Serodiscordant Relationships: What You Need To Know

Viral Suppression, Risk, and Serodiscordant Relationships: Should Serodiscordant couples practice safer sex practices? What's the real-life risk of HIV transmission? 

Remember seroconversion from your HIV 101: the physiological conversion from being HIV negative to becoming HIV positive. HIV statuses are reported in terms of positive and negative. Thus, Serodiscordant couples, also referred to as Magnetic Relationships, are those couples where one partner is HIV – and the other partner is HIV +.

As we enter the fourth generation of HIV, we are surviving the disease and living longer lives than those in previous generations. Along with this amazing gift of survival, HIV positive men and women are faced with a myriad of new issues including mixed-status dating and relationships, creating a number of Serodiscordant couples. Serodiscordant couples are presented with a unique set of circumstances to circumvent in order to have an open relationship and a healthy, safe sex life. 

In a 2013 article, John Sovec discusses how Serodiscordant couples are faced with more anxiety and fear than many relationships due to the fear of unintentional HIV transmission: often both the positive partner fears transmitting HIV and the negative partner fears becoming infected. Other challenges include worries regarding HIV care if the positive partner becomes sick, finding psychosocial support for both partners (more services available for the negative partner in a Serodiscordant relationship are needed), and issues of disclosure (who do you tell that your partner is positive?) to name a few. Creating an open dialogue is crucial for any healthy long-lasting relationship; however, it may be more crucial for Serodiscordant couples due to the health risks involved in keeping secrets and lack of communication. "These worries can create a barrier to true intimacy and leave each partner feeling unfulfilled. This is a time when each partner must risk talking about his or her needs, what forms of sexual contact feel safest, likes and dislikes, and how the couple can find ways to keep their sex life active and intriguing."

Are safer sex practices necessary in a Serodiscordant relationship if the HIV positive partner is in treatment, seen regularly by a doctor, and is undetectable? 

 Serodiscordant couples persist with a silent goal in mind: to keep the HIV negative partner negative and to keep the HIV positive partner healthy and undetectable. The goal of becoming undetectable, or viral suppression, is two-fold. One, viral suppression is key in HIV positive people to maintain a healthy CD-4 count, an undetectable HIV viral load, and long-term survival. Second, viral suppression is integral to HIV Prevention due to the fact that having an undetectable viral load carries a low to no risk of HIV transmission depending upon the research. 

Research conducted and reported upon over the last several years regarding Serodiscordant couples and HIV transmission, when the HIV positive partner is undetectable, cumulatively suggest that the real life transmission of HIV between mixed-status partners is extremely low to none. Most recently, the PARTNER study (a study on HIV transmission among Serodiscordant couples where viral suppression is reached in the HIV positive partner) reported on their findings after the first 2-year mark (the full report will be expected in 2017 after the final phase of the study is complete). The findings are remarkable and may offer astounding news about preventing HIV transmission with or without condom use. The unique thing about this study in regard to many earlier studies is that both heterosexual and homosexual couples and sex are included in this study: data from over one thousand mixed-status couples and thirty thousand sexual encounters were collected. Two years into the study, not one instance of HIV has been transmitted regardless of condom use, regardless of whether the couples engaged in anal or vaginal sex. The study also reports that the maximum chance of HIV transmission during viral suppression is 1% for anal sex (insertive or receptive) and 4% for anal sex with ejaculation (with a receptive negative partner). "When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: Our best estimate is it's zero." 

Does this mean that those of us in Serodiscordant relationships can toss out the condoms? Not necessarily; however, this is extremely optimistic and viral suppression may be one of our greatest weapons in the arsenal to contain HIV and move closer to the goal of an AIDS-free generation. It is imperative to remember that open and honest communication regarding condoms, unprotected sex, and risk associated with various sexual acts, etc. is necessary for Serodiscordant couples to make their own decisions based on facts and personal decisions. Ultimately, it is up to the individuals within the couple and centers on the HIV positive partner's adherence history and viral load.

Personally, my partner and I have been together for nearly 8 years. We began dating less than a year following my HIV diagnosis. To this day my partner is HIV negative. I become livid when it is assumed that he is HIV positive simply because I am and we are in a relationship. I do not become upset out of shame or fear, but because of the ignorance in that assumption: it is impossible for two mixed-status individuals to have a healthy, 'normal' long-term sexual relationship without both ending up HIV positive. Yet, this assumption is partly to blame for why we see young gay men seek out HIV infection; why some HIV – allow themselves to seroconvert (become HIV +); and why PrEP is being peddled to Serodiscordant couples. 

Hopefully research will continue to support the findings of low to no risk of HIV infection with ART therapy & viral suppression and HIV concerns will no longer be a part of the equation for love and healthy relationships. 

For further reading: 

Should HIV Serodiscordant Couples Always Take Preventative Measures? Experts Debate

Undetectable Viral Load Essentially Eliminates HIV Transmission Risk in Straight Couples 


Bryan C. Heitz
Risk Reduction Specialist
Community Counseling Center