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Author Topic: Serodiscordant dating  (Read 5822 times)

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Offline sats

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Serodiscordant dating
« on: March 06, 2012, 08:36:19 PM »
A few weeks ago I met a guy (I am female) who, as I came to find out, is HIV positive. I surprised myself by how calm I felt about it when he disclosed. He was diagnosed very early, and tells me that he has been undetectable for more than 6 months. I've even seen him take his meds a few times, and he seems like the type to be pretty vigilant about drug adherence.

Since we've only known each other for a short time, I don't know exactly where things with us are going, but I'm not ready to just throw this away based on his status. He has been handling things with us very well in my opinion, encouraging me to do my own research and offering to point me toward helpful resources. I know he's done a lot of research, and he believes that he will not be putting me at risk. But I'm so scared of becoming infected, and I'd never forgive myself or him if that were to happen. Of course, what I want is someone to give me the secret to make sexual encounters between us zero risk, but I know that's not possible. So what I need is honest advice and facts.

To date, as far as sexual activities involving bodily fluids, we have kissed and he has performed oral sex on me, but that's it. I am aware that oral sex is considered a relatively low risk activity when it comes to HIV transmission, but I gotta say, I'm already having worries and being extra mindful about any possible symptoms of infection. And the resources I've found give wildly different estimations of the risk of different sexual activities.

Most of the more in depth posts I see on here are understandably about male-male serodiscordant couples, so I'd love it if some of you could answer a few questions/offer advice that is more tailored to our particular configuration. How many couples like us are there on here, and how have you maintained a discordant status? Unprotected vaginal intercourse is off the table here, but what are the risks of having sex with a condom? How about giving/receiving unprotected oral? What should I be doing/paying attention to regarding my own body in order to make transmission less likely? What should I be asking him about as far as his numbers and health? How often should I be getting tested myself?

Basically, please tell me anything you think might be helpful. Links to studies are appreciated as well.

Thank you!

Offline le_liseur

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Re: Serodiscordant dating
« Reply #1 on: March 06, 2012, 09:04:13 PM »
There's a lot of questions you ask, and it's probably a good sign, because you're looking for valuable information and because you care about what could become of this relationship.

First of all, I think it's a good thing of him that he told you about his status, that he enjoined you to go seek information and not only rely on what he would tell you, etc.

Also, I can assure you that what you have done so far, kissing and receiving from him oral sex, is NOT risky.  Not even "low risk". It's "NO-risk".

I am sure moderators and others with more experience will repeat this to you.

Also, I would say that you can do everything you want, except vaginal and anal sex without condom. As long as you use a condom with him for penetration, you will be safe regarding HIV. Don't look or stress about symptoms, as they do not mean anything when it comes to HIV, and it will just make you over-anxious for no reason. Just make sure he wears a condom when you have sex. Since he says he is undetectable, it's even less risky "in case of an accident". All in all, as long as you play with condoms as you should do anyway, regardless of your partner's status, you are not putting yourself in any danger.

As for testing, I believe you should have routine checkups every 4 to 6 months or so, as anyone with a sex life should. When is the last time you were tested?

Other members will surely pitch in and give you valuable advices. :)

Edited to add : I forgot to say I just started a relationship with a negative guy this Fall, and the key to keep this working has been communication and respect. Don't be worried to ask him things if you feel uncomfortable about certain issues, and he should be able to talk about this too. His HIV status doesn't mean you will not be able to have a normal relationship with him, and who knows what from there. :)
« Last Edit: March 06, 2012, 09:09:09 PM by le_liseur »

Offline emeraldize

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Re: Serodiscordant dating
« Reply #2 on: March 06, 2012, 09:20:01 PM »
Hey Sats,

If you were my sister, I'd be asking if you know whether he's got any other STDs or if he even knows. If not, get some tests done particularly if this is turning into an exclusive relationship.

For example, you're carefully navigating HIV but if you follow Le's advice and go down on him, you risk picking up HSV. Someone can shed virus even when not in an active lesion(s) state.

Le poses an interesting question. Have you been tested recently? Is there anything you might be bringing to party?

