When Sven*, 32, meets Steffen*, who is two years younger, he already knows that Steffen is HIV-positive. They have now been a couple for eight years and have been partnered for two years. Axel Schock asked them how they felt about the message, that a functioning HIV therapy protects against transmission just as well as condoms.
How did you find out that a successfully treated HIV-positive person no longer has to use a condom when having sex with an HIV-negative person?
Steffen: I can no longer say for sure. It was very early on, as soon as the Swiss published the paper.
The Statement by the Federal Commission for AIDS Issues (EKAF) from 2008.
Steffen: Exactly. A friend of ours who is professionally involved in HIV medicine had pointed this out to us and sent us a link. Surprisingly, I didn't pay much attention to it at the time.
Why?
Steffen: Perhaps because I had already read so many strange things and supposedly sensational reports about HIV and Aids, which then fizzled out again. Maybe it was all still too dodgy for me. If it really was a credible sensation, you would have read about it in the newspapers. At least that's what I thought at the time. It was only a year or two ago that the discussion about it flared up, and that's when it started to work for me.
Was the realisation that safe sex is also possible without a condom a relief for you?
Steffen: At first, she really confused me.
Sven: Firm certainties were turned upside down as a result. The slogan "condoms protect" was hammered into us for more than half our lives, and we could recite the safer sex rules like the ABCs even when we were half asleep. And then this!
Did you experience it as a kind of liberation?
Sven: It may sound a bit strange, but it made me realise how natural the connection between sex and condoms was for me. This conditioning worked perfectly for me. I never experienced the condom as a restriction and never questioned it until then.
Steffen: It was a little different for me. I didn't get my virus like a virgin, but because I didn't follow the safer sex rules at least once. After that, the condom was always a basic requirement for me, even when having sex with other positive people. But it also always reminded me that I was positive and therefore potentially dangerous for other sex partners. And also for my loved one. This thought didn't completely throw me off track, but it was always latently present. I realised this once again when I read that, with my good viral load values, I should belong to that select group of people who can do without the rubber with a clear conscience.
What did this trigger in you?
Steffen: On the one hand, a huge burden was lifted from me, but on the other, I was angry and sad about what I might have missed out on in all the years of my infection due to the virus. Not that I would necessarily have had worse sex with a condom, but perhaps it would have been a lot more carefree and more intimate with Sven. You have the fantasy of merging with the partner you love in every way - even if that sounds a bit hackneyed. The rubber, however thin it may be, remains at least a visible, annoying obstacle.
Sven: I found it hard to understand at first because I had never experienced condoms as a restriction or burden during sex in all those years. That's why I experienced Steffen's change of mood as a very surprising emotional outburst, during which a lot of things were flushed out once again.
Steffen: It was, of course, above all a great liberation and relief, perhaps even more so than when my viral load fell below the detection limit for the first time.
What made the difference?
Steffen: Now the residual risk, officially confirmed to a certain extent, was at worst as high as having sex with a condom. It took a while for this to sink into my head, and gradually the desire to do without the condom in our relationship grew.
How long did it take you to realise this wish?
Sven: We talked about it from time to time over several months; sometimes more intensively, sometimes just casually. It wasn't really a pressing desire for me. I always thought the rubber was okay and also a clean thing. However, over time I was able to empathise with Steffen and knew why it was so important to him.
How did you proceed?
Steffen: We initially consulted his HIV specialist together. He basically just confirmed the facts we already knew, but it was good to hear it from him again. We then hoped to find testimonials from couples who were already practising the principle of "protection through therapy", but we didn't necessarily find anything.
Sven: I found this very surprising and I felt as if we were the first to venture into completely unknown, new territory. It made me feel a bit alone with my thoughts and the upcoming decision. But we made it after all.
Sven: And I am still grateful to you from the bottom of my heart today! Blood values and study results aside, it was still a huge vote of confidence. Especially because I knew that the rubber thing wasn't as stressful for you as it was for me. However, I have to admit that I was at least as excited the first time as I was the very first time I ever had sex.
Steffen: It was no different for me. Although it was probably mainly a mental thing as to why it will now forever remain this very special "first time" for me, for us. Afterwards, I felt like I'd completed my first marathon or A-level exam.
Did you make any specific agreements about how you would handle the condom waiver?
Sven: The same rule applied as before: if we had sex outside the relationship, then only with a condom. And we had decided that we would also use condoms again within the relationship if one of us felt uncomfortable without them.
Steffen: This reassurance was very important to me, for both of us. I didn't want Sven to feel pressurised or disappointed if I got the shakes one day. Because, as Sven said, we felt quite alone in the decision. Of course, no one could have taken it off our hands, but we couldn't really talk to anyone about it either.
Sven: We had brought up the EKAF statement a few times with friends after the DAH and some gay media had finally taken up the topic. However, the reactions were rather devastating. Some found it irresponsible to simply open the door to "sex without condoms". They were of the opinion that this would certainly be completely misunderstood by many because they would overlook the small print, i.e. the exact framework conditions for "protection through therapy".
Steffen: We quickly realised that our friends wouldn't be able to help us. But we didn't dare to come out to them either. At the latest when one of them said that the whole thing was nothing more than Russian roulette, because you can never rule out an infection due to the residual risk.
Did that influence your decision?
Sven: We had actually already made up our minds long ago, but of course I also saw myself reflected in many of these comments. There is still a difference between my head and my gut feeling. My head said: "It's all safe. Nothing can go wrong". But my gut was sometimes a little unsure. There was something subliminally working inside me. No matter how many facts I could throw at myself.
So you regretted your decision?
Sven: No, I can't say that. That would be really harsh. It was more subtle.
Steffen: At some point I had noticed that Sven was actually only the active one during sex. [intruding, the ed.] part. Previously, it had always been quite balanced. I spoke to him about it once, but I already suspected the reason for it.
Sven: We then talked about it. Fortunately, we have practised a very open culture of conversation in our relationship, so I was able to talk freely about my smouldering unease without fear of hurting Steffen. You were certainly disappointed, weren't you?
Steffen: Not disappointed, but rather a little overwhelmed. Because at that moment it was clear that this wasn't about prejudice, lack of information or incorrect information, but about a gut issue. But we immediately agreed that we would use condoms again from now on.
So has the experiment failed?
Sven: No, I wouldn't put it like that at all. For one thing: It wasn't an experiment, but a first attempt, and I realised that I wasn't really ready for it after all. We didn't put an end to it, but at best suspended it. It's by no means the case that I don't trust Steffen in principle or that I'm sceptical about the scientific studies and statements and recommendations of the doctors. However, this matter is far more complex for the heart, brain and hormones than it should be taken lightly. At least it's not quite as simple as the classic safer sex rules "only fuck with a condom" and "get out before it comes".
Has your sex life changed as a result?
Steffen: No. I don't feel a great loss now, along the lines of "easy come, easy go". Of course it's a shame, but I respect Sven's feelings and I also know that this will be a slow but progressive process.
Sven: I can very well imagine, in other words I am very sure, that in the near future my head and stomach will be in sync. Until then, I now have doubly safe sex: even if the rubber should burst or slip off, nothing will happen to me.
* Names changed by the editors
Further information
Safer sex can be different: Interview with a heterosexual serodifferent couple
Tremendous progress for people living with HIV: Dossier on year five after EKAF (News on aidshilfe.de from 30.1.2013)
Dossier on the topic of "Protection through therapy" in the DAH blog
