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Tips for making HIV discordancy work

Journalist Pholokgolo Ramothwala, 32, was diagnosed HIV-positive at the age of 19. A long-time HIV activist, Ramothwala writes an online diary about living with HIV and runs his own communications company. He spoke to IRIN/PlusNews about love disclosure a
(Positive Convention)

No one said love was easy. This Valentine's Day, IRIN/PlusNews brings you tips for making love and HIV work, from a couple who've been there, done that and stayed together.

Pholokgolo Ramothwala and his partner have been together since they met through mutual friends in 2003. He's living with HIV, she's not, and neither are their two children. Ramothwala gave us their tips for living successfully and safely.

1. Understand the risk

"For the partner that's HIV-negative - help them understand what they're dealing with. In the end, there's still the possibility of HIV infection and if it happens they need to be prepared for that."

If you're not sure about the risks, get a second opinion from a medical professional you trust. Finding the right doctor who is supportive of HIV discordant couples is also important.

After disclosing to his partner, Ramothwala offered to take her to his doctor for a one-on-one question and answer session. "I wasn't even part of the conversation," says Ramothwala.

He also took his partner through what he knew about HIV treatment, explaining disease progression and technical terms like CD4 counts, which measure the immune system's strength, and viral loads, which gauge the amount of HIV in the blood.

Ramothwala admits the temptation to have unprotected sex is there for most discordant couples, but it's important to resist. "You don't want to infect your partner and then regret for the rest of your life that you should have done something about it."

2. Talk about sex

Every new couple has to figure out what works for them. Those dealing with HIV also have to figure out what works with regards to protection. The biggest mistake people make is thinking that things will work themselves out - this is what puts them at risk, he told IRIN/PlusNews.

"The other thing I've learned is that people don't talk about how you have sex. There are some positions you're just not comfortable with, there's a likelihood that you don't know where the condom is and it might not even be 'in there', so make sure that as a couple you talk about that."

"When you have built that communication bridge where you can talk about anything it's easier for her to say, 'What do you think about this?'"

Although it was about a year before these conversations got easier for Ramothwala and his partner, it was worth it. Once you're used to talking about lubricants, which can decrease the risk of condoms breaking, and sexual positions, they become less daunting and you learn to joke about them, he says.

''The partner who is positive must not assume that what the negative partner is asking is stupid ... No question is "stupid" when it comes to explaining HIV''

3. Be prepared for emergencies

If you can, keep post-exposure prophylaxis (PEP) at home. PEP is a 28-day course of HIV treatment used to decrease the risk of infection after possible exposure to HIV, for instance in the case of a condom breaking, or unprotected sex.

Although it's best to take PEP within the first 24 hours after exposure, it can be taken at any time up to 72 hours afterwards, according to South African guidelines. PEP has a relatively long shelf-life of about two years.

An increasing number of discordant couples use PEP, and Ramothwala and his partner also took the medication when they were trying for the second child, having unprotected sex when his partner was ovulating and then ensuring she took PEP afterwards. 

4. Support each other

People say love is patient. "The partner who is positive must not assume that what the negative partner is asking is stupid," Ramothwala told IRIN/PlusNews. "There's a reason they are asking you that question." No question is “stupid” when it comes to explaining HIV.

HIV often affects the sexes differently and it's an important dynamic to think about, especially after the birth of a child where an HIV-positive mother may be under harsher scrutiny than an HIV-positive man in a discordant couple.

"In relation to the in-laws, women take more of the brunt of [discordancy] when they're the ones who are HIV-positive, especially in my culture where they'll ask why women aren't breastfeeding" he says.

5. Plan for the future

Advice your Mom will love whether you're HIV-positive or not - get life insurance. "One of the things I realised - like, five years later - that you do need, is life cover," he says.

"I find that because I have children I worry about them, but once you have life cover you know that they'll be protected. I grew up without parents, so I know what that can do you."


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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