I wish I could meet a guy who responds as you did -- someone who didn't look at HIV as the Great Wall. Ah well-- sufficeth to know there are people like you in the world.

Have fun.

Offline sats

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Re: Serodiscordant dating
« Reply #3 on: March 06, 2012, 09:31:03 PM »
Thank you for your responses.

I'm very...thorough when it comes to these things, so yes, I have a lot of questions.


But to address some of yours: I was last tested for HIV and the other usual suspects in December, and I was negative for all. I was geting tested around every 3-4 months before that, or whenever I felt I'd been particularly "active". I have never had vaginal intercourse without a condom, even in relationships, because I've never been on hormonal birth control. My riskiest behavior sexually is unprotected oral sex. I've had 2 partners between my last test and meeting him.

Edited to say: One thing to highlight on my my never-ending list, I'd like to hear about performing oral sex on him (unprotected), as that's something I currently don't feel comfortable doing, but very much want to.

« Last Edit: March 06, 2012, 09:34:24 PM by sats »

Offline mecch

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Re: Serodiscordant dating
« Reply #4 on: March 06, 2012, 09:32:48 PM »
But I'm so scared of becoming infected, and I'd never forgive myself or him if that were to happen. Of course, what I want is someone to give me the secret to make sexual encounters between us zero risk, but I know that's not possible. So what I need is honest advice and facts.

What sources of information make you afraid about what sex acts, regarding transmission?

Use a condom for penetration and you're gold. You won't get infected and surely, doubly sure you won't if he is undetectable.

If you are really anxious about condom breaks, then talk to your doctor or at least look up where you can go to access post-exposure treatment. In the event of a condom break and semen contact, then you will calmly go there and discuss the risk with a professional, and if necessary by the professional's opinion, get PEP.

If you can't deal with aspects of oral sex, etc, etc, just don't do it until you are completely comfortable.  The info says that this is very low risk and even lower still with someone undetectable.
« Last Edit: March 06, 2012, 09:40:37 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline emeraldize

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Re: Serodiscordant dating
« Reply #5 on: March 06, 2012, 10:43:27 PM »
Hey Sats!

Have you read what the site here offers in terms of Prevention (on the content/pages bar) regarding oral sex --in this instance performing it on your partner?

http://www.poz.com/articles/348_2126.shtml

Saw your post about all your testing -- so it appears as if you don't know about his HSV status and more. You might want to ask him to tests run--particularly since you are quite keen on avoiding STDs.

Em

Offline sats

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Re: Serodiscordant dating
« Reply #6 on: March 08, 2012, 11:41:50 PM »
Emeraldize:

I had seen that article, thank you for linking to it. It doesn't 100% comfort me, but it's good stuff to know.

I did inquire about his testing very early on, (which is how disclosure came about) and he reported being free of any other STDs after a fairly recent test and few partners in between. As for HSV, after my own recent (and intensely stressful) scare with positive...and then negative HSV-2 test results, I'm not particularly trustful of the testing that is done in the absence of lesions. I'm not inclined to stress that particular issue unless a suspected outbreak occurs. He has told me that he (like most people) has HSV-1 however. I dont think I do, I don't remember ever getting cold sores.

In any case, I would be interested in joint testing if things are moving along in an exclusive direction.

Mecch:

I'm sorry I can't reproduce the sources that were worrying me, I've been doing a lot of searching around on the internet so there are just too many for me to point to the particular ones of interest. However, even on this website, someone will say that oral sex is a no risk activity, and that no one has ever become infected from oral sex alone, but then a case study will be quoted to the contrary. I do believe that oral sex is low risk, however, as that's why I've never been worried about my HIV test results when I get tested because I use condoms religiously.

One detail I've worried about is the ""if" that is often tacked on to the the "oral sex is safe" statements. Namely, that IF you have good oral health, oral sex is safe. IF you have inflammation in the throat, then you are more at risk. Now, I don't have meth mouth or anything, but I'm overdue for the dentist and sure, sometimes when I brush my teeth I see a little pink in the sink. So one bit of info I haven't been able to find is, what constitutes poor enough oral/throat health to increase risk?

