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The Challenges of Serodiscordant Relationships

One Positive...One Negative...It Can Work.


Updated April 17, 2007

From the beginning of the HIV epidemic, relationships made up of one positive partner and one negative partner have been fraught with challenges. This couple type, known as serodiscordant, is a challenge both for the couple themselves as well as their providers, counselors, and loved ones. Serodiscordant relationships often are riddled with stress, anxiety, fear and concern.

Stress in the Serodiscordant Relationships

One would be safe in saying that there is stress in the serodiscordant relationship. In fact, scientific studies have proven that relationship stress increases dramatically after one partner becomes HIV positive. A study conducted at the University of Medicine and Dentistry of New Jersey found that psychological distress along with drug and alcohol abuse were commonly found in serodiscordant relationships. Where does the stress in serodiscordant relationships come from?

  • Transmission vs. Caregiving – In couples where both partners are HIV negative, the concern of both partners is the same: to stay HIV negative. However, in couples that have one partner negative and one partner positive, different issues are at hand. The positive partner is concerned about transmitting the virus to the negative partner. The negative partner commonly devotes his or her attention to their positive partner's health, becoming the caregiver in the relationship. This difference in perspective and direction causes emotional conflicts ultimately increasing the stress within the relationship.

  • How Did That Happen? – If one partner becomes positive while in a relationship, the first burning question the other partner will have is “How did that happen?" If the new infection is the result of unprotected sex outside the relationship or a consequence of sharing needles while injecting drugs, chances are the negative partner had no idea either behavior was going on. The stress caused by the new HIV infection is compounded by feelings of anger, betrayal, and sadness as the reality of their partner's infidelity and drug use sets in.

  • Overly Cautious – In any serodiscordant relationship, there is concern at the prospect of spreading the HIV infection to the negative partner. Sexually, the couple may become overly cautious and at the worst, stop any sexual or intimate contact in fear of spreading the infection. While it’s not the most important part a relationship, sexual intimacy is a key component of any loving relationship. Without intimacy, feelings of frustration, longing, and resentment surface and in turn, the relationship suffers.

  • Survivor’s Guilt – Guilt can be a powerful and destructive emotion. Most often, survivor’s guilt is a product of situations such as car accidents in which one person survives while many others die. The survivor feels guilty for having lived. In a serodiscordant relationship, the negative partner can feel guilty for being negative. The guilt increases if the positive partner becomes sick due to their HIV. In extreme cases of guilt, the negative partner wishes they too were infected, feeling their infection would relieve the guilt and other stressors present in the relationship.

  • The Desire to Have Children – Most loving couples will consider having a family at one time or another. In serodiscordant relationships, this decision can be a stressful one. There is the typical stress all couples feel when deciding to start a family but there are additional concerns of HIV transmission to the negative partner and the unborn child.

Stress itself can be a barrier to a successful relationship. But certain circumstances that arise in serodiscordant relationships that are particularly difficult.

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