Mixed-Status Couples

What is a “mixed-status” Relationship?

A "mixed-status" relationship is a sexual relationship in which one partner is HIV-positive and the other is HIV-negative. This can involve a couple in a long-term relationship or a single encounter between two partners.  You may also hear these terms to describe such relationships:

• Serodiscordant
• Discordant
• Serodivergent
• Magnetic
• HIV-positive/negative

Is it Safe for Mixed-status Couples to Have Sex?

For mixed-status couples, the possibility of HIV infection is a constant reality. If you are living with HIV, there is always a risk of transmitting HIV to your partner, but you can minimize it.

Tips for the HIV-positive Partner

If you are the HIV-positive partner in a mixed-status relationship, here are steps you can take to reduce your risk of transmitting HIV to your partner:

• Get and stay on antiretroviral therapy (ART). ART reduces the amount of virus in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to your sexual partners if you take it consistently and correctly. (Learn more from the CDC’s HIV Treatment Works campaign.)
• If you are taking ART, follow your health care provider’s advice. Visit your health care provider regularly and always take your medicine as directed.
• Use condoms consistently and correctly. When used correctly and consistently, condoms are highly effective in preventing HIV infection, as well as other sexually transmitted diseases (STDs). Both male and female condoms are available. For more information on condom use, see our page, Using Condoms.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. During anal sex, it is less risky for you as the HIV-positive partner to be the receptive partner (“bottom”) than the insertive partner (“top”). Remember: HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, and vaginal fluid. Sexual activities that do not involve the potential exchange of these bodily fluids (e.g. touching) carry no risk for transmitting HIV. For information on ways to reduce the risk of transmitting HIV to your partner through sexual contact, see our page on Reducing Your Sexual Risk for HIV.
• Talk to your partner about pre-exposure prophylaxis (PrEP), taking HIV medicines daily to prevent HIV infection. The CDC recommends PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection. This includes HIV-negative individuals who are in an ongoing relationship with an HIV-positive partner, as well as others at high risk. For more information, see our page on PrEP.
• Talk to your partner about post-exposure prophylaxis (PEP) if you think your partner has had a possible exposure to HIV. An example of a possible exposure is if you had anal or vaginal sex without a condom or the condom breaks and your partner is not on PrEP. Your partner’s chance of exposure to HIV is lower if you are taking ART consistently and correctly, especially if your viral load is undetectable. Your partner should talk to his/her doctor right away (within 3 days) if they think they have had a possible exposure to HIV. Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it daily for 4 weeks reduces your partner’s chance of getting HIV. For more information, see our page on PEP.
• Get tested and treated for STDs and encourage your partner to do the same. If either of you are sexually active outside the partnership, you should get tested at least once a year and talk to your provider about whether more frequent testing is of benefit. STDs can have long-term health consequences. They can also increase your risk of transmitting HIV to others. Use the AIDS.gov HIV Testing and Care Services Locator to find a testing site near you.

Tips for the HIV-negative Partner

If you are the HIV-negative partner in a mixed-status relationship, here are steps you can take to reduce your chances of getting HIV:

• Encourage your HIV-positive partner to get and stay on antiretroviral therapy (ART), and support your partner in taking all of his/her HIV medications at the right time. This “medication adherence” will lower your partner’s viral load, keep your partner healthy, and reduce the risk that HIV can be transmitted. (Learn more from the CDC’s HIV Treatment Works campaign.)
• Use condoms consistently and correctly. When used correctly and consistently, condoms are highly effective in preventing HIV infection, as well as other sexually transmitted diseases (STDs). Both male and female condoms are available. For more information on condom use, see our page, Using Condoms.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (“topping”) is less risky for getting HIV than receptive anal sex (“bottoming”). Remember: HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, and vaginal fluid. Sexual activities that do not involve the potential exchange of these bodily fluids (e.g. touching) carry no risk for getting HIV. For information on ways to reduce the risk of getting HIV through sexual contact, see our page on Reducing Your Sexual Risk for HIV.
• Talk to your doctor about pre-exposure prophylaxis (PrEP). PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day. The pill contains two medicines that are also used to treat HIV. Along with other prevention methods like condoms, PrEP can offer good protection against HIV if taken every day. The CDC recommends PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection. This includes HIV-negative individuals who are in an ongoing relationship with an HIV-positive partner, as well at others at high risk. For more information, see our page on PrEP.
• Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you think you have had a possible exposure to HIV. An example of a possible exposure is if you had anal or vaginal sex with your HIV-positive partner without a condom, and you are not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking ART consistently and correctly, especially if his/her viral load is undetectable. Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV. For more information, see our page on PEP.
• Get tested for HIV. You should get tested for HIV at least once a year so that you are sure about your HIV status and can take action to keep healthy. Talk to your doctor about whether you may also benefit from more frequent testing (e.g. every 3-6 months). Use the AIDS.gov HIV Testing and Care Services Locator to find a testing site near you, or use a home testing kit.
• Get tested and treated for other STDs and encourage your partner to do the same. If either of you are sexually active outside the partnership, you should get tested at least once a year and talk to your provider about whether more frequent testing is of benefit. STDs can have long-term health consequences. They can also increase your chance of getting HIV. Find an STD testing site. Use the AIDS.gov HIV Testing and Care Services Locator to find a testing site near you.

Keep the Lines of Communication Open

If you are part of a mixed-status couple, it is important that you and your partner communicate openly and often about safer sex practices and HIV prevention. Healthcare providers and local HIV/AIDS organizations can be important sources of information and support for you and your partner.

CDC’s Start Talking. Stop HIV. campaign has information and resources to help you start a conversation about safe sex and HIV.