Beginnings and Ends
You may wonder why there’s a relationships page on a website about staying HIV negative; the simple answer is that men in Victoria are becoming HIV positive within their significant relationships as well as in casual or anonymous sexual encounters. This section discusses some of the main reasons why men can be vulnerable to HIV within their relationships and what you can do to HIV-proof your relationships.
Beginnings and Ends
The beginning and the end of a relationship are periods in which your risk of getting or passing on HIV and other STIs is increased. This section explains why and how to be careful at the beginning of a relationship: the next section explains what can put you at risk at the end of a relationship.
Safety and security are two of the defining and most appealing features of a relationship – but it is these very feelings of safety and security in a significant relationship that lead some men to take the unnecessary sexual health risk of not using condoms with their new partner.
It’s easy to associate HIV and other STIs with anonymous or casual sex and forget that HIV doesn’t care whether you’re in a relationship or not – only whether or not it has an opportunity to pass from one body to another.
Before you stop using condoms with your new partner, we recommend you both get STI and HIV tests at the beginning of a new relationship. This ensures that neither of you are bringing anything unexpected into that relationship. Men should use condoms together until they know from the test results that they are both HIV negative*.
(*Many HIV positive men decide to stop using condoms with other HIV positive men. However, HIV positive men need to be cautious of getting or passing on other STIs and other, potentially drug-resistant strains of HIV to each other. See under ‘If you are both HIV positive’ in the HIV/AIDS & safe sex section of this website).
The condom-free relationship
If you and your partner want to stop using condoms together see the ‘negotiated safety’ page in the relationships menu, which explains the four steps that men in a relationship can take together in order to safely stop using condoms together. Basically, the process involves getting tested together (twice), so you’re both sure of each other’s HIV status, and then making some decisions together about how to ensure that neither of you subsequently brings HIV into the relationship, even if it’s open and you have sex with other men.
If you feel that not using condoms together increases the sense of intimacy and trust between you then getting tested together first is the way to do it – rather than not using condoms before you’re actually 100% sure of your – or his – HIV status.
Endings
"I didn’t use condoms in my relationship because it was monogamous, so when I came out of that relationship I didn’t use condoms and I didn’t want to use condoms. I was just feeling lost and all that stuff and hating the world and I’m surprised I’m here today and I’m surprised I’m still negative." Franck.
"He was always ‘my eyes’ – if I was ‘messy’ (i.e. strongly affected by drugs and/or alcohol) he would look out for me. So when somebody came up to the sling and went to fuck me without a condom, even while he was in the throes of fucking somebody else, he yelled out: "OY!" When we broke up, it took me quite a while to realise that my ‘eyes’ weren’t there any more, and that I had to take responsibility for what was going on sexually..." Dean.
As Frank and Dean’s stories suggest, your sexual health can be vulnerable at the end of a relationship as well as at the beginning. Just as men might not use condoms with a new partner in the rush and excitement of a new relationship, men can also make poor sexual health decisions at the end of a relationship for exactly the opposite reason – because they are depressed or even self-destructive after a break-up.
Like Frank, in the emotional turmoil of a break-up, men can fail to realise that their changed circumstances require a change in behaviour: not using condoms with his partner in a monogamous relationship was perfectly safe (if they got tested together first) but, once the relationship ended, Frank’s sexual behaviour also changed – he was having casual sex with more than one partner – and therefore he needed to rethink his sexual health precautions as well.
As well as considering the practical changes required by a change in your relationship status, it’s also a good idea to be on the alert for negative, depressive or even self-destructive emotions that can affect your self-esteem and sense of self-preservation after a relationship break-up. If you’re feeling low after a break-up, use friends or a counsellor to help you recognise and deal with any potentially self-destructive attitudes. (See below for contact details).
