HIV-Negative: How the Uninfected Are Affected by AIDS
Copyright © 1995 by William I. Johnston
New York: Insight Books-Plenum Press
"Why don't you just find an HIV-negative man and settle down?" was the question that a psychotherapist posed to one HIV-negative man I interviewed whose lover had died of AIDS. I imagine the therapist's tone was that of a Jewish mother chiding her daughter to "find a nice Jewish boy."
When I told my mother that this book would discuss positive-negative couples, she reacted as if the very idea that such couples existed was incomprehensible. "Why would anybody be in such a couple?" she asked. Perhaps she assumed that HIV-negative gay men would only consider relationships with other HIV-negative men.
A devout Christian coworker of mine who read the interview-based chapters of this book noted that anxiety about becoming infected was prevalent among those I interviewed. He asked me why abstinence or monogamy with an uninfected partner was not more often considered as a way to reduce this anxiety.
All three of these people -- the therapist, my mother, and my coworker -- expressed a common idea: that HIV-negative people should be able to manage their anxieties about HIV by becoming sexually involved only with other HIV-negative people. Not only does this idea ignore the divisiveness of discrimination based on HIV status among gay men, but it also implicitly assumes that negative-negative couples have unprotected sex without worrying about HIV. I found the latter was seldom true among the men I interviewed. Anxiety about HIV is not absent from gay men who are in negative-negative couples. HIV is not a "nonissue" for them, and therefore decisions about whether to have protected or unprotected sex are not trivial.
It is easy to see how the actual presence of HIV in one or both partners can affect a couple. Positive-positive couples often find themselves wondering who is going to become sick first and whether one partner will be well enough to take care of the other. Positive-negative couples experience other stresses: not only must they anticipate and adapt to changes in the health of the infected partner, but they must also acknowledge and reduce the risk of transmitting HIV to the uninfected partner.
When HIV makes its presence felt in these couples, whether because of declining health or the threat of infection, couples may feel that HIV demands their attention, drains their energies, and blocks intimacy. It is common for men in such couples to mention that HIV is like a third party in the relationship: "You and me and HIV makes three."
It seems logical that negative-negative couples would not experience HIV as a presence in this way. And yet HIV has so infiltrated the consciousness of gay men that it has a virtual presence even in the lives of the uninfected. For negative-negative couples, virtual HIV can be a third party, an unwanted intrusion, even though HIV is not physically present in either of the partners. Virtual HIV influences the sexual behavior and mental health of couples where neither partner is infected.
A simple example of the influence of virtual HIV was mentioned by Cal, 42, of Rochester, New York. One of the reasons Cal got retested for HIV was to reassure a new boyfriend that he was HIV-negative. "He's negative himself, and I want him to feel safe with me," Cal said. "The other night he got a little precum in his mouth and spit it out. I, on the other hand, want him to feel safe to come in my mouth. I want our sex to be as natural as it can be. But he pushes me away when he becomes too aroused." This is virtual HIV in action.
Many of the HIV-negative gay men I interviewed reported using condoms or avoiding penetrative sex even with long-term partners they believed were HIV-negative. Why is it difficult for gay men to have unprotected sex in negative-negative couples?
As I mentioned in chapter 9, some HIV-negative gay men do not believe their test results. Common reasons for this disbelief are uncertainty about the validity of the test, unresolved sexual guilt, and homophobic equations of being gay with getting AIDS. Claude, 34, whose narrative appears in chapter 8, has protected sex with his HIV-negative partner of ten years because he is unable to shake the idea that his early sexual behavior in Haiti infected him. Despite a series of HIV tests indicating he is uninfected, Claude remains convinced that he will seroconvert "out of the blue," perhaps even in his sleep. For Claude, practicing safer sex is a way of protecting his partner in case he really is HIV-infected.
