If you’re entering a new relationship with someone who has human immunodeficiency virus (HIV), or your current partner has just received a positive HIV diagnosis, you may be wondering what that means for you and your relationship. Whether it’s a new relationship — or a new diagnosis — it’s understandable to feel overwhelmed. You’ll probably have lots of questions: How at risk are you of infection? Can you continue to have sex? And how can you best support your partner?
The first thing to know is that HIV is an entirely manageable illness and by no means a death sentence for your love (or sex) life. The truth is many people who don’t have HIV are in happy and healthy relationships with HIV-positive partners. This is referred to as a “serodiscordant” relationship. However, some people prefer to use the terms “positive–negative,” “mixed-status,” or “sero-divergent” to describe their relationship.
“Any diagnosis can impact relationships,” explains psychosexual and relationship therapist Aoife Drury. “We all manage stress, worry, or anxiety in different ways, and often conflict tends to arise because of difficulties in expressing or identifying how we feel. Alongside this, specific to HIV, if there is a lack of understanding about the diagnosis, or if a stigma is being held, it can result in challenges within the dynamic. Hence the importance for couples to gain the correct information and educate themselves thoroughly to avoid myths impacting.”
By being informed about HIV, you can protect yourself from transmission while also helping your partner to stay healthy and feel supported and listened to. From using barrier protection during sex to taking preventive medication, below is everything you need to know about HIV prevention and what you can do to support your partner.
Human immunodeficiency virus (HIV) is a virus that targets CD4 cells or T-cells, a type of white blood cell that builds up your immune system. If someone’s immune system is weakened by the virus, then it can make them more vulnerable to everyday diseases such as the flu.
If you’ve never had an HIV test, then it’s likely you’ll never have been made aware of your CD4 cell count before. Your CD4 cell count is an indicator of your immune system function and can be checked by a simple blood test.
Here’s what the results of a CD4 cell count test mean:
- For a person who doesn’t have HIV, the average CD4 cell count is between 600 and 1,500 per droplet of blood.
- If someone is HIV-positive and has a CD4 cell count of above 500, then that indicates that they are in good health.
- If someone is HIV-positive and has a CD4 cell count of below 200, then they’re at a much greater risk of damage to their immune system and much more vulnerable to other diseases. It’s best to speak to a health care provider immediately, in this case. HIV treatment can help to maintain and gradually increase the CD4 cell count.
The most recent estimates suggest that 1,189,700 people in the United States and 106,890 people in the United Kingdom are living with HIV, but the annual number of new diagnoses is dropping. This may be partially due to greater access to testing, sexual health and HIV services, and sex education.
HIV has three stages: acute infection, chronic infection, and acquired immune deficiency syndrome (AIDS).
- Acute infection, also known as seroconversion illness, is the earliest stage of HIV. Some people may experience flu-like symptoms two to four weeks after being exposed to the virus, but this isn’t the case for everyone. During the acute infection stage, the levels of HIV in the blood (also described as the viral load) are at their highest, meaning this is the stage when a person is most infectious. The lower the viral load in their bloodstream, the lower their risk of passing HIV on.
- Chronic infection HIV, also called asymptomatic HIV, can last several years. During this stage, someone may have no symptoms and feel completely fine, but the virus is still active, damaging CD4 white blood cells and impacting their immune system.
- AIDS is the most advanced stage of HIV, where the body’s CD4 count is very low and the immune system struggles to fight the infection. People often confuse HIV with AIDS, but it’s important to remember that if your partner has HIV, it does not mean they will inevitably get AIDS. Most people who receive a positive HIV diagnosis never experience AIDS.
Sadly, there’s still a lot of misinformation that surrounds how HIV is transmitted. So, if your partner has recently received a positive diagnosis, you may feel scared to ask questions for fear of coming across as insensitive. However, it’s important to remember that you’re in this together and can be a vital support. Your health care provider will be able to provide both you and your partner with any information you need and point you in the direction of support networks.
These are the facts about HIV transmission: HIV is most commonly passed on when you come into contact with semen (including pre-cum), vaginal fluids, breast milk, and blood. If these fluids contain HIV, the virus can be transmitted by entering an HIV-negative person via the mucous membrane of the vagina, rectum, mouth, or penis. HIV can also enter the bloodstream through open cuts.
