Trying to charm someone on a first date is difficult enough without the added worry of an elephant in the room. This is the concern of Andre Fischer, a German management consultant living in south London. In most of Andre's romantic encounters he quickly runs in to a dilemma: when or if he should disclose that he is HIV positive.
"I'm always stuck meeting the nicest man, knowing they're negative, and I still have this pink elephant to reveal and it's the trickiest beast," he says.
Two years ago Andre contracted HIV while on holiday in Portugal after he slept with a guy who initiated sex without a condom. He stopped him, but shortly after the encounter he knew something was wrong.
"I was on the flight back and I was feeling really shit. I lay at home for three weeks thinking I was about to die. You can have no idea when the virus converts the body: some people have a little mini-flu, and for others like me it can strike really heavy. I had a terrible fever, I lost 2st, I couldn't walk."
A self-confessed hypochondriac, Andre went in for an HIV test immediately. Two weeks later his worst fears were confirmed.
"Always through all of my life, I've always been really super-safe, and every year, or twice a year, when I did my tests, I was always sitting in that waiting area, and I always felt one day I'll be getting this news, and suddenly I had it, and you know it was a real shock," he says.
Fortunately for the estimated 100,000 people living with HIV in the UK, remarkable medical advances in treatment now allow for near-normal life expectancy. Antiretroviral therapy can reduce the risk of transmission from mother to unborn child to less than 1% and massively reduce the risk of transmission to a sexual partner. However for all the medical advances, a near-normal love life remains elusive.
After recovering from the initial onset of the illness, Andre quickly found himself in the curious world of HIV dating. Using the HIV chatrooms of gay dating websites he discovered a nihilistic subculture prioritising the pleasure of unprotected sex over concerns about contracting a drug-resistant strain of the virus.
"There are a lot of guys who are in a sort of self-destruct mode. They're often drug-addicted. You get a lot who just want to have 'chems' [drugs] and sex straight away: 'I want to date, but let's have sex first, and I want to have chems-sex.'
"For the first two months I was shocked to tears. And I thought I can't have unprotected sex because the doctors continue to tell you about these other strains you can get, but when you go online and you talk to people, and everybody does it. So far I've talked to one positive guy who insisted on condoms.
"You can hook up with someone through a website and get directed to an address with an unlocked door and inside is a guy who's completely naked – and then off you go and have your fun. No 'hello', no nothing.
"Sometimes I feel like I'm turning into a vampire; you live a different life. You're like a weird creature who does things people shouldn't do. All that blood and cum, it's bizarre."
While sex may be easy to find for Andre, lasting relationships are more difficult to come by. People living with HIV constitute 0.2% of the UK population, roughly under half of which are "men who have sex with men". With such a small group it is inevitable that people will look outside the HIV-positive community for a partner.
But, for Andre, dating HIV-negative men remains a tricky business.
"The problem I have dating-wise is do I tell them straight away, and sometimes I do and they say: 'No I'm not interested.' Or they're like I was in the old days, and they want to be politically correct and they say: 'Oh I don't mind' but deep inside they do mind … and slowly the contact is less and less." he says.
To help couples embarking on "mixed status" relationships 41-year-old Montse Magadan leads a workshop at HIV support group Body and Soul.
"Many people are thinking: 'I have to live with a person who is positive.' And it's easier because you don't need all this disclosure. But that isn't the case for everybody," she says. "People start to move forward when they meet other people like me. They start to think: 'Well if she can do it maybe I can do it too.'"
In 1988 Montse contracted HIV when she lost her virginity after a brief relationship with an older man. It wasn't until she was 19 that she found out from her then-boyfriend that the man she had slept with was a known drug addict and was HIV positive.
After taking a test and discovering she had the virus, Montse was devastated.
"I was thinking of ways to kill myself. I was living with my sister at the time. I remember going out telling her I was going to the swimming pool. And instead I walked up and down the city, just wandering around [asking myself]: 'How can I have ended up like this?'"
Her boyfriend, who tested negative for HIV, was supportive. They continued to have protected sex, but he was scared he would get infected.
"He couldn't cope with that. And the fact that if he was having sex with me he was going to get infected if the condom breaks. He was too scared." she says.
Because of these difficulties they split up a year after her diagnosis.
It is an experience typical of problem that "mixed HIV status" couples face. For the negative partner there is a fear of contracting a life-threatening illness; for the positive partner, a sense of guilt for endangering their partner's health and for having contracted the virus in the first place.
For these reasons many mixed-status relationships are destined to fail, but not always, as Montse discovered when she met Alberto in 1992. A few weeks into their relationship Montse knew she needed to tell him about her status.
"We were having a conversation over the phone, and she said she had something she needed to tell me but couldn't say it over the phone, but I persuaded her to," says Alberto. "And so she said: 'OK … I'm HIV positive.' And at that moment there was kind of, a minutes' silence between us. I couldn't say anything, all that was going through my mind was the posters at school about how you can get HIV."
But in spite of the risks to his health, Alberto was able focus on his affection for her.
"I needed a person who would love me for who I was rather than what I was, and we often say it was like a love at first sight. And I decided to take everything, with the luggage, if you know what I mean," he says.
20 years later they're still together, and have 12-year-old son who is HIV negative.
"I come from a broken family, my dad disappeared when I was about 13 and I don't want my child to go through the same thing as I did. So I made one commitment to be with my wife and look after her and look after my child. I don't want to break that commitment."
Alberto's devotion to his wife does not stop there. As part of an ongoing clinical trial he regularly chooses to have unprotected sex with his wife.
In 2008 a research paper released by Swiss Federal Commission for HIV-Aids made the controversial claim that by reducing viral loads to an undetectable level – under 40 copies of the HIV virus per ml of blood – the risk of transmission could be eliminated.
The findings published in the Bulletin of Swiss Medicine are not conclusive and have not been endorsed internationally.
Montse and Alberto understand that they are an exceptional case and are keen not to encourage others to do the same. They stress that the only way to rule out the risk of infection is to use protection.
"That's my message to people, that if you are HIV positive and if you are having sex with somebody who is negative, you should protect that person. It is for that person also to choose if they want to use a condom or not," says Montse.
But that Alberto – who is still HIV negative – can consider not using protection to be an option, shows how far treatment of the virus has come. It is his and Montse's hope that attitudes towards HIV will one day catch up.
"People think that it's too easy [to get infected], but it's not. Even to kiss someone with HIV or hug them, people think they can get infected like that. It makes me really upset, that after all these years, people still think like that.
"The problem is the ignorance. And until they get educated there's always going to be that issue."
Life in my Shoes is Body & Soul's campaign that challenges the fear and misunderstanding surrounding HIV in the UK.
To donate, or find information and support about HIV-related issues visit bodyandsoulcharity.org