Communication
Being in a relationship won’t protect you from HIV - unless you make the most of the advantages of being in a relationship - good communication in particular. Honest and effective communication is probably the most important factor in keeping your relationship sexually healthy. From beginning to end, communication is key to adapting as a couple to change as it happens
However, honesty and communication about sex can be a particular challenge in the beginning of a relationship: for example, when is the right time to discuss with your new partner whether or not you want to be monogamous? Some men avoid discussing this because they’re afraid their would-be partner will have different views or needs. What happens, for example, when one partner expects a monogamous relationship and the other partner expects an open relationship? Some men prefer to assume that their partner wants the same thing they do rather than having a potentially confronting conversation about it.
Monogamous or Open
Monogamy or open relationship?
"By the end of the first relationship I was having sex outside of the relationship, which was kind of OK. We had an understanding, but it wasn’t my ideal relationship; that’s not what I wanted in a relationship. I hear from friends, ‘Oh we’re so in love’, and they’re completely monogamous and they can show each other to their parents and be like a real couple and that’s what I wanted… We don’t have a monogamous relationship, even though we tried to have a monogamous relationship, but it just doesn’t work because I’m much more sexually active than he is, so we use condoms at home and stuff and that’s fine." Frank.
"I’m an arsehole! I mean, when I’m with someone the first six months are really exciting – everything is new, I love doing everything together but after a while I can’t settle down. I want different people to have sex with." Indi.
Whether a relationship will be monogamous or open is the most confronting issue for many couples. While many gay men today are seeking relationships along heterosexual models – i.e. monogamy, marriage and children – many others believe that men are by nature not designed for monogamy and that their relationships need to cater for this need by allowing the men in it to have sex with other people as well. These are called open relationships.
For many men who seek monogamous relationships, the safety from HIV and other STIs is just one of the advantages of an exclusive relationship. However, men entering a monogamous relationship and planning to not use condoms together need to get tested together to ensure that HIV is not already inside the relationship (unless, of course, they already know that they are both HIV positive: many HIV positive couples don’t use condoms together).
Whether it’s monogamy or open relationships that feel right for you personally, you cannot assume that the same choice is right for everyone else, including your new partner: you need to discuss exactly what you and your partners beliefs, wishes and expectations are.
Men can feel very guilty or embarrassed about wanting to have sex with other men when they’re in a relationship, especially if their partner has made it clear they want monogamy. However, as Brent describes in his story, if one partner is too dogmatic about the terms of the relationship it can result in the other partner simply going behind their back because they feel they can’t talk about it:
"I was serially monogamous right up until I was 26. In my last relationship at that time there were a whole bunch of rules… Before this relationship I suppose it was assumed that I would be monogamous, and so I was, but in this relationship this guy laid down the rules, and I think, because of the way he did that, I ended up saying to him, ‘Fuck ya! I’m not playing by your rules’… I don’t think at that time I had the capacity to say, ‘I don’t like the way that this is being negotiated’ and among all the rules I was explicitly told that I couldn’t have sex outside the relationship – it was non-negotiable. So that wasn’t a very good experience, and I think that at that point I started having casual anonymous sex…" Brent
And, like Frank, men in an initially monogamous relationship may discover over time that one or both of them wants either more sex, more partners or both. Again, change can make people vulnerable and, again, communication is the key to successful adaptation: as a result of Frank beginning to have other sexual partners, for example, he and his partner agreed to resume using condoms within the relationship.
Setting ground-rules
Many men with open relationships agree upon rules in their relationship to set some boundaries and to cater for their particular emotional needs. Some common examples of rules men set in an open relationship include:
- No bringing other sexual partners home
- No anal sex with other partners
- Partners to never have sex with another man more than once, to avoid forming emotional attachments
- Sex with other men is OK if you tell me about it
- Sex with other men is OK if you DON’T tell me about it!
- Package deal: the couple only have sex with other men together
Sitting down and setting some boundaries together so you both know exactly what you’re comfortable with is essential in a relationship. However, you should also work together to agree about some physical rules that will prevent HIV from entering the relationship. Some rules might include:
- No anal sex outside the relationship
- No anal sex without a condom outside the relationship
- Making sure either partner feels safe enough to tell the other if he has broken any of the agreements. If a couple agree in advance not to split up if this happens, but to return to using condoms until they can get retested together there is a better chance that either partner will be honest with the other if this situation arises.