Part of Claude's difficulty in accepting that he is HIV-negative stems from the fact that several of his former sexual partners have died of AIDS. Having been "touched" so closely by AIDS makes it hard for him to believe he is uninfected. Aaron, 46, told me that he and his partner, Max, feel similarly "touched." Even though they have both tested HIV-negative, doubts linger in their minds. "We still wonder if we can trust our results," Aaron said, "because Walter -- Max's former lover of ten years -- is HIV-positive." These doubts influence Aaron's sexual behavior with Max:
We've both tested negative, and yet I still don't quite feel comfortable ingesting Max's precum, because of the lingering knowledge of Walter being positive. When I have oral sex using the "harmonica method" with Max, I am tempted to take his cock in my mouth, but the only way I can do that and feel comfortable is with a condom. It's not the same thing, but it's better than not having oral sex.
Three years after we both tested negative, we're trying to be a little more flexible about what we define as safer sex. I would like to be able to come into contact with Max's precum. I would love not to have to worry about safer sex. We have not yet reached the point where we feel comfortable with that. It's something we're struggling with. What we're doing is trying to accommodate our anxiety. The anxiety is more of a risk than getting HIV is. When can we both really believe that we're negative?
Walter's HIV positivity has affected Max and -- by extension -- Aaron. Walter's influence is also apparent to Aaron because Max is still living with Walter as a housemate. "Max is living every day in the same house with Walter," Aaron said. "In many ways he is taking care of Walter. Emotionally this is a real obstacle in our relationship. What's going to happen to Walter? Who's going to take care of Walter if Max moves in with me?" Aaron guesses Walter "will remain a shadow in Max's life, probably for the rest of his life," just as Walter's HIV positivity remains a shadow in their sexual life.
Many gay male couples are not sexually exclusive, so some men in negative-negative couples practice protected sex because they are not certain that their outside sexual contacts are safe. For such men, insisting on practicing safer sex within the couple is a sign of their commitment to each other's health. "Safer sex is the ultimate form of caring," was the way Derek, a 25-year-old graduate student from Muncie, Indiana, put it. Another man in a sexually nonexclusive negative-negative couple told me, "We use condoms even though we both know we're shooting blanks." His metaphor reveals that although he hopes he is not packing a "loaded gun," he fears he or his partner might be.
Sometimes avoiding unprotected sex is the result of indoctrination by AIDS prevention efforts. Phillip, a 30-year-old high-school teacher, told me that when he began a relationship with Dave, he had only nonpenetrative sex because he wanted to continue following the safer-sex guidelines he had adopted early in the epidemic:
When I first became sexually involved with Dave, I was only interested in jerking off and kissing. That was what I was comfortable with, and I felt okay doing that with anyone, regardless of HIV status. In fact, I didn't usually ask anyone about HIV status, because I didn't want it to influence my behavior.
I met Dave after I found out I was HIV-negative, and he was actually the first sexual partner who told me he was HIV-negative too. That threw me. All of a sudden I had to reexamine my safer-sex routine. Why shouldn't I swallow his cum if he was HIV-negative? Why shouldn't I let him fuck me if he was HIV-negative? If he wasn't HIV-positive, why should I treat him as if he was?
Finding out Dave was HIV-negative did not change Phillip's sexual behavior immediately. Social norms, he said, influenced him. Phillip was a volunteer on an AIDS hot line, and he thought it would be hypocritical to say one thing to callers on the phone and yet do something else in his personal life. It was difficult for Phillip to flout education campaigns that encouraged gay men to "use a condom every time with every partner."
But in addition to these social reasons, Phillip told me there was also a more personal reason for his reluctance to have unprotected sex. He was not ready to relinquish control over his HIV status to someone else:
I wasn't sure I should trust Dave with my life. That's what unprotected sex amounted to. As long as I stayed with my safer-sex guidelines, I had complete control over my own HIV status. No one could change it. That made me feel secure.
