Friend in Need

Thursday, November 10, 2011

Question

I made friends with a really cute guy when he had just moved in to my building and  knocked on my door to borrow laundry detergent. We keep discovering more and more things that we have in common. We spend three or four nights a week together, just hanging out. We talk on the phone every day. He understands me better than my mother or any other friend I've got.

Now our relationship has its first serious challenge. He is sero-converting. He is HIV-positive. I encouraged him to go get tested so now I feel guilty about bringing this terrible news into his life. We are both in our late 20s. He looks and feels so healthy and full of energy. How long can that last? Will he eventually get AIDS? Will it shorten his life?

We have talked about the fact that there is some sexual energy between us. I was seriously considering seducing him because I think we would be a great couple. I've never had a boyfriend I liked as much as I like him. But isn't this a killer window for transmission? Somewhere I heard that HIV is especially easy to transmit when you first get it. I don't know if I could relax and enjoy sex with someone if I knew for sure he was positive.

You probably think I am a shallow gay boy to bring all of this up when AIDS is old news. But now that it is in my life, it isn't old news any more. I guess I should also mention that my friend claims he didn't do anything dangerous to get infected. I don't know what to think about that!

 

Answer

Doctors often assess an HIV infection by measuring the quantity of retrovirus in the patient's blood. Research shows that people in the acute (first) phase of infection have an especially high count or viral load. If a person with an acute HIV infection has unprotected sex, he or she is especially likely to pass the infection on to someone else. Ironically, because their immune system is still struggling to react to HIV, they may not show up as positive when being tested. The test looks for antibodies to the virus, and it takes a while for the body to start making these cells.

It's important to remember that there is no “safe” period during the course of this disease. The viral load can fall to undetectable levels, without eliminating the possibility of infection. Being in a relationship with someone who is HIV-positive means committing to a rigorous policy of safer sex. Being consistent in using condoms or having non-penetrative sex is as important for the HIV-negative partner as it is for an HIV-positive person who is taking medications to slow down the viral invasion. Can you do this? Have you avoided HIV via good luck or by making a virtual fetish out of condoms? 

Of course, I am assuming that you care about remaining HIV-negative. Some men feel that if their partner is positive, they should allow themselves to be infected so that they will feel closer. But this rarely works, because the person who has HIV will feel guilt and shame about being the source of someone else's infection. While some HIV-positive men do not take precautions with other positive guys, there is still a potential danger of being infected with a different strain of the virus. People tend to build resistance to each course of therapy. Their doctor then helps them to switch to a slightly different regimen. A dual infection could saddle you with a virus that can't be curbed by your current medications. In other words, it could eliminate certain medications that you might one day want to be able to take. It's also true that people who are positive are even more vulnerable than the rest of us to catching other STIs, and you don't want to have to cope with herpes or syphilis or their cousins on top of HIV.

The fact that your friend can't identify the behavior that exposed him to HIV is a little unusual, but not impossible. The stereotype is that people get HIV by sharing drug injection equipment with or being penetrated sexually by an infected person. Because the risk of catching HIV during oral sex is quite a bit lower than the risk associated with anal sex, many men do not use condoms during this activity. But it is still possible to get HIV by sucking cock. It is even possible to be exposed if you are topping (penetrating your partner) without a condom. The lining of the urethra is a mucous membrane that can allow the virus to pass into your system.

The fact that you would hesitate to get involved with a man you love as much as you love this guy is one of the tragedies of our age. How long have you waited to find somebody who is this compatible and caring? If you should be using condoms anyway, what's the difference? The fact that he is HIV-positive might eliminate your “wiggle room” to stray, and this could actually result in you staying healthy.

This doesn't, of course, eliminate the stress of knowing that your loved one faces a serious health challenge. He will need to see a doctor and get expert advice about how often to be assessed for medication. Doctors commonly wait to begin HIV treatment until tests indicate that the body can no longer manage the infection on its own. These medications often have side-effects that are difficult to manage, so it's important for an HIV-positive person to do everything they can to stay as healthy as possible. Having a secure relationship can reduce stress on the immune system. By simply being with him, you could have a really good effect on his ability to battle infection. Research is constantly improving the drugs and their dosages. Your partner could remain healthy for many years. 

I personally know many “magnetic” couples (one positive, one negative) who are happy together. HIV does not succeed in keeping them apart, nor does it ruin their sex life or automatically jump from one man to the other. You do need good communication. It's important to be able to talk about this as often as you feel the need, even if the conversation seems repetitive. People who swallow their fear of losing their partner and keep that fear to themselves will often withdraw to protect themselves. This creates a premature separation, hardly a desirable state of affairs.

AIDS is such a scary disease that I think many of us ignore every other potentially fatal illness. I don't want to be depressing, but I do want to be realistic and remind you that having a boyfriend who is HIV-negative is no guarantee that he will stay healthy. Men get prostate cancer, for example, and dozens of other lethal illnesses. All of us are going to die by one method or another. You could be creating some great memories with this man rather than equivocating about what the future might hold.

Only you can say if you care about this guy enough to navigate all of the potential difficulties. And we aren't even considering what you might do if he likes you a lot but doesn't see you as a potential sex partner or lover! While you are exploring how you feel about him, you might want to find someone you can talk to outside of the relationship. Even if the two of you simply remain friends, you will want to know how he is doing and be involved in his health care. It is sometimes easier to ask a stranger the hard questions than it is to bring them to a loved one. Get in touch with local AIDS service organizations and see if they can hook you up with reliable information and support. There may even be a local group for men in serodiscordant relationships.

 

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