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Strange Bedfellows: Should HIV-Positive and HIV-Negative Men Ever Have Sex With Each Other?

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Thirty years into the epidemic the stigma surrounding HIV/AIDS has greatly diminished, especially in big cities and in areas such as Palm Springs and its environs. "It's so prevalent in this community that you inevitably rub elbows with or know someone who's positive," says Dr. John Stansell, an internist with Eisenhower Medical Associates whose gay men's practice revolves predominantly around HIV management. "I think the prejudice has pretty much gone by the wayside. You don't see people running in fear from the positive individual."

Nevertheless, there undeniably still exists a dividing line between the pluses and the minuses, no matter where they find themselves. "A lot of guys don't want to be intimate or even consider a relationship with someone who's positive," says Rafael Flores, 35, the owner of a Palm Springs housecleaning business. Michael Jortner, a 46-year-old marketing manager, concurs. "Here in the desert, the positive-positive couples seem very common to me. And in online casual sex arenas like Grindr, Adam4Adam, Manhunt, and Scruff, it feels extremely divided." Jortner adds that he's witnessed the younger generation of negatives be especially averse to commingling. "I have literally been told by more than one 20-something, 'You've had sex with positive guys? Well, we aren't having sex, then,' even though I've tested negative for 30 years!"

"It's serosorting, and I've championed it for many, many years," says Stansell, referring to the practice of coupling with only same-status mates. "I think the average HIV-positive person now doesn't want to have sex with a negative individual, because it does carry too much risk. I don't know anyone who wants to be responsible for someone's seroconversion. That's a huge psychological burden to carry."

Flores agrees that there's incredible stress surrounding sex with a serodiscordant companion. "A lot of negative guys are aware of the illness and educated, but they don't know what it's like to actually be positive and have to deal with the medications. When you're both positive, it feels more relaxed. When I think of a long-term relationship -- you know, having the whole life, the white picket fence, the dogs, the this and the that -- it's with someone who's positive and who understands where I'm coming from."

Of course, not all men serosort. "I don't color within the lines. Why limit myself?" says Cathedral City's Rafael Alzamora, 30, a shift supervisor at both Palm Springs branches of Koffi. Then he adds with a smile, "Why deprive someone of enjoying what I have to offer?" Like Flores, Alzamora always makes it a point to reveal his HIV-positive status to potential sex partners as early as possible. "If someone's OK with it, then why not? You're a full-grown adult. I've disclosed it. You want to take that risk? You're a big boy. Put your big-girl panties on, and, you know, deal with it."

"I'm somewhere in the middle," says Jeff Taylor, 49, a Coachella Valley AIDS research advocate and HIV treatment educator who's been positive for 30 years. "I've dated both poz and neg, with mixed results." Taylor was once dumped by one negative man for refusing to bareback, and by another (a physician, no less) who later admitted he didn't want to be involved long-term with a poz guy. "I would feel better with a poz partner," Taylor admits, "but I wouldn't necessarily feel worse with a negative partner."

"Do I consider myself HIV-friendly?" asks Jortner. "Yes, but with qualifications. I generally prefer to date or have sex with HIV-negative men, yet I've had several HIV-positive boyfriends, and, undoubtedly, positive sex partners over the years." He still tells himself what he learned in San Francisco in the mid-'80s at the height of the AIDS crisis: Always assume the other guy is positive, and have safe sex. "It really does work, or I would be positive by now."

"I'm very HIV-friendly," says Chuck Wilhelm, 62, a retired minister and nonprofit executive who worked with many AIDS service organizations as both volunteer and staff member over the last three decades. He relocated to Rancho Mirage six months ago. "I'm aware of what I need to be aware of. I know what one needs to do and not do to remain healthy. It doesn't shut me down when someone tells me they're positive."

Jortner's and Wilhelm's attitudes point to the unavoidable truth that we now do know what behaviors are most likely to transmit -- and not transmit -- HIV. "If there were a huge risk associated with oral sex, every gay man in this country would be HIV-positive," says Stansell. "Topping is extremely safe. It's about the same risk -- with or without a condom -- as oral sex. Nothing is 100-percent safe, but 99.9 percent of the risk is to the bottom, always, in anal sex. If you could simply convince negative bottoms to always play safe, you would interrupt the epidemic."

Recent scientific research shows that people with HIV who are on meds that render their viral load undetectable are 96-percent less infectious. So the question becomes: Shouldn't we all be HIV-friendly? Some men use a double standard. "They'll hook up with someone who's positive," says Taylor, "but when it comes to getting in a relationship, they don't want to deal with it."

Others will let more permanent partnerships lead them in the exact opposite direction. Dr. Winston Wilde, a sexologist who has a private practice in both Rancho Mirage and Beverly Hills, was the partner of author and activist Paul Monette at the time of his death from AIDS in 1995. "As my history shows, I would not hesitate to get involved with someone because of a disability if I was really head over heels," he says. "Love doesn't come too often in life."

"It's about my heart. It has nothing to do with the disease," echoes Wilhelm. "If I'm in love, I'm in love. And if you're positive, that's terrific!"

Even Flores says, "I would prefer my long-term partner be positive, but I'm not going to say that if I meet and fall in love with someone who's negative, I'm not gonna consider it."

Alzamora puts it this way: "Would it be a little harder, a little more complicated? Yes. Is it doable? Of course it is. Condoms forever, that's fine. They make a million types. I'm sure one of them feels OK."

Ken Howard, L.C.S.W., a licensed psychotherapist in private practice in West Hollywood who has specialized in working with gay men for more than two decades, has been positive for 22 years. Married to a negative man for 10 of those, he knows firsthand that serodiscordant couples can stay that way. "I think for most negative guys, it amounts to the fact that they might have to get dinner started themselves occasionally because their partner is stopping by the pharmacy after work to get his monthly meds and he'll be a half-hour late coming home," he says. "It's not 1988 anymore. It's not even 2002 anymore. For most serodiscordant couples, straight and gay, it's really not a big deal."

Still, despite all the evidence that supports lovers being able to protect each other's physical and mental health, Stansell understands a positive or negative man's reluctance to slip between the sheets with a serodiscordant partner. "But at the same time, he's missing a lot of great sex."

"At the end of the day, it's all about the choices we make, individually, to protect our own health and that of our partners," says Desert AIDS Project CEO David Brinkman. "Some negatives will choose to serosort by only having sex with other negatives, just as some positives will choose only other positives."

"It's less prejudice than it is self-preservation," concludes Stansell. "There is no such thing as not risky. And there is no wrong protection."

A version of this piece was originally published in the May 2012 issue of Desert Outlook, the Gannett LGBT monthly glossy published in Palm Springs, Calif.