The most common way of contracting HIV is through unprotected sexual activity (including vaginal and anal sex). There is a very small risk of contracting HIV through oral sex, but the risk is very low. It can also be passed on by sharing needles with someone who is HIV-positive or receiving infected blood during a transfusion. Mothers can also pass HIV to their babies during pregnancy, birth, and breastfeeding, but medication can drastically reduce the risk of this happening.
Let’s bust some HIV transmission myths while we’re here: The virus cannot be passed on by sharing saliva during kissing, sharing a toilet, sharing household items, or through coughing and sneezing.
Every person’s HIV experience will be slightly different. Some people report flu-like symptoms within a couple of weeks of infection, while others don’t have any symptoms at all. The most common symptoms of HIV include:
- Night sweats
- Muscle and joint pain
- Sore throat
- Swollen lymph nodes
- Mouth ulcers
It’s important to note that all of these symptoms are associated with other illnesses, like the flu. So if you notice a change in how you’re feeling, speak to your doctor and try not to worry. They will do a blood test if there’s a chance you may have contracted HIV.
A HIV test is a blood test, which means a small sample of your blood will be tested to look for a protein found in HIV cells or HIV antibodies. It will either be taken with a finger prick or with a blood draw and then sent off to a lab for analysis. You should then receive your results that same day (in the case of a rapid test) or within a few days. Your health care provider may also offer you a urine test or a saliva test.
"[It's important] for couples to gain the correct information and educate themselves thoroughly to avoid myths impacting"
You can get tested for HIV at a sexual health clinic, an HIV testing center, or at your health care provider’s office. You can even self-test at home using a postal HIV test kit.
Being open with your partner that you’re going to do an HIV test, showing up to the clinic together, and asking questions can be a really small but significant way to show that you’re there for them and want to support them from a place of love.
Some good news: Treatment for HIV has developed monumentally over the last few decades. While there’s no known cure at the moment, research is ongoing, and many HIV-positive people live long, happy lives.
In fact, there are a number of treatment options available, so you can explore what’s best for you.
Antiretroviral therapy (ART) is the most commonly used medication for treating HIV. It involves taking a daily combination of HIV medications (HIV treatment regimen) in the form of pills. ART suppresses the virus by reducing the amount of it in the blood, referred to as the “viral load.” ART can also help prevent HIV infection if your partner is HIV-negative.
“These medications will increase your T-cell count in the process,” explains Dr. Sameena Rahman, MD, an OB-GYN (obstetrician and gynecologist). “These meds help keep you healthy, reduce the chance of transmitting the virus to your loved ones, and reduce the chance of giving the virus to your unborn baby if you are pregnant.”
Although PrEP doesn’t treat HIV, it’s highly effective at preventing HIV transmission. This is known as “treatment as prevention.” PrEP can be taken if you are HIV-negative and are in a relationship with someone who is HIV-positive.
“If an HIV-negative person is in a relationship with an HIV-positive individual, they should take medications that may prevent the transmission while in the relationship, after first testing themselves and seeking advice from their clinician,” says Dr. Rahman.
PrEP isn’t always necessary if you are in a monogamous relationship with an HIV-positive partner who has an undetectable viral load (the amount of HIV in the blood is so low it’s undetectable), but Dr. Rahman explains that the preventive treatment has minimal side effects, so the benefits outweigh the risks.
PrEP can be taken in two different ways: one pill daily or only when needed, referred to as “on-demand” or “event-based” dosing. On-demand therapy is not approved by the US Food and Drug Administration currently and isn’t recommended by the Centers for Disease Control and Prevention. Both methods have been shown to be highly effective, but the use of “on-demand” PrEP has, so far, only been studied in gay and bisexual men.
PEP is a medication taken to prevent HIV after a possible exposure. It should be used only in emergency situations and has to be started within 72 hours of potential exposure to HIV. You can be prescribed PEP from the emergency room in the US. It might also be available at a sexual health clinic near you or some Planned Parenthood health centers. You should call your health care provider ahead of time to make sure they have PEP.
In the UK, PEP is available for free from the National Health Service at a sexual health clinic, HIV clinic, and general practitioner’s office. If you need to take PEP when clinics are closed, you can access it at the emergency department.
ART, PrEP, and PEP are all highly effective treatments on their own, but there may be situations when you can combine methods for even more protection. If you or your partner want to explore a treatment plan, then you can speak to your health care provider about the options available to you, if they have any side effects, and how they might impact your sex life.