Improving your relationship skills
The VAC/GMHC’s Peer Education program offers free, popular six-week Relationships workshops to help gay men to improve their relationship skills. You don’t have to be in a relationship to do the workshops – the workshops help single men define what it is they’re seeking from a relationship as well as helping men already in relationships to improve their relationship skills. Couples welcome! Participants will also learn a lot about managing their sexual health. For more information call Asvin at the VAC on (03) 9865 6700.
The VAC/GMHC Counselling Services offer couples counselling as well as one-on-one counselling for men in relationships or single. For information call the Counselling Duty Worker at the VAC/GMHC on (03) 9865 6700.
Pos-Neg Relationships
Positive/negative relationships
Many HIV negative men are in a relationship with an HIV positive partner. In some cases men enter a relationship knowing their partner’s HIV status is different to their own; in other situations one partner may become HIV positive in the middle of a relationship, or a couple in a new relationship may only discover that one of them is HIV positive when they get tested together in order to stop using condoms together.
In these situations, ensuring that the HIV negative person remains HIV negative is a primary concern. However there are other issues men with a different HIV status to their partner need to be aware of. This article discusses some of these issues. It is taken from a booklet specially designed for HIV negative men with an HIV positive partner. The booklet, called Opposites Attract covers issues including:
- Getting the most out of your sex life
- Communicating effectively
- Resolving conflict
- Understanding HIV and safe sex
- Alcohol and other drugs
- Same-sex domestic violence
For a free copy of the booklet contact ACON – the Australian Council of AIDS Councils – at acon@acon.org.au or on (02) 9206 2000, or download it from their website at: www.acon.org.au
If you are the HIV negative partner of an HIV positive man and would like to talk over some problems with men in a similar position, VAC Counselling Services offers a Negative Partners group. Call the Duty Officer at the VAC between 2 and 4pm Monday to Friday on (03) 9865 6700 for more details.
Three’s a crowd: HIV & the relationship
HIV can create fears in a relationship; fears that may be real or imagined. Although the perspectives are different, both partners can fear that the positive partner may become ill and possibly die, or that the negative partner might contract HIV, or that practicing safe sex all the time will become frustrating. The partner with HIV can also fear that he will be rejected or abandoned, or that his partner will become overly concerned by the way he does or doesn't take care of his health.
The partner without HIV can assume too much responsibility for his partner's health, feel guilty that he is not being supportive enough, or believe that his own needs are not as important as the needs of his partner. In some cases HIV can become an excuse to justify other difficulties in the relationship, or it can even become a reason why people stay together.
These challenges need to be dealt with, and this requires both awareness of each other's needs and honest communication between both partners. HIV is an important issue that both partners need to face together.
"HIV is important in that it's a part of my partner's life, so in turn it becomes part of mine. After 18 months, HIV plays a fairly minor role in our relationship, as my partner has never been ill. My concern is for his health but probably no more or less than concern for my own wellbeing. I sometimes worry that I may become HIV positive through the law of averages, no matter how safe we are, but realistically I know that's unlikely. I would be concerned about the impact it would have on our relationship if I were also to become positive." Shane
Disclosure
Some men have had shocking experiences when revealing they have HIV and, unfortunately, rejection is rife in sexual or relationship scenarios. If your lover had unprotected sex with you, then that's a different story. But if you were having safe sex, he may have decided not to tell you (or anyone in your position) because previous sex partners may have rejected him, either outright or in more subtle ways.
Experience from telling previous lovers might mean he had used too much of his own energy in supporting them. They may not have been able to cope with their feelings, and that's just a whole bunch of other stuff for him to have dealt with. You may have been the best person he could have told, but how was he to know that?
Once a relationship starts to develop, it can then be difficult to pick the right time to reveal all. It can feel too early one day and then too late the next. One moment he's holding back to test the waters and get to know you better, and the next - it feels like he's withheld information and has been hiding things from you.
