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Mixed-Status Couples and Safer Sex

by Shaun Knittel

EDGE Media Network Contributor

Monday August 29, 2011

For gay men, an HIV-positive status may not be a deal-breaker for a romantic relationship. Although some stigma around HIV/AIDS still exists, the barriers to having a mixed status relationship are falling. More and more it has become common for men of varying status to date.

It is estimated that more than one million people are living with HIV in the U.S. In total, the Center for Disease Control has estimated 1,142,714 people have been diagnosed with AIDS in America since the beginning of the epidemic. Just over 75% of adults and adolescents living with an AIDS diagnosis are men.

Although a person could come in contact with the disease in all 50 states, there are some U.S. cities where there is a higher concentration of HIV rates, making it more likely that if you live in Miami (number one on the 2010 U.S. Census list of Top 25 cities in the U.S. with the highest HIV rates), New York, San Francisco, or Washington D.C., you would find yourself asking yourself if the man you met at the club -- who is HIV positive -- is someone you would want to enter a mixed-status relationship with.

In 2009, Terrence Delgado, 27, was diagnosed with HIV. He thought, as many young men do following a positive test result, that he would never be able to date a negative person again. "The two worlds just don't seem to mix," Delgado told EDGE, "I mean, sexually anyway."

Then, in late 2010 he met a man who describes as "my ideal match, both visually and socially" Online. Delgado maintains that, due to the fact that the first meeting between he and Sam Ulrich, 31 and living without the disease, was over the Internet, it was easier for Delgado "to let him know that I was living with HIV."

"I know we are not the only ones this happens to so I didn't want to freak out or be, like, you know, scared to proceed," Ulrich told EDGE. "We hit it off right away and we were obviously attracted to each other. I thought that his telling me was very brave and I thought, 'Hey, you know, now all the cards are on the table.' In a way, it made it easier to proceed with Terrence because he was honest from the get-go."

The two men entered a mixed status relationship and have been seeing each other for nearly a year. As of August 25, Ulrich has tested negative and, because he is taking is medication correctly, Delgado has a nearly undetectable viral load.

The key, say HIV/AIDS officials to having a healthy and happy mixed status relationship is education. You must know what you can do, and what you cannot do, in order to minimize the risk of infection to your partner. There's no way around it, for mixed-status couples, the possibility of HIV infection is a constant reality.

Mixed Status, But Playing it Safe

The risks of HIV infection depend on more than what you do with each other sexually. For example, more important than sex is your partner's viral load.

According to HIV InSite, a comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy website from the University of California San Francisco, a high viral load and any STDs on either of you really increase the risk of transmission because both will increase the population of virus and infectious cells.

For this reason, an STD checkup may be in order for both of you. Even if your partner has a low viral load, this only reflects levels of HIV in the blood. Levels in the genital tract where semen is produced can be much higher, particularly if there is an infection such as an STD, which has been shown to increase production of the virus.

"HIV positive men with HIV negative partners can still enjoy physically intimate relationships," says Terrence Delgado. "You know, I always joke with friends that our concerns, as a couple, are the same as everyone else's."

"Oral sex on you is safe, however if you go down on him there is a risk of transmission," says Nicolas Sheon, HIV InSite Prevention Editor. "To reduce the risk you can either use a condom or be sure to squeeze out and wipe off any precum and avoid getting cum in your mouth."

The risk of oral sex, including deep kissing, really depends on the health of your gums and throat, he said.

"If you have bleeding gums or a sore throat, then I would avoid kissing and oral sex until these have been resolved," continued Sheon. "One way to reduce the risk of bleeding gums is to use mouthwash instead of brushing and flossing when you are together because brushing and flossing can cause little scrapes and cuts in the gums."

There are a small number of recorded cases of people getting HIV from performing oral sex and taking ejaculate into their mouth. In almost all of these cases, the person had herpes sores, wounds, cuts, or infections in their mouth. It isn't easy for HIV to enter the bloodstream through the mouth or throat when sucking.

You can practice "outercourse," say HIV InSite officials. Pretty much anything you can do with your hands, or "outercourse," is a lot safer than penetration by the penis.

"Outercourse" could include, kissing, cuddling, stroking and massage, masturbation, mutual masturbation, ejaculating on unbroken skin, and urinating on unbroken skin.

Another "outercourse" method, for example, is rubbing his penis between your butt cheeks while you lie flat on your stomach. Using some water-based lube really helps.

If having his penis inside you is important, then you need to find some good quality condoms that fit him well. He might have a brand that he likes. Double bagging (two condoms) may not be as safe as just one condom. Two condoms rubbing together might increase friction and cause them to break. Two condoms may also be more likely to slip off due their greater combined bulk than a single, sheer condom.

Other sex-practices that need special attention are: Penetration with the anus with finger or fist: avoid if there are cuts or abrasions on the fingers, hand or arm. To be absolutely sure, wear a latex glove; Rimming: HIV can't be transmitted via oral-anal tongue contact, but other diseases can so use a barrier such as a dental dam or clear plastic wrap (but not the 'microwave-safe' variety -- it has tiny holes in it); Feces: HIV can be transmitted if there is blood in the feces so don't allow feces to come in contact with the eyes, mouth or cuts on the skin; and Sex Toys: always put a condom on any sex toy (such as a dildo) before use and wash all sex toys after use with warm water and soap.

"HIV positive men with HIV negative partners can still enjoy physically intimate relationships," says Delgado. "You know, I always joke with friends that our concerns, as a couple, are the same as everyone else's."

"Yeah," agrees Ulrich, adding, "After we learned about what was safe and what was unsafe in the bedroom for us, we turned are attention to the real important issues of the day like, what's for dinner or which shirt I think he should wear (laughs)."

"But in all seriousness, it just comes down to whether or not you are willing to go that extra mile with a guy you really, really like and make sure that you are being open and honest with him to protect him from infection," said Delgado. "I love Sam and I wouldn't want anything to happen to him because we were careless. So we make the conscious effort to always have safer-sex. In every other area we are just like any other couple. Happy and in love."

Shaun Knittel is an openly gay journalist and public affairs specialist living in Seattle. His work as a photographer, columnist, and reporter has appeared in newspapers and magazines throughout the Pacific Northwest. In addition to writing for EDGE, Knittel is the current Associate Editor for Seattle Gay News.

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