It can be stressful or even scary being attracted to someone with a different HIV status than your own. In the early days of HIV, the idea of having a sexual relationship with someone HIV positive was often considered off limits.
Now, mixed-status couples (also known as serodiscordant couples) can enjoy satisfying sexual relationships and even conceive children with minimal risk. But HIV remains an incurable, stigmatized disease. Serodiscordant couples still need to be smart about sex and talk about it.
HIV is transmitted through bodily fluids, such as blood, semen and vaginal and rectal excretions. It cannot be passed to another person by touching or closed-mouth kissing. But for intimate couples and those wanting children, the realities of the disease can get in the way of a happy and intimate relationship. Even with an undetectable viral load, the virus can be passed from an infected partner to another.
The good news is that with medical advances, new medications have serodiscordant couples talking about sex again.
In 2011, doctors published an international study known as HPTN 052. The research found that antiretroviral therapy, or ART, does more than quell replication of the virus in people with HIV. It also greatly lowers the risk of transmitting the disease to someone else. Most people in the U.S. begin ART upon diagnosis of HIV and have access to the medication.
The study looked at more than 1,700 couples, most married and heterosexual. Almost all of the couples reported using condoms during sex and all received counseling. Infection risk was reduced by 96 percent among those couples who began ART early.
HIV-negative partners can protect themselves by taking a medication called pre-exposure prophylaxis, or PrEP. PrEP is another way of prescribing Truvada, a pill used to treat people who already have HIV. In those without HIV, a once-a-day regimen has proven effective at preventing infection.
The pill only works if taken exactly as directed. According to the Centers for Disease Control (CDC), one study of homosexual men showed that the medication reduced transmission in couples by 44 percent overall. That study showed many participants did not take the medication regularly, reducing the pill’s effectiveness. Studies among heterosexual couples have shown risk reductions of as much as 90 percent. Many insurance companies pay for PrEP for at-risk people, such as individuals in mixed HIV-status relationships.
Medical breakthroughs do not mean that people in serodiscordant relationships are free and clear to have sex without precautions. HIV may still be present in semen and vaginal and rectal fluids even for people with an undetectable viral load.
Condoms offer added protection in addition to medications. With any precaution, the possibility of infection remains each time you have sex. The more sex you have, the greater your risk for HIV transmission.
Serodiscordant couples who want to have children have many options available for safe conception and delivery.
To protect an HIV-negative mother, an HIV-positive man's sperm can be certifiably stripped of the virus in a laboratory. The procedure costs about $10,000. It can then be implanted in a heterosexual partner or surrogate mother. Heterosexual couples who want to have a baby via sexual intercourse can take precautions to reduce risks. Consult your doctor to explore your options.
In the case where an HIV-positive partner is on ART and the negative partner takes PrEP, risk for HIV transmission remains low even without a condom. But sex without a condom needs to be very rare and only during times of peak fertility. In those cases, both partners need to be on medication.
The chances for HIV transmission from a mother to her baby is greatly reduced if the mother is on ART before and during conception and delivery. Risk is further reduced when the baby is delivered by Caesarean section and the mother avoids breast feeding. According to the U.S. Department of Health and Human Services, all of these measures combined result in only a 2 percent chance of an HIV-positive baby.
In the early days of HIV, those who were HIV positive often would not consider partnering with those who were negative, and vice versa. HIV transmission concerns often drove that decision.
But people also worried about losing a partner to AIDS prematurely. Judgmental attitudes toward people in mixed relationships added further strain.
Now, people with HIV can be expected to live long and healthy lives with the right treatment. Plenty of anti-stigma campaigns also exist to make it easier for individuals and mixed-status couples to talk openly about the disease.