she would even speak to me again.
Rightfully so. She felt betrayed. She felt like we were friends. We had been building this friendship all this time. She felt I should have been able to discuss that with her, even before we decided to have sex -- which I probably should have. I just could not find the way to do it. I could not bring myself, for whatever reason, to do it.
How long ago was this?
Keith Green: This was in 2000.
Do things like that still occur? Or do you have rules about this now?
Keith Green: Oh, yeah. There are rules about this now. This is a totally different world at this point. I disclose. At the point that I think this may get serious, I'm going to disclose. So if it's not sexual, if we're talking, dating, considering ... look, this is who I am.
-- David Salyer
It's easier now, especially here in Chicago, because I'm pretty out there. If you're black and gay and you go out, you may see a plugger [an advocate]. So it's pretty easy now. It's a lot easier. Most people already know. Like David said, it's kind of easy. But now it's a lot different than then. I don't waste any time disclosing.
David, do you have any disclosure rules? Can you kiss somebody without disclosing? How far can you go?
David Salyer: Yes, I have done that before. I have met somebody, and if there was some energy between us, some chemistry, I've kissed them. But beyond that, no. If I thought it was going to go any further than a kiss, just a casual kind of kiss, then I would disclose to them.
Perry Halkitis: So David, you set your limit at kissing. So, no oral sex, nothing else beyond kissing without disclosure.
David Salyer: I'm never going to climb into bed with someone unless they know. It's just not going to happen.
Why is that?
David Salyer: I think that's the most uncomfortable conversation to have, when you're in bed already. When you've already entered the bedroom and you're starting to take your clothes off, to me that's just not the time to start disclosing your HIV status.
It's not the time personally for me to start talking about boundaries and what you consider safe, and here's what I consider safe. I want to have that conversation outside of the bedroom, very casually, with the lights on. I don't want to do it in the bedroom. I can't think of something that would make me more anxious than that.
Perry Halkitis: David, what do you say to a person who is HIV positive who says, "You know, I'm really attracted to someone and I want to have sex with them. I'm just going to have oral sex with them. It's not necessarily a high-risk behavior. So I don't feel like I need to disclose at that point in time, because I'm not putting this person's health at risk." What would your response be to somebody like that?
David Salyer: Well, that does come up a lot of times when I am facilitating group discussions. Very often you'll have a wide range of opinions. If I'm in a group, for instance, the group's dynamic will take over, and they will try to get that person to understand that they need to disclose.
Now, what I usually do, if I'm talking one-on-one to somebody, I'll say, "What's really going on here? Is there a fear of rejection? Do you have some discomfort around talking about sex with somebody? How do you feel about your own sex?"
Because I feel like you have to get to their emotions about it, what's going on with them. So rather than try to come from some judgmental place and go, well, you've got this moral and ethical responsibility to disclose, I just try to get them to tell me what's really going on with them, what's making them uncomfortable.
About the moral and ethical responsibility, though: If you look at it a different way and you say, well, if I give someone oral sex, there's no risk of them getting HIV from me. So why not? I think people will rationalize it that way. What is it that you think is moral and ethical to tell somebody?
David Salyer: I feel like for me to keep my integrity, then I have to disclose if it's any kind of sexual activity. That's what I'd say for myself, personally. But what I usually do with other people is use it as an opportunity to get them to talk about their status, and how they feel about it. I want to get to their emotional well-being. Let's see what's going on with them. You know, everybody is going to make up some rules about sex. I can stand up and deliver safer sex information over and over again, which I have done since 1994. I know that when people walk out of the room, they're still going to make up some of their own rules and their own dos and don'ts. So I don't have a lot of control over it.
I wanted to discuss some of these issues because I think there are people who say, "Well, that's a no risk thing, and everyone knows the risks out there. Why am I responsible for somebody else? Why do I have to protect them? They know there is HIV everywhere. There is particularly HIV in the gay world. So I'm supposed to tell them the news, and say, 'By the way, I could be positive?'" So I wondered what you thought of that argument. And how many people are disclosing, do you think?
-- Keith Green
Keith Green: I think, Bonnie, for me, the lesson that I learned from not disclosing was that I don't have a right to take away somebody else's right to choose. And that's really what I got from it. This is really not about me. I know where I stand, and I know my status, etc. So it's really about the other person's right to choose to accept that risk. No matter how great or how small it is; it's not my place to negotiate anybody else's risk, at all.
Perry Halkitis: Keith, I definitely hear what you're saying. Once you disclose your status to someone, then you said it's the other person's decision what risk they are willing to take. But isn't that really more of a negotiation that should happen between the two people?
Keith Green: Oh, absolutely. It's a negotiation that happens between the two people. But I would assume the bottom line really lies with the person who is HIV negative, and is putting themselves at risk. Now, sure, I am also putting myself at risk for other STDs [sexually transmitted diseases] or reinfection, etc., etc. So there is negotiation on my part, too. Yes, I agree with you. It is a two-way street.
Perry Halkitis: I think Keith raises a really, really good point, though, that people tend to forget when you're talking about dating and being HIV positive. The positive person is placing him or herself at risk, too. People tend to forget that. You know, if somebody's walking around with a very virulent strain of gonorrhea or undetected syphilis, for an immunocompromised person, this can be potentially a problematic situation.
David Salyer: I agree with that, too. I would also say that I agree with what Keith said about the issue of choice and giving the other person a choice in whether they want to go forward with sexual activity. Also, my experience is that when you don't disclose, it will eventually come back to bite you in the ass.
Keith Green: Sure.
David Salyer: Because it is really a small world and people can find out later, down the line, that 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.
Gay HIV-Positive Social Groups in the United States
This is a sampling of the many social groups in the United States for people with HIV. Many HIV organizations across the country have straight and gay support or social groups. To find a group near you, visit The Body's extensive list of AIDS organizations. Remember, you are NOT alone! But it's up to you to reach out and connect with others!
DC Young Poz Socials (Washington, D.C.)
Life Happens (Tampa Bay, Fla., area)
POZ Seattle (Seattle, Wash.)
Sac Valley Pozabilities (Sacramento Valley, Calif.)
PSPozabilities (Palm Springs, Calif., area)
Strength In Numbers (Los Angeles, Calif.)
The Hope Foundation (Washington, D.C; Baltimore, Md.)
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.
-- 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."
-- 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.
-- 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.
-- 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.
-- 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?
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 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.
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.
-- 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.
-- 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.
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.
-- 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 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 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?
-- 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.
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.
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