Issues about confidentiality may also concern him. His HIV status may not be a problem for you, but your friends may have different ideas about it. Your new man is also going to want to have some control over who you share his news with as well. It may be a situation that you're going through -but it is his HIV status!
HIV and AIDS support services, such as counselling and support groups, are there for people whose lives are affected by HIV, not just for those who are positive. Contact your local AIDS Council for these services. It is not unusual for negative partners to need support, comfort and the reassurance that their partner may not be able to give them.
A tricky question when entering a relationship with a positive guy is - who do you talk to about his positive status? He may be happy for you to discuss his status with your friends and family, but then again he may not. There are many reasons why a person living with HIV may want to keep his status confidential. These may include: fear of rejection by friends or work colleagues; not wanting to be treated differently and/or pitied; not wanting to be continually reminded of his status; a fear of discrimination at work - including not getting promotions because he may get sick and wanting to avoid the stigma attached to being HIV positive.
To maintain a healthy relationship it may be important for you to be able to talk to somebody about the particular issues that arise with having a positive partner, either with someone in a similar situation, a close friend, a counsellor, or in a negative partners' support group. Being in a positive/negative relationship can at times be isolating; if either of you feel this way, you should discuss the need to chat with other people and work towards negotiating a compromise with your partner.
"My partner told me his status the second time we had sex, a month after we met. I responded in a low-key fashion. I was expecting him to tell me something awful - like he just wanted a fuck buddy, he already had a boyfriend, or didn't want a serious relationship. As a result I was kind of relieved, having decided already he was my kinda guy and worth pursuing." Cameron
Slip-ups
Slip-ups happen. When they do, it may help to talk through what happened with someone, but choose that person carefully. Friends can be judgmental about HIV negative men who have unprotected sex with their HIV positive partners, and most of what they say boils down to "you should know better." But knowing often isn't enough.
Try to access a health professional - contact your AIDS Council for access to free or affordable counsellors who are going to understand your situation. Then talk through the encounter - how you felt beforehand, what mood you were in, what substances might have been involved, the history of the relationship to that point, etc. Discuss the act itself and be as honest with yourself as possible.
By working out what contributed to you putting yourself at risk, you stand a much better chance of not allowing that situation to arise again. The solution might be anything from just making sure that you're well stocked and don't run out of condoms, to focusing on the values that are operating within the relationship, and maybe enter into counselling. Just because a slip-up happened, doesn't mean that it will have to go on happening. You can prevent it if you want to.
If he is undetectable, does that mean we can fuck without condoms?
No matter what your partner's viral load is, there is a risk of contracting HIV. Some guys use viral load as an indicator for the type of sex they are going to have, and choose to fuck without condoms if viral load is low. However there are a few things you need to consider before making any similar decisions. Most viral load tests measure the level of the virus in the blood. A low blood viral load does not necessarily mean that the viral load in your partner's cum is also as low. The presence of some other sexually transmitted infections, such as gonorrhoea, can cause viral levels in cum to increase significantly. Sex with condoms and lube is still the safest way to have anal sex.
"Sometimes we fuck without condoms. When we do we're usually pissed or out of it. It feels good at the time because we don't care, but for a couple of days after I feel like shit. I can't guarantee it won't happen again though. Waiting for the test results can be stressful." Isaac, 36
Condoms
A likely slip-up that gay men experience is slipping of the condom - where the condom slips off your dick. Because of high manufacturing standards, condom breakage or slippage is more likely to be the result of incorrect use rather than the product being faulty. Condoms tend to break more often during anal sex than with vaginal sex, as the rectum does not self-lubricate. Here are a few things to consider when using condoms:
- Use plenty of water-based lube to reduce friction. Oil based lubricants weaken and damage the latex and should never be used with condoms.
- Condoms that have expired, or which have been exposed to heat, light, or air pollution, are more likely to break.
