Hot Topic: Mixed Status Relationships
What is a mixed status relationship?
A “mixed-status” relationship is a sexual relationship in which one partner is HIV-positive and the other is HIV-negative. This can be a couple in a long-term relationship or a single sexual encounter between two or more partners.
What are other names for mixed status relationships?
Serodiscordant, Discordant, Serodivergent, Magnetic, HIV-positive/negative
It is possible for heterosexual (straight) and LGBTQ individuals in mixed status relationships to have healthy sex lives without transmitting HIV. Here are a few ways that HIV negative and HIV positive partners can protect each other:
Tips for a HIV-positive partner
1. Get and stay on antiretroviral therapy (ART)
- Reduces the amount of virus in your blood and body fluids.
- Reduces your chance of transmitting HIV to your sexual partners if you take it consistently and correctly, especially if your viral load is undetectable
- Will not cure your HIV, but can keep you healthy for many years when taking it consistently and correctly
2. Visit your health care provider regularly and always take your ART medicine as directed
3. Use condoms consistently and correctly
- Condoms can prevent HIV infection and other sexually transmitted diseases (STDs)
- HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, breast milk, and vaginal fluid
4. Choose less risky sexual behaviors
- Anal sex is the highest-risk sexual activity for HIV transmission. During anal sex, it is less risky for you as the HIV-positive partner to be the receptive partner (“bottom”) than the insertive partner (“top”)
- Sexual activities that do not involve the potential exchange of bodily fluids (e.g. touching) carry no risk for transmitting HIV
5. Talk to your partner about pre-exposure prophylaxis (PrEP)
- When taken daily this medication can prevent HIV from infecting your body
6. Talk to your partner about post-exposure prophylaxis (PEP) if you think your partner has had a possible exposure to HIV
- Starting PEP immediately and taking it daily for 4 weeks reduces your partner’s chance of getting HIV
- Talk to your doctor or visit an Emergency Room to receive a prescription
- If you had anal or vaginal sex without a condom or the condom breaks and your HIV negative partner is not on PrEP they should take PEP
- Your partner should talk to his/her doctor within 36 hours if they think they have had a possible exposure to HIV
7. Get tested and treated for STDs and encourage your partner to do the same
8. If you or your partner are sexually active with other people outside the relationship, get tested at least once a year and talk to your provider about whether more frequent testing is beneficial
Tips for a HIV-negative partner
1. Encourage your HIV-positive partner to get and stay on antiretroviral therapy (ART), and support your partner in taking all of his/her HIV medications at the right time
- Consistently taking ART will lower your partner’s viral load, keep your partner healthy, and reduce the risk that HIV can be transmitted
2. Use condoms consistently and correctly
- Correct and consistent, condom use is highly effective in preventing HIV infection, as well as other sexually transmitted diseases
- HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, and vaginal fluid
3. Choose less risky sexual behaviors
- Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV- negative, insertive anal sex (“topping”) is less risky for getting HIV than receptive anal sex (“bottoming”).
- Sexual activities that do not involve the potential exchange of bodily fluids (e.g. touching) carry no risk for getting HIV
4. Talk to your doctor about pre-exposure prophylaxis (PrEP)
- PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day
- Using PrEP with other prevention methods (e.g. condoms) can offer protection against HIV if taken every day
5. Talk to your doctor right away (within 36 hours) about post-exposure prophylaxis (PEP) if you think you have had a possible exposure to HIV
- Examples of a possible exposure are having anal or vaginal sex with your HIV-positive partner without a condom, and you are not taking PrEP
- Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV
6. Get tested for HIV
- Get tested for HIV at least once a year so that you are sure about your HIV status
- Talk to your doctor about whether you may also benefit from more frequent testing (e.g. every 3-6 months)
7. Get tested and treated for other STDs and encourage your partner to do the same
8. If you or your partner are sexually active outside the relationship, get tested at least once a year and talk to your provider about whether more frequent testing is beneficial
- STDs can have long-term health consequences and can increase your chance of getting HIV
Mixed Status and Making A Family
It is safe for people in mixed status relationships to have children, although there are some extra steps that may need to be taken to prevent HIV transmission. Before trying to get pregnant make sure to make an appointment with a health care provider/ doctor so you can ask any questions you may have about the safest way to get pregnant without transmitting HIV to your baby or HIV negative partner. Here are some examples of questions you can discuss with your health care provider:
- When is the best time for me to conceive a baby?
- Is my viral load undetectable?
- What’s the safest way for my partner and I to conceive?
- How do I avoid transmitting HIV to my partner, surrogate, or baby during conception, pregnancy, and delivery?
- If my partner is on pre-exposure prophylaxis (PrEP), will we have a lower chance of transmitting HIV to our baby?
- If I become pregnant, will HIV cause problems for me during pregnancy or delivery?
- Will my baby have HIV?
- Will my HIV treatment cause problems for my baby?
- If I become pregnant, what medical and community programs and support groups can help me and my baby?
Information for HIV-negative people with a HIV positive partner
- Ask your health care provider about Pre-Exposure Prophylaxis (PrEP) a daily pill that can prevent HIV during conception and pregnancy
- Encourage your partner to get and stay on ART, which can reduce the chance that your partner will pass HIV to you
- Get tested for HIV when you are planning a pregnancy or as soon as possible after you find out you are pregnant
- Get tested again for HIV in your third trimester if you engage in behaviors that put you at risk for HIV
Information for HIV-positive people with a HIV negative partner
- A combination of HIV medications called antiretroviral therapy (ART) can lower your risk of passing HIV to your baby during pregnancy, labor, and delivery
- Newborn babies born to HIV-infected mothers are also given HIV medicines to protect them. Talk to your healthcare provider about HIV medicines for you and your baby before, during, and after your delivery
- Talk to your health care provider about delivery options; some women* with a high or unknown HIV viral load near the time of delivery may need a scheduled cesarean delivery (C-section) at 38 weeks of pregnancy to reduce the risk of mother-to- child transmission of HIV
- HIV can spread in breast milk; women* with HIV should not breastfeed their babies, infant formula is a safe and healthy alternative to breast milk
If you are already on HIV medication (ART):
- Don’t stop taking your medicine; it is important to stay on treatment to protect your health and prevent passing HIV to your baby
- Your HIV regimen may change during pregnancy; work closely with your healthcare provider to find an HIV regimen that is right for you and always talk to your doctor before making any changes
*The term woman is used to describe biological sex and not gender in order to refer to any individual with the reproductive organs to give birth.