Going through life as a gay, bi or man who has sex with men (MSM) can be complicated enough when it comes to dealing with HIV, but what do you do when your partner is HIV positive, and you’re not?
For some it’s a deal breaker, especially when it comes to a new relationship – and they may choose to simply walk away. The idea of being sexually involved with someone with HIV is too scary. They may fear the risk of becoming infected (even if they were to only practise safer sex) - no matter what they might feel for the HIV positive guy, or how hot he might be.
If you’re HIV negative and already in a relationship with someone who is HIV positive (known as a ‘sero-discordant couple’), you’re less likely to head for the hills. There’s an existing bond and so you’re more likely to try to make things work. And good for you!
The good news is that in both cases, you don’t need to panic or act irrationally. Things are not as difficult as they might appear to be. Today, especially with effective treatment, being in a discordant relationship can be safe and healthy for both guys.
The first thing to consider is if you’re willing to adapt your sex life to an HIV positive partner or if he’s willing to do so for you. Each couple needs to discuss this carefully and decide what works for them. For many people, taking precautions like not having anal sex (hey, many gay guys have awesome sex lives without it) or using condoms is no big deal.
And, if your HIV positive partner is under treatment and his viral load (the amount of virus in his blood) is undetectable, then even better. Studies have shown that the risk of HIV transmission could be greatly reduced (possibly by more than 90%) if the HIV positive partner is undergoing ARV therapy that has successfully lowered his viral load to undetectable levels.
Some men, however, find it difficult to practice safer sex consistently, whether they are in a discordant relationship or not. Also, an HIV negative person may not be willing to rely on his HIV positive partner sticking to his treatment. In these cases, where a guy is at high risk of becoming infected, medical science can finally make a real difference.
In June last year, medical specialists in South Africa accepted the use of medication, known as PrEP (Pre-exposure Prophylaxis), for men who have sex with men who are at high risk of HIV infection. The medication, say doctors, can help these men avoid becoming infected with HIV.
Studies have shown that by using PrEP, and using it consistently and regularly as indicated by a doctor, an HIV negative MSM can reduce his chance of becoming infected dramatically - by up to 90 percent. Those who took the medication less consistently saw a reduction in risk of an average of 44 percent, but this varied considerably depending on their adherence in taking the medication. In other words, the more you stick to your medication, the more effective it is.
According to the experts, a daily dose of PrEP may also be suitable for HIV negative men “who are in a discordant relationship, especially if the positive partner is not on antiretroviral therapy”.
In discordant couples in which the positive partner is under treatment and has an undetectable viral load, it’s likely that the risk of the HIV negative partner becoming infected will be even further reduced.
While the use of PrEP for MSM is now accepted in medical circles in South Africa, it’s not like you can just pop off to the chemist and get it. You should speak to your doctor about your specific circumstances and he can decide if PrEP is right for you.
The medication is not, for example, ideal for men who have kidney problems, and you may need to do HIV, Hepatitis B and kidney tests before being prescribed PrEP. You will also need to agree to see your doctor regularly and be monitored to make sure that all remains well and that you don’t suffer from any harmful side-effects.
Doctors have also pointed out that while it appears as if PrEP is effective, they don’t really know the long term consequences of using it. America’s Centers for Disease Control and Prevention (CDC) notes, however, that “no studies conducted to date have identified any significant safety concerns associated with use of daily oral PrEP”.
If you’re in a discordant relationship or feel that you are at high risk of becoming infected with HIV because of your sexual behaviour, contact your doctor or HIV clinic and discuss the possibility of PrEP for you. Remember that not all health care providers in South Africa may be informed about PreP for MSM yet. If that’s what you experience, please contact an MSM friendly service, such as OUT, for assistance.
For advice, counselling and information on getting PrEP, or any other sexual health services for men who have sex with men, contact OUT in Pretoria on 012 430 3272 or ask Dr Dick here.