When one partner in a relationship is HIV-positive, there are likely to be some difficult issues to deal with. Most couples, however, deal well with the situation after some time. The risk of the HIV-negative partner becoming infected is very low if you practice safer sex - and, in an emergency, by PEP.
The fear of passing on HIV is likely to be more of an issue at the beginning of the relationship. There may be some feelings of guilt or blame , especially if the positive partner has become infected by someone else during the course of the relationship.
On the other hand, sometimes the HIV-negative partner will treat their partner as if they were dangerously ill – although the positive partner would much prefer to be treated normally.
When HIV leads to long-term problems in a relationship, a counseling session at an AIDS service organization may help.
If one partner is positive – perhaps they have even received their positive test result during the course of the relationship - both partners may be worried that the other may also have been infected.
It is helpful to remember that safer sex offers effective protection. If something ever goes wrong, there is always the possibility of PEP, which considerably reduces the risk of infection.
If the HIV-positive partner is on HIV treatment the risk of transmission is much lower anyway (see also "viral load").
Sometimes, however, it is the case that one or both partners want the other to be infected too. HIV is seen as something that divides them. In such situations, both partners are responsible for ensuring that a decision with such a lot of consequences is not made without careful thought.
It's important to talk to your partner about feelings of guilt, fear and anger. A counseling session at an AIDS service organization can be very helpful.
If both partners are positive, some couples are not sure whether they need to use condoms. The answer is different in every case.
If neither partner is on HIV treatment, there may be a risk in some circumstances that they could infect each other with different strains of HIV - especially if one of them has only recently been infected or if they have a high viral load. In this situation, condom use is recommended.
If at least one partner is on effective HIV treatment, the risk of infection is so low it need not be a concern. If in doubt, couples should ask their doctor if they can stop using condoms.
People in open relationships should consider the fact that condoms also reduce the risk of other sexually transmitted infections.
If both partners in a relationship are aware that one partner is HIV-positive, they carry the responsibility together. Both know what they are faced with and decide how to deal with it.
If the HIV-negative person does not know that their partner is HIV-positive, the HIV-positive person has a particular responsibility. For example, it would not be fair to continue having unprotected sex because you were afraid of telling your partner about your HIV status. Your partner, with good reason, would see that as a breach of trust. What's more, by not telling their partner, the HIV-positive person makes themselves liable to prosecution.
It can be particularly difficult when HIV is transmitted within a relationship. Accusation on one side and feelings of guilt on the other can put a heavy burden on the relationship. Some relationships break under the strain. Sometimes it comes to a legal battle.
A counseling session at an AIDS service organization can help to deal with problems of this kind.