Sucking Dave off or getting fucked by him without a condom would have taken away some of my control over my own HIV status. It would have meant relying on someone besides myself to keep me uninfected. Maybe avoiding unprotected sex was a way of telling Dave that I wasn't sure I could rely on him, that I wasn't ready to trust him fully, or that I wasn't ready to give up the sense of absolute control I had over my HIV status.
Phillip voices here an important truth about relationships in the time of AIDS: Without trust, unprotected sex with an HIV-negative partner feels dangerous.
Not all gay male couples use condoms for sex.An Australian study reported in 1993 that among 82 gay men with regular partners, 41 never had sex without condoms, while 41 often or occasionally had sex without condoms. Among the 41 who did not always use condoms with their regular partners, 30 were HIV-negative, and of them, 26 had HIV-negative partners, 3 did not know the status of their partners, and 1 knew his partner was HIV-positive. These data suggest that HIV-negative men who have unprotected sex with regular partners usually have it in the context of negative-negative couples.
The study authors suggested that the term "negotiated safety" be used to describe unprotected sex in negative-negative couples, because they found that the decision to have unprotected sex was frequently linked to explicit agreements about whether sex outside the relationship was allowed and, if so, what kinds of sex were defined as "safe." Several of the men I interviewed spoke with me about this kind of "negotiated safety" and, in so doing, revealed some of the ways they have managed to have unprotected sex without the anxiety reported by other men.
For Don, 33, whose narrative appears in chapter 14, unprotected sex with his partner, Ben, is something he has valued for a long time. The two men have never had protected sex with each other since they met in 1982. To do so now that they have both tested HIV-negative, Don suggested, would be "a major change ... a psychological shift for us," one that would symbolize distrust. When Don had an affair overseas, he told Ben about it, and they decided to abstain from sex rather than use condoms while they waited for subsequent HIV test results.
Because Don and Ben had been practicing unprotected sex before they knew their HIV status, they faced the decision of whether to continue doing so. Younger gay men accustomed to practicing protected sex because they grew up in the age of AIDS -- and others starting new relationships -- face a different decision: whether to initiate unprotected sex when they are in a negative-negative couple. Greg, a 26-year-old medical student, spoke to me about the way he and his partner, Arthur, made this decision.
Greg and Arthur met as teenagers, but it was a long time before they had anal sex. "It was mostly just oral sex," Greg said, "and never to the point of taking semen in the mouth. We decided we wanted to get closer together emotionally before we started doing anal sex." When they did, they used condoms at first for safety reasons, because Arthur had had other sexual partners during the beginning of their relationship. Even with condoms, anal sex was not a major part of their sexual life; it was something they did perhaps once or twice a year.
Three years into their relationship, when Greg and Arthur realized they were staying together and wanted a monogamous relationship, Greg asked Arthur to be tested, so he could be confident they were both HIV-negative. Greg told me about the first time he and Arthur had anal sex without condoms, after they had both tested negative:
One night, we were making love, and it happened: we had unprotected anal sex. We talked about it afterwards. I said, "What we just did was very dangerous. I want to feel confident that what we've talked about in the past year is where we really stand." He was honest with me and told me it was. "We can do this if we agree to do this," I said, "but only if we're not fooling each other." And I added, "Arthur, if anything ever does happen, don't have unprotected anal intercourse with me. Start using condoms." So we agreed about that. We've had a monogamous relationship since then.
Greg is confident about his decision. "We have a really open dialogue about sex now," he said, "so I feel confident that if Arthur had sex with somebody else he would tell me. And if I was going to do that, I would be able to tell him. Yes, there's that one millionth of a chance that he could lie to me, but I know Arthur: he couldn't keep anything from me."
Because of the open communication in their relationship, Greg is not threatened by the idea that one of them might stray from sexual exclusivity. In fact, Greg recognizes that sexual exclusivity is probably not realistic:
I doubt I will spend the next 60 years with Arthur without him ever having sex with someone else. It seems plain to me that the human animal is not the most monogamous thing created. We have a commitment to a monogamous relationship right now, but we realize that people are human beings.
