Rising HIV prevalence rates around the world have changed how we date and how we love, at least in theory. The sexual history discussion comes up earlier in dating, and HIV testing as a couple is just a step below becoming "official". Then comes figuring out how to navigate love and also HIV.
For Pholokgolo Ramothwala, media owner and a father of two whose partner is HIV-negative, being an HIV activist made disclosing his positive HIV status easier, but the decision was still accompanied by fear of rejection.
"I have this policy - you either take it or leave it," he says. "[But] even after I told her, I said to myself, 'Look, you've told her - now you have to deal with whatever she says. If she wants to stay, fine; if she decides she can't, you have to live with it."
Having counselled other discordant couples, Ramothwala knew it wasn't a given that she'd stay. Recently, the fiancée of a friend had called the wedding off because of his positive HIV status.
When Ramothwala's partner decided to stay, "We did our own mini HIV treatment literacy session," he told IRIN/PlusNews. "I had to explain that if there is unprotected sex, it's very likely that she would get infected.”
Ramothwala is on antiretroviral (ARV) treatment and his viral load, which measures the amount of HIV in the blood, is undetectable and the chances of infecting his partner are significantly reduced. “One of the questions that she asked me was, 'so do you think you'll ever get sick?'".
In May 2011, the HPTN-052 trial, conducted among couples in which only one partner was HIV-positive - discordant couples - showed that that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner by 96 percent.
It's not all stress, says JP Mokgethi-Heath, an Anglican priest who, like his husband, Paul - also a priest - is living with HIV. For JP, HIV has proven to be a blessing in disguise.
They tested HIV-positive together, which meant they learned how to manage HIV together, but after the diagnosis others pressured them to break off the relationship.
JP met Paul 14 years ago through his work with the gay community as well as local street children, who came to the soup kitchen his church set up in Hillbrow, an inner-city suburb of Johannesburg, South Africa. When Paul needed a room to escape an overcrowded flat, JP opened his home to him. After a long courting period, that involved copious amounts of rusks and tea in bed every morning before services, JP won Paul over.
Paul's eyesight began to go in 2000, prompting the couple to test for HIV together, although at first Paul had not wanted to go.
They were both found to be HIV-positive, but with treatment unavailable in South Africa's public sector at the time, their doctor enrolled them in a clinical ARV trial at Baragwanath Hospital in the Johannesburg township of Soweto. It was the only way to access free medication at that time, says JP, who went every week in his clerical collar with Paul to collect their drugs.
"Many people said to me, 'How can you stay with him? He's positive.’ Yet I was positive too. I don't know where the HIV came from and it doesn't matter," JP told IRIN/PlusNews. "The reality is we both found ourselves HIV-positive and we both loved each other, and we loved each other enough to want to care for each other."
Unpacking safer sex
Ramothwala and his partner, now years into the relationship and with two children, have figured out safer sex. He and his partner have had to talk it through - from sexual positions in which they can both be sure the condom is still on, to what kind of condoms to use and how to have children safely.
For their first child they used sperm washing - a procedure that separates an HIV-positive man's sperm from the semen, which is thought to pose most of the HIV infection risk to women.
The process cost about US$670 without the expensive fertility tests that Ramothwala says often drive up the costs. To conceive their youngest daughter, the couple used post-exposure prophylaxis (PEP) - ARVs that reduce the risk of HIV infection if taken within 72 hours of possible exposure. The couple timed unprotected sex to coincide with ovulation and ensured that she took PEP within the prescribed window period.
Watching her go through the medication's side effects was painful. "She couldn't eat, she was vomiting," he said. "It makes you wonder if you really want to be in the relationship… [if she has] to go through that, but she doesn't seem to think it's a problem."
Ramothwala admits it isn't always smooth sailing. "One of the most difficult [times] was when she asked me, 'Can't we just have unprotected sex once or twice? Don't you ever wonder what it feels like?”
Despite knowing the risks, many couples dealing with HIV still crave the intimacy some attach to unprotected sex. "I thought she was joking and then I realized she wasn't. For me, it's been like this [with condom use] for years, but I understood where she was coming from."
Although JP and Paul are both HIV-positive, they still have to practice safe sex to avoid re-infection because people living with HIV can contract additional strains of the virus that may complicate treatment and lead to drug resistance.
"My doctor said to me, 'Wear a condom when you are masturbating, wear it at all times," JP says. "But you also learn in a relationship to find ways of satisfying each other without having penetrative sex. I will not have another person say I was responsible for their infection or re-infection."
Paul and JP, like Ramothwala and his partner, have learned a different language of love.
"You have to develop a vocabulary of sexual expression... finding the words we could use to speak about sexuality,” JP said. "If you going to find ways of satisfying each other without always having penetrative sex ...I have to be able to say to Paul, 'I like it when you touch me that way and Paul is able to say the same to me."
JP agrees. "HIV forces us to do what we should have been doing in the first place. I don't think people talk about those levels of sexual engagement nearly enough. In that sense, HIV was a gift to us, it helped us to speak about things we hadn't previously spoken about."