What I'm truly struggling with is the numbers game, and the idea of known vs unknown risk. To put it briefly, if I continue to see this guy and not seek other partners, am I safer with him than going out and having many sexual encounters with others whose status is unknown? This is keeping in mind that my sexual safety practices would be the same anyway.  I know there is no good answer for this, but it's just something I've thought about.

I know, I know...I have a lot of questions and concerns, but even if I didn't want to know these things for my current situation, it's great general knowledge to have for life. I might as well learn all I can. So please dont be shy with advice and info, it's all much appreciated.

Offline jkinatl2

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Re: Serodiscordant dating
« Reply #7 on: March 09, 2012, 01:05:18 AM »
The oral sex thing has been hacked to death on these forums. It's a theoretical risk, as peer-reviewed study that eliminates patient bias (patient report after the fact) has yet to produce a single documented instance of HIV through receptive fellatio (sucking a guy).

It is, of course, known that cunnilingus and insertive fellatio (getting sucked) presents no risk. IMHO it must take some awfully drastic and stunning circumstances to infect via oral sex. You mentioned meth mouth? I'm thinking exactly that. A perfect storm of viral load and ample opportunity.

But this is all conjecture unless/until one of the serodiscordant studies comes up with an example. And until now, it's pure guesswork because we have yet to come up with a single instance.

Also, PLEASE disregard estimates of risk, especially those that quote a statistical number. Those are almost ALL based on a single study that has long been discredited as the researchers, having NO examples (even via the unreliable patient report) simply made up statistical numbers for sex acts for which there were no examples.

It all boils down to what YOU are comfortable with. ANy sex except that with your hand carries a risk of something, however wildly hypothetical or far-fetched. Negotiating that risk is part of any relationship outside your own body.

One of the more frustrating things I did in the nineties was convince ASOs to quit wasting money on flavored condoms. No one was using them for oral sex. Getting people to use a condom for anal sex needed to be the primary - hell, the singular focus for preventing HIV. Luckily, scientific data since the advent of HAART has more than backed me up on that.

Here's the information I/we use in AM I INFECTED.


Here are some of the  scientific findings.


No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS:  Volume 16(17)  22 November 2002  pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.




"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline mecch

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Re: Serodiscordant dating
« Reply #8 on: March 09, 2012, 08:26:41 AM »
SATS -
If your partner in question is undetectable, some of your worries about misc. risks of  transmission seem even less based on science and reason, than on your personal anxieties.

Would it be an insult to his integrity if you asked him to show you his lab report? We all get them you know.  When you see the doc after your get your labs, you can get a piece of paper that shows your labs.  One of my docs used to give me a little printout that even showed the basics of all my labs to date - e.g. my history of being undetectable.

Maybe asking him for that would insult him - meaning you don't trust him. But maybe if you rather just explained you have a "little" final effort calming your own worries and seeing it on paper would help - then he would show you no problem.

_________

What I'm truly struggling with is the numbers game, and the idea of known vs unknown risk. To put it briefly, if I continue to see this guy and not seek other partners, am I safer with him than going out and having many sexual encounters with others whose status is unknown? This is keeping in mind that my sexual safety practices would be the same anyway.  I know there is no good answer for this, but it's just something I've thought about.

If you are having safe sex, then the risk would be the same! In principal. If someone has safe sex with 1000 different people, then there is little to no risk of infection! Same as safe sex 1000 times with one person who is HIV+.   I might wonder however, that if you are worried about the .0001 chance (or whatever it is) of a safesex encounter being a risk, than being with an known undetectable HIV+ person would be less of a risk in that tiny tiny tiny fraction than being with a person of an unknown status.  If you had some horrible horrible condom breaking sperm contact risk with a person of unknown status, you would have to get that person to 100% verify his/her HIV status (might be impossible) or you would surely be recommended Post-exposure treatment.  Right? 

But why are you operating and focusing on these infinitesimally small risks?

Is is possible you are "displacing" some other hesitations or fears or doubts about this relation, or about anything really, onto this question of "risk of HIV transmission"?  Considering that by following safesex rules it is SO small, and by knowing about PEP it is even less of a concern.

