For many, HIV is the ultimate boogeyman of the modern sex-scape. Years of horror stories have led some to fear contracting the virus so much that it becomes a constant phobia. It has also led to the stigmatization of HIV-positive individuals as toxic or wicked—and desexualized. Who, this line of thought goes, once struck with HIV could think of themself as a viable sexual object ever again? And who would view them as viable partners for any form of physical intimacy?
It is absurd that this even needs to be said, but people living with HIV are humans living full, long lives with a chronic but manageable condition, like so many others. They desire, and are deserving of, love and intimacy like anyone. Being in a relationship can actually be a vital motivator for some people to seek and keep up with treatment.
One might assume that HIV-positive people choose to date those who share their status, so as not to worry about transmitting the virus. And sure, this happens. But many HIV-positive and -negative people still pursue sex and intimacy together, in what are known as “serodiscordant” or mixed-status relationships. In the U.S. alone, there are at least 140,000 mixed-status couples, possibly many more, as that estimate was extrapolated from 23-year-old data. In countries where HIV is especially prevalent, more than 3 percent of all relationships are serodiscordant, and up to two-thirds of HIV-positive individuals are in such relationships.
Not all these couples know from the start that they are serodiscordant, thanks to a positive partner not knowing their status or contracting the virus while already in an established relationship. But many partners know they are mixed status when they get together and make it work.
There is no single strategy for HIV-positive and -negative people to pursue sex and intimacy. Some agree to pursue only emotional intimacy, perhaps consenting to forms of non-monogamy as well. Some only engage in non-penetrative sex. Some use condoms at all times. Increasingly, though, there’s recognition that effective treatment can lower one’s viral load to untransmissible levels. This makes the risk of an HIV-negative partner contracting the virus functionally nonexistent during unprotected sex with a HIV-positive partner who has had such a low load for at least six months and is maintaining their treatment regimen. The spread of PrEP—a preventive drug regimen used by an HIV-negative partner that reduces the risk of transmission by up to 99 percent—in recent years has also opened up new possibilities for a sense of security and less restrained intimacy. Some couples mix and match strategies as needed.
Vasilios Papapitsios: I became positive when I was 19. I’m 28 now. I’d just come out of the closet. I was living in a very hateful state [North Carolina] that had just defunded the AIDS drug assistance program, and I was going to school at UNC-Chapel Hill. As much as it thinks it is a progressive community, I was already feeling outed by a lot of my community members.
At that time, it was definitely easier to conceive of a relationship—or just casual sex—with another HIV-positive person because of the stigma I’d internalized and the fear of passing it along.
Elijah McKinnon: I’m from the San Francisco Bay area. I grew up in a pretty liberal household. I talked about sex and various STIs, including HIV, with my parents, who were in an open relationship and very open sexually. I had various relatives die from AIDS.
I had a lot of friends who were young and positive, but not out. It was more hidden than I think a lot of people are now about their status. So the first thing I learned is that I need to take ownership of my own status. What are the ways I can best protect myself? I mean not only from STIs, but a more holistic approach—like my mental sanity, my emotional sanity.
I never thought about serodiscordant relationships from this taboo perspective. One of my first…let’s just call him a boyfriend, was HIV positive. That’s when I discovered PrEP. I had to be 19, 20. This is right when the FDA approved it. I was super skeptical like, you want me to take what? Then after being involved with the study that changed the entire landscape of PrEP a couple years ago by testing a lot of people [using it] and seeing the significant decrease in [transmission of HIV], it was sort of a no-brainer for me. Leading into this relationship, I don’t think I had any barriers.
Vasilios: [Just before I met Eli in late 2016,] I’d been in New York for about half a year. It was suddenly an environment where people just didn’t care about my status. It was: That’s okay, the same way it’s okay for you to be gay. I felt more liberated and free to just be myself.
[Then I moved to Chicago.] It was the first time I was very open about my status to the public. I witnessed communities of people who were all on PrEP, or they know about it. I had been undetectable for a year or two. That was a major factor in terms of my internal stigma and fear.
My world blossomed. I was allowing myself to have intimacy and love and sex in ways that I couldn’t before…I realized I just deserved that and wasn’t this scourge of society.
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Elijah: I met Vas during a performance where they were doing a blood ritual [that involved taking a bath in fake blood] that centers on queer people living with chronic illnesses. So I was very much aware of their status.
Vasilios: I knew she was the PrEP girl. [Eli helped develop PrEP4Love, a campaign raising awareness of PrEP among black gay men, straight black women, and black trans women, and was a model in campaign ads all over Chicago.] She knew I was the poz artist and advocate.
Elijah: I’m black and queer and non-binary. We live on opposite ends of the country. We have different interests and passions. We’re constantly approaching things from the perspectives of our past traumas. There are constantly tensions between our other identities that we are processing. Our status is, I don’t want to say low on the totem pole, but there are other things we are processing.
Vasilios: We have an open relationship. Usually it’s separate. Sometimes it’s not.
I have to be aware that there are other STIs when you do not use a prophylactic. Even if people I’m having sex with are on PrEP, that doesn’t mean other things are thrown out the window. For me, PrEP is like a mental prophylactic. It gives us the opportunity to get into it and not have to think, oh my goodness, this little act of intimacy or sex is so wonderful but there’s still a lingering fear. That doesn’t really exist for me anymore. And that is an amazing gift. But any sex interaction, I have to think about, huh, I don’t know this person or whatever, I’m taking a risk.
How do I put this… We use condoms [together] if we need to. But we don’t really want to.
Elijah: There are a lot of tools that people don’t know about when navigating sex. Like the number of partners, or knowing how to have communicative conversations with those partners as just number one. That allows you to navigate sexually through an experience however you want to.
There are obviously condoms and PrEP, but also positioning [in terms of who is the recipient of penetrative sex; the receiving partner is at more risk]. There are ways of being intimate that are non-penetrative. There’re so many different things we discuss. Everything on our relationship is on the table. When it’s not, things begin to spiral because we’re not being communicative.
One thing that really has been intimate about our respective statuses is that I feel, versus a lot of other relationships, we’re more actively involved with each other’s holistic health. Not just okay, what’s your CD4 count? But how’s your mind doing? Let’s check in. How are you eating?
Vasilios: I think we have learned from our past experiences. And we complement each other in our different healing journeys.
Elijah: Up until about a year ago, I got a lot of questions, like: Aren’t you scared? Don’t you just think it would be easier with a negative person? I don’t even know what any of those questions mean!
There are still a lot of people who are very unaware due to fear and stigma around how to not only be in a serodiscordant relationship but be in a gay, queer, alternative relationship in general. Because they don’t have any models and the models that we do have are very monolithic. If it weren’t status, it’d be something else, like: How is it being in a mixed-race relationship?
That is just one facet of our multi-faceted relationship. It’s a topic that’s up for discussion, not so much negotiation. And it isn’t a barrier to accessing our most intimate depths of pleasure and joy.
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This article originally appeared on VICE US.