When Opposites Attract

An Exploration of Serodiscordant Relationships

Note: All names have been changed.

Alex's HIV status didn't affect Robin's decision to marry him. She loved him and, for her, that was all that mattered.

They talked extensively with doctors and numerous health educators about the risks involved with pursuing a relationship like theirs -- where one person is positive and the other is negative. They understood everything that they were told, but there was nothing that anyone could say or do to curtail their love for one another. They believed they were a match made in heaven.

They learned that their kind of relationship is called serodiscordant. They also learned that it would be considerably different from the preconceived notions of "normal" relationships that they both once held -- specifically as it related to the bedroom. Totally uninhibited porn star style sex would not be their reality, if Robin was to remain HIV-negative. But sex had not been what brought them together so, as Robin so proudly declares, it sure as hell wasn't going to keep them apart.

They learned that Alex should try, as often as possible, to take his medications at the exact time and at the exact dose in which they were prescribed. This would help to keep his viral load down, decreasing the risk of his transmitting the virus to Robin.

They cautiously explored the sexual playing field until they discovered fun and creative ways to keep hope alive in the bedroom. They experimented with various kinds of foreplay, sex toys, and mutual masturbation. They watched soft porn-like videos on stimulating ways to put a condom on your partner. And, because they both desperately wanted children, they researched alternative ways to pro-create, such as sperm washing and artificial insemination.

Bad Luck, Good Luck

While the process of finding the right niche for them was more fun then either had anticipated, Alex admits that it was kind of scary at first. "I was very self conscious," he reflects. "I watched my moves very closely. I did not want to harm her in any way." As time passed, however, safer sex practices became second nature for both of them. "It got to a point where we didn't even think about it anymore," Robin says. "We just did it."

And they did it without incident, until one dreadful moment in the middle of a sporadic early morning lovemaking session when, you guessed it, the condom broke.

Words could not describe Alex's fear. "That [moment] was even harder than finding out that I was HIV-positive," he remembers. "Just the possibility that I may have infected her was way too much for me to bear."

In that instant, all of the knowledge that they had acquired since they made the choice to be together came into focus. They clearly understood the seriousness of such a mishap. But because they had been armed with knowledge of post-exposure prophylaxis, they were able to maintain Robin's HIV-negative status. (See March/April 2005 and July/August 2005.) She immediately began taking a regimen of Alex's medications until they could get her a prescription of her own. This task would prove difficult in and of itself because nobody in their country knows of Alex's HIV status.

They live in a country where it is against the law for an HIV-positive person to knowingly marry someone who is HIV-negative. Alex commutes to London every three months or so to visit with his doctor and to receive his medication. In order to avoid bringing any attention to their serodiscordant relationship, while also trying to prevent the onset of an HIV infection, Robin would have no choice but to do the same.

Today, four years later, she remains HIV-negative -- as does their daughter, Lauren, who was conceived in that same moment. The combination of routine HIV testing along with a strategic and strict plan of antiretroviral therapy given to Robin throughout the course of her pregnancy kept her and their child free of HIV. Alex and Robin credit their incredible stream of good luck to their belief in real life miracles. The scientific world credits it to the power of applied knowledge. Both may be right.

Bad Luck

Unlike Robin, 22-year-old Ricardo was not so lucky (or knowledgeable). Following a night of heavy drinking and partying with a group of his college buddies, he went home with a guy he hardly knew. He knows for sure that they didn't discuss HIV status, but he genuinely does not remember whether or not they used a condom -- though up until that point, he always insisted on using them. And though he knew the possibility of having been exposed to HIV on that solitary night, unfortunately, he knew nothing of post-exposure prophylaxis.

A couple of months later Ricardo began dating Jorge. The two had been friends for a little over a year and became incredibly close during that brief period. In fact, it was Jorge who had picked Ricardo up from the stranger's house following his drunken mishap. They hadn't acknowledged their attraction for one another because, at that time, Jorge was in a relationship (which was consistently on the rocks). Ricardo supported Jorge through the difficult break-up and it was during that period when their mutual attraction was unveiled.

Because they were friends first, they were already familiar with each other's mental and emotional make-up. So they spent their first couple of weeks as a couple exploring each other's physical likes and dislikes. They decided to go together to be tested for HIV and other STIs (Sexually Transmitted Infections), before taking the relationship to the next level. Jorge admittedly hates using condoms and, before either of them could agree to a committed condom-less relationship, they wanted to be sure that it was safe to do so.

Neither expected his test to come back positive (despite Ricardo's previous mishap and Jorge's disdain for condom use), but Ricardo's did. And while Jorge fully understood that they would have to approach their sex life in a totally different fashion than originally planned, he assured Ricardo that his HIV status would not alter his decision to be with him.

"We'll get through this," he said, comforting Ricardo. He loved Ricardo and, for him, that was all that mattered.

At first, things were relatively easy for the two of them as it concerned sex -- they simply weren't having it. Ricardo, emotionally distraught from recently learning of his HIV status, was not feeling up to it and was even more terrified at the thought of infecting Jorge. Jorge understood, remaining supportive and patient as Ricardo processed this life-altering situation. He admits, however, that he did not share Ricardo's fears. "My concern was for him and how he was doing," he says. "For the most part, he had been the safe one. I was the one who did not like to use condoms. It was all really overwhelming. My main concern, though, was to make sure that he was okay."

