A "Negative" Outlook: Dr. Steve Natterstad Shares Secrets to a Successful Magnetic Relationship
August 10, 2010
Have you and Bob had any concerns as far as sex and intimacy in your relationship?
We've never felt impaired in that area. I think Bob and I have a great intimate relationship. I wouldn't trade it for the world. But we certainly have dealt with some of the concerns that I'm sure are pretty typical for a magnetic couple, in terms of keeping things safe.
What I've been reminded of over the years is that this is a negotiated risk. It's not something that only I can decide as the negative partner, or Bob can decide as the positive partner, in terms of how we're going to conduct our more intimate life. I think perhaps some negative partners may feel, "If I'm comfortable pushing things a bit or taking more of a risk, then that should be just fine." But as Bob has reminded me, and I'm sure other positive partners have reminded their negative partners, that isn't the way it works. The positive partner is obviously very concerned about infecting the negative partner. That positive partner may turn out to be more cautious for a variety of reasons that the negative partner has to respect.
I think that's an ongoing conversation that members of a magnetic couple have. And the reason it's ongoing is because things change. We've had new data come out. We had the Swiss study come about in the last couple of years, which concluded that if you're part of a magnetic couple and your positive partner has an undetectable viral load and no other sexually transmitted diseases, and has been on treatment for at least six months, that there's really no risk of sexually transmitting HIV.
I'm sure that came up at the dinner table of many a magnetic couple during those initial days, and I'm sure it still does come up. Certainly that hasn't become a mainstream recommendation by any stretch, but it was pretty out there to have a reputable group come to that conclusion. That's something that I think we'll all keep dealing with until there's a cure. I think we're still heading for at least a couple more decades of this.
I'm glad you brought up the Swiss study, and I'm curious to hear why you think it hasn't become a mainstream recommendation. It seems that often people who are working in HIV prevention and care have quite strong feelings about the Swiss study, whether from the perspective of wanting the Swiss study's findings to translate into universal recommendations so that magnetic couples can feel more comfortable relaxing some of their prevention precautions; or believing that the Swiss study's findings might foment recklessness and not even wanting to discuss the study at all. What do you make of this debate?
There are still some open questions about how accurate the viral load in the blood is, what's going on in other body compartments and in other body fluids. So I think that's one reason that people haven't bought into it completely. Also, there are some reports where HIV transmission has occurred even in the face of an undetectable viral load. So I do think there is still reason for caution there.
I think there's also reason for some reassurance and some encouragement in terms of sexual transmission, perhaps more in the area of less risky behavior -- let's say oral sex, for example. The majority of us agree that the HIV transmission risk from oral sex is significantly less than with vaginal or anal intercourse. There are those of us that would be incredibly content if we could just get our patients to use condoms when they have anal or vaginal intercourse. Even if they don't use them during oral sex, I think we would be happy if we could just get them to commit to the former.
I think a study like that can be encouraging when it comes to oral sex. There's still plenty of panic out there about transmission via oral sex, as I'm sure all the readers of TheBody.com are aware. So I think a study like this can be reassuring that risk is quite low and that without extenuating circumstances, oral sex can be considered safe -- or safer, I should say. It's all relative.
Going back to the beginning of your relationship: How did you and Bob first begin the conversation about safer sex? Was it a ubiquitous conversation in the community and you didn't even need to talk about condoms or what sorts of prevention methods you were going to use; or was there a particular conversation that you had before you became sexually intimate?
I think for us we were in a bit of a unique situation, since we're both in the medical field. We were both aware of what safer sex entailed, and that was always part of our relationship. So when the disclosure of Bob's status happened, it didn't change how we were already conducting our relationship.
Obviously, we had discussions. We all believe that we need to approach all partners as if they're positive and use safer-sex measures accordingly, but having the knowledge someone is definitely positive is going to change things, or at least bring up discussions. But because of our knowledge of HIV medicine, we really didn't have to stretch too much on that issue. It was kind of set in motion and didn't change a whole lot.
Getting back to something like the Swiss study: I think we like to dream about and discuss hypothetically when we'll be able to have a bit more of a carefree relationship in this regard. But I think we're holding the line there and basically staying tuned. We haven't altered our behavior based on any recent studies.
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