Negative (in More Ways than One)

For several years now, public health departments have offered treatments that will keep you from becoming HIV-positive after a condom breaks and exposes you to infected semen. This usually consists of giving you the same cocktail that your partner is taking to control his HIV infection. If he is on such medications, make sure you keep a current list of their names and doses. You won't have to be on these medications forever, only for a matter of weeks. It sounds like you need to make some phone calls to locate the clinic in your area that offers this prophylaxis. Local AIDS service organizations should be able to tell you where to go. Don't procrastinate, track it down.

I don't think that's all you should do, however. What I'm getting from your letter is a lot of repressed feelings about having a partner who has HIV or AIDS. It sounds like you feel it would be wrong to “make a fuss” about this or express any feelings of fear, sadness, or anger.

I have a fair amount of experience doing counseling for gay male couples who are sero-discordant (in other words, one of them is HIV-positive and one is HIV-negative). The topic of this difference is usually off-limits for discussion. The HIV-positive partner is fearful of his own future and afraid to experience guilt about getting infected, potentially infecting his partner, or being a burden or a source of anxiety. The HIV-negative partner is afraid to add to the positive guy's troubles. As Walt Odets pointed out decades ago, there isn't much support in the gay male community for HIV-negative guys to value their uninfected status and preserve it. This creates a situation where negative guys almost feel they have to apologize for being healthy, and some of them feel pressure to seroconvert so they won't bother their partners with using condoms any more.

This is not a healthy situation. Eventually it leads to people becoming estranged from one another. Your partner has a life-threatening illness. You have to be worried about him. Maybe you feel that there are things he ought to be doing to take better care of himself. Perhaps you are worried that at some point he will be dependent on you. You may be unsure of your ability to provide care. All of these things are important to talk about. His side of this needs to be expressed out loud as well. This can be a painful process, but I honestly believe that couples who avoid such an important subject won't be couples for very long.

Sero-discordant couples sometimes fantasize that they would feel closer sexually if both of them were positive. But the emotional burden of infecting another person is so great that I strongly discourage taking such a drastic step. Still, using condoms can be alienating, and I encourage the two of you to talk about how you really feel about using them. Sometimes just expressing a frustration is enough. Talking about what you give up when you practice safer sex can help the two of you to have more clarity about why it's important. Some younger gay men feel that by coming out as gay, they have decided to eventually become HIV-positive and have AIDS. This is a tragedy, and I feel that we need to identify these self-fulfilling prophecies so they won't keep coming true.

I promise that you also won't feel great about yourself if you allow yourself to be infected. You will blame yourself and punish yourself. I don't think HIV-positive people benefit from feeling guilty, but it is important to ask yourself why you feel that you don't deserve to be safe. A partner who cares about you will want to protect you. But do you feel that it's okay for you to want or need this?

Please talk to a counselor about some of these issues. It's a big gnarly ball of barbed wire. Nobody should have to sort it out by himself.