Also, in your internet searchers, have you read the Swiss Statement? Maybe that will help with your anxieties.

http://www.aidsmap.com/page/1429357/

http://i-base.info/guides/pregnancy/swiss-statement

You situation is not identical to the subjects in the swiss study, but perhaps you can extrapolate, as many have done, to calm down the anxieties.






“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline sats

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Re: Serodiscordant dating
« Reply #9 on: March 11, 2012, 03:11:19 PM »
Thank you for your responses!

I do not feel that he would be insulted if I asked to see his lab results. In fact, I believe he has already offered to give them to me if I wanted to speak with a health professional about the risks. The more I post in this forum, the more I realize how open he has been about this, which is obviously a good thing.

I had read the Swiss Statement, it is one of the first studies he mentioned to me upon disclosure. I've been doing some more of my own research, and figured I'd share what I've found both for my own record and for those who find themselves in a similar situation.

A good article/collection of studies regarding ART, viral load, and transmission risk: http://www.medscape.org/viewarticle/728655

PDF of a case report of HIV transmission even though partner was undetectable:
Is transmission of HIV-1 in non-viraemic serodiscordant couples possible?
Martin Stürmer, Hans W Doerr, Annemarie Berger, Peter Gute
http://www.intmedpress.com/serveFile.cfm?sUID=8be42e39-7915-4b36-929c-0f1a603e989e

No infections occurred in couples where the HIV-positive partner had viral load below 1500 copies:
Quinn CT et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine 342 (12): 921-929, 2000.

No partner was infected in couples in which the index case had been treated with HAART (P = 0.0123). HIV prevalence among nonindex partners declined from 10.3% during the pre-HAART period (1991-1995) to 1.9% during the late HAART period (1999-2003; P = 0.0061)
Castilla J, del Romero J, Hernando V, Marincovich B, Garcia S, Rodriguez C. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr. 2005;40:96-101

Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study - http://www.bmj.com/content/340/bmj.c2205.full


Offline mecch

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Re: Serodiscordant dating
« Reply #10 on: March 11, 2012, 06:43:52 PM »
Thanks for the links.
So how are you feeling most recently about the issues that are making you anxious?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline sats

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Re: Serodiscordant dating
« Reply #11 on: March 11, 2012, 07:10:41 PM »
I'm feeling a bit better. I'm a pretty risk averse person, particularly with health issues so it's almost amusing that I'm in this situation. Almost. Reading the studies definitely has been hammering into my brain that staying negative is possible, particularly since I don't really fuck around when it comes to protection. One of the studies I read was conducted in Spain, and what was interesting about it was that they reported the number of natural pregnancies that occurred over time, which is of obvious significance. In the group of 144 serodifferent couples in which the HIV+ partner was on combined ART, there were 47 natural pregnancies, but no seroconversions. Compelling stuff. http://www.bmj.com/content/340/bmj.c2205.full

I'm not as scared as I was before, but I'd hardly say I'm as comfortable being sexual with him as I would with a partner I thought to be HIV-. I'm wondering if I can handle the stress of worrying about infection more than anything. Statistics and probabilities don't matter much if you're the 1 in a million. Nonetheless, I'm not running yet.


I'd still love to hear from someone who has been in a long term hetero serodiscordant relationship in which the male is HIV+ if there's someone like that lurking on here. Also, one bit of info I haven't been able to find is if there is an increased risk from receptive fellatio when the male is uncircumcised, which is relevant to us.

Offline mecch

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Re: Serodiscordant dating
« Reply #12 on: March 11, 2012, 08:08:07 PM »
I'm not as scared as I was before, but I'd hardly say I'm as comfortable being sexual with him as I would with a partner I thought to be HIV-. I'm wondering if I can handle the stress of worrying about infection more than anything. Statistics and probabilities don't matter much if you're the 1 in a million. Nonetheless, I'm not running yet.

Statistics and probabilities DO matter a very lot.  You don't have a rational relation to the information you are seeing. 

You are ruminating on a miniscule risk.  And do you do this about other risks in life?  Crossing a busy street?  Riding in a car?  Swimming? Being the victim of a murder?  Cracking your head against a tree when you ski?  Riding a bike? Eating in a restaurant?