- If doing the fucking, it's a good idea to take your dick out straight after cumming. Many guys lose their erection fairly quickly after orgasm, making slippage more likely.
- When removing your dick, hold on to the base of the condom so it doesn't slip off. Regardless of the risk of HIV, it is not much fun fishing up your arse for a used condom!
Post Exposure Prophylaxis (PEP)
PEP is a drug treatment that men can take if they think they have been exposed to HIV. This drug treatment will, in the majority of cases, stop HIV from establishing itself in your body IF treatment begins within 72 hours of the event that caused the HIV transmission. It is important for people in a relationship with someone of a different HIV status to be aware of the availability of PEP in case of a slip-up.
PEP is a combination of at least two anti HIV drugs taken at strict times of the day over a four week period. PEP is not a simple treatment. TAKING PEP DOES NOT GUARANTEE PREVENTION OF HIV INFECTION! Research shows that PEP may decrease the chances of HIV transmission.
These drugs are extremely powerful and can cause unpleasant side effects like cramps, diarrhoea, vomiting, headaches, and tiredness. These side effects can be treated with other drugs, but sticking to the strict routine is crucial.
PEP is most effective when taken immediately or within a couple of hours after exposure to HIV. The earlier you start PEP the better. However PEP may still be effective if taken within 72 hours of the incident. If you think you’ve been exposed seek medical advice as soon as possible. You can get PEP from HIV treatment prescribing doctors, sexual health centres or hospital emergency wards. Due to long waiting times at hospital emergency wards, if possible seek advice from a prescribing GP or sexual health centre first.
For quick access to PEP or for more information call the PEP hotline on 1800 889 887 or visit www.getpep.info.
Negotiated Safety
Introduction
This section explains the only safe way to stop using condoms with your regular sexual partner. Unfortunately, there is no safe way to not use condoms while fucking with a casual partner. This is because it is not possible to reliably know if someone is HIV negative simply by looking at them or asking them.
If you and your partner think you are HIV negative and you want to fuck together without condoms, there is only one safe way to do it. This process is called ‘negotiated safety’: it is also known as ‘The Four T’s’ – Talk, Test, Test, Trust.
TALK
One of the most important discussions you need to have with your partner is about HIV status and safe sex. Many men who are – or think they are HIV negative - always use condoms, even if their sexual partners say they're HIV negative. However, many other HIV negative men choose not to use condoms if their partner also says he is negative. Yet having unprotected sex with a new partner is risky, even if he says or thinks he's negative. It's important to ask yourself what it means when he tells you he's negative.
Some important questions
When did he last have a test? It may have been a good while ago.
Why did he have the test? It might have been a regular checkup. However, people often get tested soon after having unsafe sex. If the "window period" had not passed when he was tested, he could be positive without knowing it. (The HIV antibodies that show that you are HIV positive in the HIV test take several weeks to show up so if you have a test too soon after the day you caught the virus the test will come back HIV negative when you are in fact HIV positive. See ‘Window period’ below).
What has he done since then? He may have taken risks since his last test, such as unsafe sex or unclean needle use. Is he lying? Sometimes people aren't as truthful as you'd like. If he said he's negative, he may feel he has to 'dig in' when questioned, rather than admitting he's not really sure.
Talking
The first step is to talk about it with your partner - even if you think you already have an agreement. Many couples stop using condoms without having really discussed what this means for their relationship. It may be uncomfortable or difficult to talk about issues of sex, trust and honesty, especially if it's early in the relationship. When you and your partner are talking about whether to continue using condoms, it's important that you have clear communication, and feel that you can trust each other -- easier said than done!
Consider what implications the decision might have: for example, it might make it difficult to go back to using condoms if the relationship breaks up, or gets rocky. By deciding not to use condoms, you are putting your trust in each other to keep to the agreement. Therefore it's good to make sure you're both agreeing to the same thing.
