The Challenges to Intimacy and Sexual Relationships for Gay Men in HIV Serodiscordant Relationships: A Pilot Study
Palmer, Robert, Bor, Robert, Journal of Marital and Family Therapy
Human Immunodeficiency Virus (HIV) infection and disease progression create imbalance in long-term, HIV-serodiscordant, gay male relationships, particularly in sexual relations and issues of physical and emotional intimacy. Stage of disease progression and worldview of the couple both affect the relationship and its survival. To redress imbalance, partners employ a range of coping strategies and techniques. This article explores these issues in the context of HIV serodiscordant gay couples and how they preserve their relationships in the face of these unique challenges. For workers who provide psychotherapeutic and community support for people with HIV and for their partners, the results of this study may be helpful in recognizing stress factors for couples, and tailoring support services to the needs of both partners. Overall, this study provides a basis for further work examining the dynamics of serodiscordant relationships.
Compared with the vast literature available that considers heterosexual relationships, little has been written on long-term gay relationships. It is difficult to draw comparisons or make contrasts between heterosexual and gay relationships given the limited empirical research in this area (Green, 2000). The added issue of a potential life-threatening illness in one partner complicates our understanding of the dynamics of couple relationships. The impact of Human Immunodeficiency Virus (HIV) infection on a heterosexual or a gay relationship cannot be underestimated (Bor & Elford, 1994).
Living with a disease that may lead to the death of the infected person brings emotional upheaval and distress to a relationship. This is not only evident at diagnosis, but also throughout the relationship (Rolland, 1994). HIV and Acquired Immune Deficiency Syndrome (AIDS) are very different from other conditions, such as cancer, in which one partner may get ill and die, and the other survives. Disclosure of HIV status communicates not only information about an infection but also reveals information of sexual behavior and lifestyle (Kalichman & Nachimson, 1999). HIV can be transmitted between partners and, therefore, is a constant threat within a sexual relationship in which the couples are serodiscordant-that is, in which one partner is infected. Fears of infecting and being infected by one another are real (VanDevanter, Thacker, Bass, & Arnold, 1999), and reach the most intimate aspects of the relationship.
Rolland's (1994) work on the impact of illness on couples' relationships is seminal in understanding how HIV infection affects both the seronegative and seropositive partners and the psychosocial strain that results. It is a challenge that can either strengthen or destroy relationships. Rolland recognizes that couples need to be able to adapt the relationship to the changes illness may bring---on a continuing basis-as the disease progresses toward possible death. This is most evident in the importance of continuing to revise intimacy within the relationship to include (rather than try to exclude) illness and the threat of death.
Throughout the history of the HIV epidemic, the focus for health care workers has been on the provision of medical, psychological, and social interventions for the person living with HIV. However, HIV seriously disrupts family and social relationships (Bor & Elford, 1994). The factor of discordance introduces imbalance into the relationship (MacDonald, 1998). One partner may become the cared for, the other the caregiver; one presumably having a 'normal' life span and the other facing the threat of an untimely death (Bor, Palmer, & Salt, 1995). The seronegative gay partner's response to both his own and his partner's diagnosis, coping with HIV infection as an ongoing presence within the relationship, as well as the many available drug therapies, their side effects, and long-term adherence to treatment regimen may all affect the relationship and its healthy sustainability. …