One way to monitor viral load is to do frequent blood tests. This indicates how treatment is lowering the viral load in someone’s bloodstream. If your partner’s viral load is so low that it can’t be measured, then they have what is known as an “undetectable” viral load. This doesn’t mean they’ve been cured of HIV, but it does mean they can’t pass HIV onto someone else even when they have unprotected sex. This is what’s known as U=U, or “undetectable equals untransmittable.”
U=U may be reassuring for anyone who is HIV-positive and serodiscordant couples who might want to conceive or no longer want to use barrier protection (like condoms) during sex. And studies have shown just how effective it can be.
In 2016, the landmark PARTNER study looked at 58,000 instances of unprotected sex in serodiscordant couples. It found that when an HIV-positive partner was on medication and had an undetectable viral load, there were zero cases of HIV transmission. This was confirmed in the PARTNER 2 study, published in 2019, which showed zero cases of HIV transmission among 782 gay male couples.
There are two things to bear in mind here: Effective treatment is fundamental to U=U, and it can take up to six months after starting treatment for an HIV-positive person’s viral load to become undetectable. So, it’s important to keep using barrier methods of protection like condoms during that time. Remember too that if someone with an undetectable viral load stops HIV treatment, their viral load will increase and become detectable again.
Now that we know how HIV transmission, testing, and treatment work, let’s dig deeper into the emotional side of an HIV diagnosis.
Finding out that your partner has HIV doesn’t have to mean an end to the relationship, nor does it mean sex is off the table. “An HIV diagnosis should not thwart a happy, healthy sex life. Many people who are in a serodiscordant relationship can have a fulfilling and thriving intimate sex life,” says Drury.
“It's important to listen and be attentive and meet them without judgment, blame, or shame."
“Try and make a conscious and deliberate effort to be open with each other and carve out time to be intimate,” says Drury. “Spend time discussing what you love about your sex lives, rather than focusing on the negatives. You can always reach out to a therapist if you need extra support — psychosexual therapists are trained to support couples with their sex lives.”
Keeping everyone in the relationship happy and healthy is a team effort, and all couples should understand that maintaining good sexual health is a shared responsibility. For serodiscordant couples, that might mean adopting prevention methods for the partner who is HIV-negative, supporting your HIV-positive partner, or both. You might consider taking PrEP. It’s also key to use barrier protection like condoms and dental dams during sex.
Regardless of whether your partner has just been diagnosed or if they’ve been living with HIV for a long time, there are plenty of things you can do to support them. Some research even shows that when supported by their significant other, a person with HIV is more likely to stay on track with their treatment.
“Your partner may be in shock or experience distress if they receive a HIV diagnosis,” says Drury. “It's important to listen and be attentive and meet them without judgment, blame, or shame. Asking, ‘How could I best support you right now?’ can be very helpful, rather than assuming. Encourage them to get the support they need — be it medical, support groups, or therapy — and offer them help to attend appointments if they would like and where appropriate.”
Speaking to your health care provider and reading up about HIV treatment and prevention can help keep both you and your partner healthy and safe. However, it may also give you some of the tools to support your partner through their diagnosis.
“Being present for them is key,” adds Dr. Rahman. “Whether that’s being present at their doctor’s appointments, helping them adhere to their medications, helping them understand the disease and that it is not a life sentence, [or] making sure to remind them of their appointments and follow-ups. Help them help themselves. So many HIV patients become depressed and scared; it’s important to help alleviate those fears and anxiety.”
It’s entirely possible to have a healthy relationship and a fulfilling sex life with a partner who is HIV-positive, without the risk of getting HIV yourself. Here are a few things you should keep in mind:
- Get tested for HIV regularly. Screening for HIV is the only way to be certain you haven’t contracted the virus. This is especially important if your partner’s viral load is still detectable.
- Consider PrEP. Although it’s not required, PrEP can reduce your risk of contracting HIV by 99%.
- Use protection. Everyone who is sexually active should be using protection to prevent unplanned pregnancies or sexually transmitted infections, but in serodiscordant couples, barrier methods are especially important if your partner still has a detectable viral load or if you’re nonmonogamous.
- Be there for your partner. An easy way to support a partner with HIV is by reminding them to take their meds. That way an HIV-positive person who is on ART and has an undetectable viral load can’t transmit HIV to you or others.
Written by Olivia Cassano