I don't want Arthur to go out and have sex with other people, but I don't want him to feel that if he makes a mistake he can't tell me about it. It would matter, but I don't think it would end our relationship.
If we needed to alter the way we have sex, that would be fine. Maybe I would say, "If these things continue to happen, this is what I'm willing to do sexually." It would probably mean that if we had anal sex, it would be protected.
Phillip and Dave too were able to come to an agreement about having unprotected sex, based on a mutual understanding of what kind of sex would be considered "safe" outside the relationship. "Because I was so afraid of HIV," Phillip said, "I asked Dave to agree that if either of us had sex outside the relationship, it would involve just kissing, touching, and mutual masturbation -- no oral sex or anal sex." Agreeing to this allowed Phillip and Dave to have less restricted kinds of sex:
It was something that happened gradually. First we started having oral sex without condoms but without coming in each other's mouths. Two years into the relationship, I decided I was ready to swallow his cum, and another year later, I let him fuck me. I resent the fact that it took me so long to feel comfortable with that. It shows how much the fear of AIDS has entered my consciousness.
For Phillip, having unprotected sex with Dave was an indication of his growing trust. This is evident in the way his attitude about being "in control" has changed. "Having unprotected sex with Dave means that in some ways I am no longer in control of my HIV status," Phillip said. "I used to worry about that. Now, strangely, I find it comforting to no longer feel I have to be in control. Instead, I can share the responsibility for staying negative with my boyfriend. It feels good to be able to trust him this way."
Although many negative-negative couples don't use condoms for sex, their decisions are not widely supported, at least in AIDS education campaigns in the United States. By promoting a single course of action -- use a condom -- for all people, whether HIV-positive, HIV-negative, or untested, AIDS education efforts in the United States neglect negative-negative couples to whom such a strategy is unappealing, unnecessary, and unrealistic.Other countries, such as Australia and Canada, offer more fully elaborated AIDS education materials, which acknowledge that some negative-negative couples do not need to use condoms.
Aside from the general tone of AIDS education, negative-negative couples are also discouraged by HIV-positive people from deciding not to use condoms. One HIV-positive woman I knew who died recently used to speak about AIDS to high-school and college audiences. She said that one of the questions she frequently heard was from couples wondering, "When can we throw away the condoms?" She usually answered, "When sex is over." I'm sure her facetious answer got lots of laughs, but it dodged the issue.
At an HIV-prevention conference in Dallas in 1994, I attended a small-group discussion during which an HIV-negative man spoke about his decision to swallow his HIV-negative partner's semen during oral sex. He characterized his decision as "a major psychological and emotional step" in his relationship. Reactions from the group to this announcement were mixed. One participant -- an HIV-negative AIDS prevention researcher -- said that it sounded like an example of rational decision making about HIV. Another participant -- an HIV-positive test counselor -- cautioned against this decision by referring to an example from his work experience. Recently, he said, he had counseled a couple that were both initially HIV-negative, and later one of the two seroconverted as a result of outside sex. Because the couple was having unprotected sex, he said, the other partner seroconverted as well. He offered this story by way of warning.
The insistence by some HIV-positive individuals that everyone use condoms may simply be self-serving. After all, if everyone uses condoms every time with every partner, then there is no responsibility to disclose one's HIV-positive status and potentially suffer rejection as a result. Then again, insistence by the HIV-positive upon universal condom use may be more generously attributed to a desire that others not become infected. Eager to discourage others from their own fate, some HIV-positive people are Cassandras: they seek to warn people of imminent danger and at the same time despair that their warnings may go unheeded. Perhaps these feelings are what motivated the HIV-positive woman and man described above to caution people against unprotected sex.