As time moved on, the initial trauma of learning that one of them was HIV-positive began to subside. The "newlyweds" found themselves anxious to bring their sexy back. "We didn't know what we could do," Ricardo recalls. "I didn't want to do anything at all to put him at risk, so every little thing became a big deal." He even insisted that they not shower together anymore because he was afraid of passing the virus on to Jorge.

Looking back now, they realize just how absurd some of their fears were. The reality, however, is that they are not alone. Of the many interviews conducted on the subject for this article, Alex and Robin were by far the exception. Many people, both HIV-positive and negative, lack proper knowledge of safer sex practices (outside of abstinence and consistent condom use) and post-exposure prophylaxis. Most don't understand the real risks involved with a "typical" sexual experience. Others understand those risks all too well and, as a result, have altogether lost their zeal for having a sex life.

Other Views

"I just don't have sex anymore," an HIV-negative interviewee (whom we will call Mike) said frankly. "It's just not worth it."

This 30-something year old gay man finds his release through his on-going quest to find the world's most exotic porn. "It's become a hobby, really, bordering on addiction. I collect all different kinds of porn -- from amateur straight to extreme gay bestiality type stuff. I really enjoy it all." He's been celibate for over three years and says that he honestly has no desire for sex with another person right now.

On the other end of the spectrum, however, others have thrown caution to the wind and are having what they say is the best sex of their lives.

"I have more sex now than I ever have," said Roxanne -- a 32-year-old, bisexual, HIV-positive woman from Chicago's South side. "I have sex with men and women who are, for the most part, HIV-negative. I keep myself and my partners educated. I try to keep my viral load at an undetectable level and I always disclose."

Roxanne, who is not necessarily interested in a monogamous relationship and currently has multiple male and female sex partners, says that she finds that her HIV status is often not an issue for people -- particularly HIV-negative straight men.

"I've only been rejected one time, and that was because I didn't take the time to educate the gentleman about the risks involved," she says, almost too confident. "Had I done that, there would have been no way he could have rejected me."

To her knowledge, Roxanne has never infected another person with HIV. "And the people I deal with, especially the men, hate to use condoms," she says. While the risk of contracting other STIs or becoming infected with a different strain of HIV is always in the back of her mind, she feels that her "sexual revolution" is what helps to keep her spirits up as she copes with living with a chronic disease.

"Living with HIV is no shopping spree on the Magnificent Mile," she says with attitude. "But it doesn't have to be a nightmare on Elm Street either. I do what I do, how I like to do it. I understand the risks involved and, if I ever feel the need to change, I will. Right now, this is what works for me."

Dr. Bell's Safer Sex Spectrum

Dr. Margo Bell in Chicago (see November/December 2005 cover story) spends a great deal of time in her practice educating people about safe and safer sex. In theory, she believes, safe sex can only occur if you have never had any type of sexual contact with another person before and you know for sure that your first partner has not either. Safe sex includes masturbation, mutual masturbation, grinding with clothes on, showering together, and other activities that do not involve the exchange of body fluids.

Safer sex, on the other hand, involves decreasing your risk of transmitting any type of Sexually Transmitted Infections (STIs) or preventing pregnancy by using some type of method or barrier. For her patients, she constructed the scale below which rates the level of risk involved with certain sexual behaviors. Although it is not all encompassing of the multitude of sexual behaviors that exist in the world, it is general enough for anyone to find themselves and what they like within it.

Male/Female Sexual Risks (From Most Risk to Least)

  • anal sex without a condom (most risk)

  • vaginal sex without a condom

  • oral sex without a condom/dental dam

  • anal sex with a condom

  • vaginal sex with a condom

  • oral sex with a condom/dental dam

  • mutual masturbation or intimacy without exchanging body fluids (least risk)

Male/Male Sexual Risks (From Most Risk to Least)

  • receptive anal sex without a condom (most risk)

  • insertive anal sex without a condom

  • oral sex without a condom/dental dam

  • penis to penis sex (where urethras touch together)

  • anal receptive with a condom

  • anal insertive with a condom

  • oral sex with a condom

  • mutual masturbation or intimacy without exchanging body fluids (least risk)

Female/Female Risk

Although there is very minimal risk of HIV transmission associated with female-to-female sexual contact, Dr. Bell does encourage the use of sterile dental dams for oral sex as well as the sterilization of all sex toys prior to each use. She also recommends new toys be utilized at the onset of play with new sexual partners.

Dr. Bell says that she always stresses to people the importance of knowing the HIV status of their sexual partners and for the HIV-positive partner (if there happens to be one) to be on, and adhere to, HIV medications. She also encourages them to understand how post-exposure prophylaxis works and how they can go about accessing it in the event of an emergency. (See March/April 2005 and July/August 2005.)

She encourages gay and bisexual men to consider having conversations about "positioning" -- where what happens in the bedroom between a serodiscordant couple is determined by HIV status. So, for example, the HIV-negative partner would be positioned primarily in the insertive role of anal sex (with a condom), because there is less risk involved than being in the receptive position, in the event that the condom should happen to break.

Her motto: Informed dialogue leads to informed decisions. "Know the facts and have fun," she says with a smile.

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