I am reading between the lines that "running" is kind of what you want to do, or expect you will do (thus the "yet").  But you are rational enough to see it won't be based on risk, cause now you have your science studies.  So, running will be based on  your anxiousness about perceived risk.  Why is "running" even on the table???   You sure its not a displaced - like there is some OTHER reason this isn't the guy for you.  Honey either he is the guy for you or not, HIV really doesn't factor into it. If your fear of HIV is overriding, then he's not the guy for you.  Fair enough. Some people can't deal. 

Let me ask you, what would happen if you were with a guy 10 years and he seroconverted.  End of relationship?

That's maybe not a fair question, because its hypothetical.  I think people certainly have a right to choose what potential partner is ok or not, when things are just starting. 

You sure its fear of getting HIV??

I think you need to talk to someone more clever than me about how to manage these issues.  Your partner of course.  But maybe a therapist with experience in anxiety problems.

Its not easy, you are certainly giving it your best, and I hope things work out for the best for both of you.
« Last Edit: March 11, 2012, 08:18:06 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mecch

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Re: Serodiscordant dating
« Reply #13 on: March 11, 2012, 08:10:35 PM »
Oh, and I was in a sero-discordant homo relation as the negative partner. 3 times.  We loved each other, we used condoms there was no transmission and there was oral sex.  Thats the best I can do for personal experience to offer you.  Not sure anyone's personal experience can top the research you have read, though.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Dr.Strangelove

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Re: Serodiscordant dating
« Reply #14 on: March 14, 2012, 08:13:48 AM »
You are doing the right thing by educating yourself and reading as much as possible about this rather complex topic.

Statistics and probabilities DO matter a very lot.  You don't have a rational relation to the information you are seeing.

Mecch is right.
Sometimes there is a huge gap between perceived risk and actual risk.
I'm absolutely confident that you are more likely to get struck by a lightning a dozen times before you catch HIV from protected sex with your undetectable boyfriend.

The question is, how concerned are you about those lightning bolts? Probably not very much. Then why freak out about a theoretical residual risk that is even smaller? Nothing we do in our lives is 100% guaranteed risk free.



Statistics do put things in perspective. But sometimes emotions are stronger than the mind.

My parents have never taken a plane in their entire life because it's too dangerous. But they both drive a car every day. No matter what statistic I show them about airtravel being statistically more safe than driving, it doesn't change their perception...
« Last Edit: March 14, 2012, 08:16:35 AM by Dr.Strangelove »

Offline SimplyHope

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Re: Serodiscordant dating
« Reply #15 on: March 16, 2012, 10:39:50 PM »
Hi Stats! I know you were looking for someone in a hetero  poz/neg relationship. My boyfriend and I are approaching our two year anniversary and are very happy. First of all I'm glad his status did not scare you away. All relationships have their challenges but the rewards truly pay off in the end.

Educate yourself and be open with him. It's a fine line between education and overwhelming so take it slow.

As far as anything sexual, know what the REAL risks are and decide for yourself what you are comfortable with. I did my homework and feel at peace and the decisions I've made for my sex life.

Feel free to ask any questions you like, I'm totally open to it!

p.s. please remember you're not alone

Offline jkinatl2

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Re: Serodiscordant dating
« Reply #16 on: March 17, 2012, 03:27:34 AM »
If you love him more than you fear him, it will work.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline carlydavids

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Re: Serodiscordant dating
« Reply #17 on: May 06, 2012, 06:08:17 PM »
I totally understand how you are feeling. When I first started dating my husband he found out 2 months later that he was HIV positive. It was a tough time and I was super paranoid about getting infected, as was he with infecting me.

Here we are exactly 3 years later and I'm still HIV negative and with virtually no paranoia. We are still "safe" but its just become routine for us now. It's actually not that easy to become infected believe it or not, and if you use condoms then there is nothing to worry about! We had an accident once and I took the PEP to ensure I would not get infected, but really my husband is undetectable so there is practically no risk of that.

In fact, I looked at a study recently of over 200 serodiscordant couples who had unprotected sex in order to conceive a baby, and 6 years later, no one seroconverted to HIV positive, neither mother or baby! Not that i'm recommending that you do this, but it makes you think and also be more relaxed. Just always be safe and you will be fine :)

 


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