ABSTRACT
A sexual act between two individuals is, by necessity, much more than a physical act. It involves a plethora of cognitions, emotions, and symbolic meanings that may facilitate or interfere with sexual behavior. When the two individuals in question happen to be of the same sex, sexual interaction becomes a stigmatized behavior. Furthermore, when only one of the partners is infected with the human immunedeficiency virus (HIV), many issues related to health and risk of contagion come into play. In this chapter, we focus on topics to be considered in therapy with male couples of mixed-(or serodiscordant-) HIV status. The psychotherapist who sees these couples in consultation may have to deal with specific sexual problems (e.g. diminished desire, erectile dysfunction, or premature or delayed ejaculation) that may constitute the focus of the work. Yet, for the therapy to succeed, the therapist must consider the wider context in which such sexual problems are embedded. We use quotes both from patients in our clinical practices and research participants to illustrate some of the issues discussed.
