My girlfriend told me she wants to go on PrEP. I’m OK with condoms and she said she is too; she just wants extra protection. I have a lot of feelings coming up about my status, like I’m damaged goods or something. I’m afraid she’s going to talk herself out of wanting to stay with me.
PrEP has been a game changer in a lot of ways, including helping to lower the risk of HIV infection for individuals in serodiscordant relationships, like yours. But the PrEP decision can conjure up some ghosts from the past, as you are experiencing, and some insecurities about the future. Serodiscordant couples have a couple of extra hurdles when it comes to sex. First, there’s the importance of negotiating safe sex and having a routine in place in terms of what you can do, can’t do, and need condoms for. That’s pretty straightforward. But what is not so simple is the feelings that come up in a serodiscordant relationship, like fear and insecurity on both sides. I have often had serodiscordant couples tell me how hard it can be to talk about sex. HIV-positive partners may think of themselves in terms like “damaged goods” early on in the relationship and fear that their partners may think of them that way as well. They have fears of passing the virus to their HIV-negative partners. And they may feel insecure about whether their partners will want to be with them in the long term. Of course, their partners also have some fears around the possibility of becoming exposed to the virus.
As you said, you and your girlfriend have worked out these concerns over time. As in most serodiscordant couples, condoms have become routine with you. It sounds like you two have adjusted just fine — or so you thought. Now, about your reaction to your girlfriend’s decision to go on PrEP. It’s only human for you to experience this decision as a blast from the past, calling up insecurity about how your status might affect your relationship going forward, along with those fears about being damaged goods. But that’s only one way to view it.
Let’s look at her decision from another angle. While comfortable with using condoms, your girlfriend may have had some lingering concerns about her chances of becoming infected, e.g. if a condom broke. Even if your viral load is undetectable. So for her, PrEP use may be a way of putting those concerns to rest. Or your girlfriend may simply see PrEP as an opportunity for an added layer of protection. It’s available, so why not take advantage of it?
And consider this: Chances are, your girlfriend is considering PrEP because she loves you and wants to build a future with you. While we’re shifting perspectives on this decision, how about also taking a look at the potential benefit of PrEP on your relationship? If your girlfriend is feeling all that more confident and secure, that can only strengthen the connection the two of you have with each other. Here we are, you and I, trying to read your girlfriend’s mind. Productive only up to a point. Maybe it’s time to sit down with her and have a conversation about PrEP? Or maybe another conversation, with less defensiveness on your part and on hers. I hope I have helped to “prep” you to have this talk. Be ready to listen with an open mind. Take ownership of your feelings. And don’t assume the worst. Team up with your girlfriend. Make the PrEP decision a relationship builder!
Mental health editor Gary McClain, Ph.D. (JustGotDiagnosed.com), is the coauthor of several books, including The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.