In my interviews, the most poignant example of an HIV-positive gay man warning people against unprotected sex came from Saul, a 37-year-old administrative assistant from Los Angeles:
I learned the hard way that you have to take your health and life into your hands and not rely on sexual partners to tell you their status or to even tell you the truth.
I was dating a guy for five months last year. I was at fault for not putting two and two together. There were a lot of signs, but I didn't see them or didn't want to. I had talked with him about how lucky I was to be negative all this time. He agreed.
I didn't realize until we broke up -- and a week later I got tested and was positive -- that he was only agreeing that, yes, I was lucky to be negative. I assumed he meant that he too was glad to be negative. Well, he wasn't. I got it from him.
I was at fault too for not practicing safe sex, but I am damned pissed he didn't have the balls to tell me he had AIDS. It has taught me a lesson about people, even people who tell you they love you. Unfortunately, I didn't learn this lesson before I got HIV. Treat every sexual situation as if the person has AIDS. Unfortunately, that is now a way of life for us. There are honest people out there who will tell you the truth, but there are some who won't, so you have to take control of your life and health.
Saul's example shows the dramatic consequences of faulty assumptions and miscommunication about HIV. In addition, Saul expresses beliefs that are now common among many HIV-negative gay men, namely, that treating everyone as if they have AIDS is "now a way of life for us" and that because some gay men are dishonest, gay men should never trust each other. To have unprotected sex within a negative-negative couple is an expression of such trust, and the difficulty that some men have with such intimacy reflects their difficulty in trusting other gay men. That gay men feel they cannot trust each other shows how profoundly HIV has undermined their mental, emotional, and spiritual health even when it is not present in their bodies.
It would be misleading to suggest that men in negative-negative couples use condoms solely because HIV-positive people encourage them to, or because they fear infection from untrustworthy partners. It may be that something larger is being expressed by protected sex in negative-negative couples: a kind of community solidarity.
Having sex without condoms underlines a way in which HIV-negative men are different from HIV-positive men. By having sex with condoms instead, men in negative-negative couples identify themselves with the besieged community of HIV-positive gay men. If HIV-positive gay men can't have unprotected sex, these men seem to be saying, then we shouldn't either. Wearing condoms or avoiding penetrative sex does not really do anything to "protect" men from HIV if HIV is not present in either partner, but the activity may be viewed as part of a community effort to eradicate HIV.
Tucker, 31, who in chapter 3 described growing up with the "grim reaper" of AIDS at his bedside, spoke to me about the ethic of community participation that motivates some men in negative-negative couples to use condoms. "In the face of this immense frightful specter," Tucker said, "we have -- predictably -- manufactured new forms of behavior. Safer sex has become an ethical obligation." Tucker used a wartime analogy:
During World War II, when there were shortages, government authorities would ask people to save certain things -- bottlecaps or whatever -- and then turn them in. Sometimes they didn't actually use these things. But it was a standard of behavior that gave people a sense that they were doing something positive to help the effort.
HIV-negative men may use condoms with other HIV-negative men, Tucker suggests, not because it keeps them free of HIV, but because it is part of the "war effort," something HIV-negative gay men can do to show that they are willing to make sacrifices in their sexual lives voluntarily, sacrifices that those "on the front" -- the HIV-positive -- have been forced to make.
Giving up unprotected sex is a bit harder than collecting bottlecaps, however. That so many gay men do so suggests that no sacrifice seems too much in the face of AIDS. Aaron, Max's partner, revealed to me how easy it is to dispense with important forms of sexual expression and to discount this loss. "I've been feeling the loss of unprotected sex for years," he said. "It's like mourning: it's a fact of life. Maybe at this point I'm so used to loss, having lost so many friends, that losing forms of sexual expression is just another loss. It's certainly nothing compared to having lost friends, so I feel I don't really deserve to mourn it too much." But gay men should not discount this loss. Aaron does deserve to mourn it.
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Conclusion · Appendix A B C · Notes · Contributors