As a sex and relationship therapist, I spend my working hours helping people manage differences. Any time we share our lives with people in an intimate way, we have to navigate this. Partner A is a night owl, and Partner B is a morning person. Partner A is a beach vacation lover, while Partner B longs for the mountains. Of course, some differences feel higher stakes than these. Opposing political affiliations, cross-cultural and differing religious community membership are frequent flyers. The past few years have highlighted issues like differences on vaccination and gun ownership.
As a sex therapist, the differences I specialize in helping couples navigate are usually very vulnerable topics for the parties involved. It can be made even more difficult when the concern carries stigma from the culture at large. Sero-discordant couples face this uniquely, and also betray our society’s ignorance of sexual health advances.
What is a sero-discordant couple?
A sero-discordant couple is typically defined as a partnership where one member is HIV positive, while the other is HIV negative. Of course, sero-discordance can also be a part of non-monogamous relationships, where not all partners have the same HIV status. This dynamic is most often associated with gay men, given the history of the US AIDS crisis, but it certainly is not contained to gay male relationships. Anyone can be in a sero-discordant relationship. And anyone can thrive in one.
Our current fear around HIV/AIDS does not align with the scientific advances. This is not to say we should treat HIV/AIDS prevention casually! But, we can hold the dialectic that HIV is a serious health concern that we should take steps to prevent, and that living with HIV is no longer the death sentence it was. HIV positive people live long, happy, healthy lives. Additionally, they can do so with HIV negative sexual partners.
Risk profiles do not discriminate based on identity. Identifying as a “gay man” does not make one more able to contract HIV; sexual activities are how we assess risk. Unprotected anal sex is much more likely to spread HIV than other ways of having sex. While gay men might report having more anal sex, certainly people of all identities can engage in this activity, and not all gay men engage in anal sex.
No matter your identity or sexual activities, we’ve got so many amazing tools now to really protect folks. And due to that, HIV positive people are living longer, healthier lives; with appropriate treatment, they are living as long as their HIV negative counterparts! Some argue that many HIV positive folks are living longer than some HIV negative people, because HIV+ patients, when they have access to good health care and make use of it, see their physicians more regularly than HIV- people, resulting in early detection of other health issues, and may also be inclined to take better care of their overall health to support a long life with HIV.
One of the more important advances in HIV care comes via drugs for controlling the virus in patients. The drugs partients take (antiretroviral, or ART) lower the viral load in the body to such a degree that it becomes undetectable on blood tests… and it prevents the virus from being transmitted to a sexual partner! The public health catchphrase for this is U=U; undetectable equals untransmittable. This is a startling advance in medicine!
And the good news keeps coming: the HIV negative partner can take a prescription pre-exposure prophylaxis medicine. You may have seen public health campaigns refer to this as PrEP. This preventative medication is 99% effective in preventing new HIV diagnosis in an HIV negative partner. Couple that with an HIV positive partner compliant with their ART medication, and those partners are having very safe sex. Many of my clients have added condom use to this equation as well for added protection (and of course, if the couple is non-monogamous, there are other STIs to protect against, as well as pregnancy, depending on the anatomy of partners involved).
Sex Therapy with Sero-Disordant Couples
So why would a sero-discordant couple need sex therapy? The good news is, I am doing less of this work than I used to, given the advances described in this blog post that make living in a sero-discordant relationship much easier. However, the stigma HIV still carries can weigh heavily on a relationship, and certainly a new diagnosis can feel traumatic for some, and at very least an adjustment for most. Sometimes patients do not feel they get enough time with their physicians, and having a full therapy hour to get more psychoeducation can be helpful. Therapists are also trained in helping couples communicate, set boundaries, and develop plans for management of life stressors; the additional training in sexual health that sex therapists receive can enhance that conversation for sero-discordant couples.
The good news is that for those of us who remember the 1980s, we are in a very different era for HIV positive people. Yet, it can be hard to let go of that fear instilled in us as we recall our loved ones who did not live to see this new technology and possibility. Celebrities are helping to break down the stigma by talking openly about their status, normalizing a life well-lived, in long-term partnerships. Jonathan Van Ness of Queer Eye writes beautifully about this in their memoir, and references their status on the show and their social media, with their adorable husband by their side, and a rigorous yoga and gymnastics practice too!
HIV is treatable and liveable. It is also part of a community trauma history that defined our queer community. It makes sense if you are struggling. There is help available.
Mary-Margaret Sweeney, MSW, LCSW, CST is a certified sex therapist licensed and practicing in the state of Indiana. You can read more about her practice and reach out about working together here.
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