You might be thinking, "I have absolutely no idea how to bring up this kind of stuff with my partner." Don't give up yet! Use enquiries rather than interrogatory questions: "how would you feel about" and "what would we think of" questions. Hypotheticals can help too: "If we did have sex outside the relationship and the condom broke, how could we go about telling each other?"
Getting Tested
The second step in agreeing not to use condoms in your relationship is for both of you to get a sexual health checkup including an HIV antibody test. You'll need to decide whether you want to get tested together or separately. Getting the test and your results together means you have the support of your partner and also means you don't have to rely on each other's word. Getting tested also includes being counselled to prepare you for the results, especially if either or both of you get a positive test result.
In Victoria, getting a test means you get pre and post-test counselling. This means getting an explanation of what the test is about, what the result means and what support or referrals are available.
Even if you've already had unprotected sex in your relationship it's still important to get a test done and to continue (or recommence) practicing safe sex until your (second) test results come back.
The Window Period
HIV antibody tests don't look for the virus itself - they test for antibodies your immune system has developed to fight the virus. It can take up to three months after infection for antibodies to appear, which means it's possible to get a negative test result if you were infected less than three months ago. Because of this window period, it's important that if you test negative you both return and get tested again in three months. You and your partner need to agree to continue using condoms during the three-month period.
The three-month wait before your second test can be really difficult. It can be tempting to stop using the condoms if the first results came back negative. Yet if your first test happened during the window period of a new infection, the risk of passing on HIV is very high. Viral load is a measure of the amount of virus in a person's body fluids, and during the first few months of a new infection, viral load is very high, as the body doesn't have mechanisms to control it yet. This means there is more virus in body fluids such as blood, cum and pre-cum, and a greater chance of passing on HIV during unsafe sex.
As long as you continue to use condoms and practice safe sex and safe injecting between the first and second test, then you can know for sure if the second result is negative that you do not have HIV.
Some couples choose to have only one test because they are confident that in their sexual history they haven't had any unsafe sexual activity, ever, or since their last HIV test. This requires a lot of trust and a sophisticated knowledge of HIV transmission, so it's safest to wait three months and have the second test.
If one or both tests come back positive there are support structures in place to talk about what it means, how it happened, and how you can maintain your health and your relationship.
It's also important to talk about your result with your partner, whether it's negative or positive. You might want to see a counsellor, either on your own or together. VAC/GMHC has a counselling service means-tested for affordability for all people.
Sex Outside the Relationship
Once you've established that both you and your partner are negative, you need to talk about what type of sex will occur within and outside your relationship.
Many of these issues are difficult to talk about, especially in the early stages of a relationship. Different people can have equally strong but very different views about monogamy and open relationships. If you have a difference of opinion, it's important to work through the disagreement. You can disagree with your partner's opinion while still respecting the experience that led to it. If you become emotional and make categorical statements (like "If you ever cheat on me you're dumped!") it will make it very hard to discuss the issue again later.
Some questions to ask:
Will we stop using condoms in our relationship?
Will we agree to allow sex outside the relationship? For one or both of us?
What type of sex will be allowed outside the relationship: anal sex with condoms, or no anal sex?
Will we agree to tell each other when/if we have sex outside the relationship, or will it be "don't ask, don't tell"?
If we decide not to have sex outside the relationship and someone does, will he be able to admit it has happened?
Slip-ups
If for whatever reason your agreement about sex outside the relationship is broken, you need to make sure it's possible to talk about it. If telling you would be a threat to the relationship, he might not tell you. It's important to talk about this possibility before it happens, so you can feel more comfortable about raising it again if it occurs.
If unsafe sex happens outside the relationship, you need to begin using condoms again inside the relationship, and get tested again and once more in three months' time. Alternatively you might choose to go back to using condoms inside and outside the relationship.
Re-establishing trust can take a lot of time and effort, and you might benefit from advice from a GP or counsellor, particularly to help reduce the chances of unsafe sex happening again.
Revising the Agreement
Relationships can change over time, so you may need to revisit the agreement you have, to make sure no matter what sex you're having, with whom, within/outside the relationship, that everyone is safe.
