Serodiscordant Couples: Sex after HIV

Growing up, I always visited Washington D.C. each summer for vacation. While in the nation’s capital I would stay with a family friend, Bob. Bob is a homosexual, and had a life partner by the name of Michael. Michael passed away from an AIDS related opportunistic disease in 1993.

What is "Serodiscordant"?

The term serodiscordant describes the conflicting HIV status of a couple. Serodiscordant means that one partner is HIV+ (sero-positive) and one is HIV- (sero-negative). There is a constant concern of HIV infection for the sero-negative partner.

Sex in a Serodiscordant Relationship

Participating in a serodiscordant relationship does not mean an end to one’s sex life. Partners can still partake in almost every sexual act with little risk. There are some, however, that can be riskier than others. Rectal douching and fisting, as well as, vaginal fisting are among some of the riskier sexual acts. This is because while fisting skin is torn and these small slits, scars, and fissures make HIV infection easier upon contact with infected blood, semen, or vaginal fluid. Additionally, S&M (sadist and masochist) practices are extremely risky.

When using protection, anal-penile, penile-vaginal, oral-vaginal, and oral-penile pose little risk of infection. Oral sex is a surprisingly low-risk activity. The risk increases when there are sores and cuts in the mouth, or the partner has recently brushed their teeth. Withdrawal method for heterosexual or homosexual male couples is still risky because HIV can be transmitted through pre-ejaculation.

For heterosexual and male homosexual couples it is highly recommended to always use a condom while performing sexual acts. As stated earlier, oral sex is a lower risk activity, but using a condom is a better way to prevent transmission rather than just “chancing” it. Unprotected receptive anal intercourse (URAI) has a transmission rate of 0.82%.

Additionally, homosexual female serodiscordant couples should also always use protection. Not sharing sex toys, or if they are shared, using a condom or washing thoroughly before passing back and forth, are precautions that should respected. Mutual masturbation and ejaculating on unbroken skin is a very low-risk activity for all couples to engage in.

For both female and male couples it is recommended to be open and communicate thoroughly with partners. This is one of the most important requirements for keeping a sero-negative partner uninfected. Asking to use protection should not be embarrassing, and doing research about the risk associated with different activities is important.

The Condom Broke - Now What?

If a condom breaks or exposure occurs infection is not inevitable, there is another option. Post exposure prophylaxis (PEP) is a round of medicine taken each day for a month to avoid infection. These medicines are very expensive, although, and not always known about. In a study done in 1999, one-quarter of all respondents had heard about post-exposure prevention; however, only five of the seronegative partners reported taking medications after a possible exposure to HIV.

Negative Views

There are also several negative views surrounding serodiscordant couples. The first, is a fatalist attitude of the sero-negative partner. Some believe that it is only a matter of time before they become infected with the disease, so safer sex practices are merely a waste of time. Another negative belief is that those who are infected seek out negative partners to infect them. It is actually illegal to knowingly infect someone else with HIV or AIDS, yet still transmission rates have skyrocketed over the years. It can be argued that this is a result of partners not knowing their sero-status, but some must know and still engage in sexual acts. Many believe it is irresponsible for those infected to engage in any sexual relations with sero-negative partners, because there is always some risk of passing on HIV.

Overcoming the Challenges of Serodiscordancy: A 4-Prong Approach

Serodiscordant couples in lower-income or rural areas are faced with additional challenges because of their location, education, and proximity to facilities capable of dealing with the disease. Whereas Bob and Michael were a white upper-class couple from a wealthy area in Washington D.C., and had every opportunity to prevent transmission, many couples are not as lucky. In order to overcome these difficulties, I suggest a four-pronged approach that I believe would ensure lower infection rates among men and women in these areas. This initiative would involve sex education, accessible contraceptives, regular HIV testing, and communication among partners.

1. The first step is sex education in the schools. Unfortunately, abstinence only education has never been affective and something more is needed. All schools should not only focus on how to have safe sex, but also safer alternatives to intercourse. Learning how to properly use a condom, diaphragm, etc. is a huge step in the right direction but it is not enough. As stated earlier, mutual masturbation, for example, is a safer option with almost no risk, and still provides the benefits of intimacy and orgasms. Another key component of sex education that must be improved is the stressing of open communication among partners.
2. Accessible contraceptives are one of the easiest ways to prevent the spread of HIV and AIDS within all populations. Condoms, in particular, are highly effective at preventing HIV infection among partners, depending on the type used. Latex and polyurethane are the most effective, and when used properly are completely impermeable to viruses including but not limited to HIV and Hepatitis B. On the other hand, condoms made of natural materials such as lambskin are not as effective as their counterparts. In research done, the HIV virus leaked across the lambskin condom in one out of two of the studies. Many couples cannot afford, however, to purchase condoms on a regular basis to use one every time.
3. Even if condoms were made readily available, some couples would still choose to engage in unprotected sex, which is why regular HIV testing is necessary to help slow the spread of the disease. HIV testing is vital to ensure that couples can both know their sero-status, and realize what risks are associated with certain sexual acts or behaviors. Hospitals such as Robert Wood Johnson Research Hospital provide free and anonymous HIV testing, but rural communities do not always have a facility willing and able to do this.
4. Many researchers have highlighted the importance of communication among seriodiscordant couples to help prevent the transmission of HIV from the sero-positive to the sero-negative partner. It is first important to no longer consider sex a taboo subject to discuss. The more comfortable people are discussing sex in general, the more likely they will be to discuss it when it really matters – with their partner. This communication with one’s partner is necessary to discover not only likes and dislikes, but also sero-status, number of sexual partners, how recently they were tested, etc. These things may seem like uncomfortable questions to ask but they are vital to ensure that the each partner is on the same page and understands the risks being taken. Also, it is important that if one or both partners stray during the course of the relationship that they get tested again and notify their partner. Again, this may be an uncomfortable situation, but it is crucial if both parties are to remain healthy.

Sometimes the most difficult discussions can also be the most rewarding. Finding a partner that accepts a sero-positive status, can be the beginning of a long and loving relationship; one in which both partners remain healthy... and sexually satisfied.