ABSTRACT
A sexual act between two individuals is, by necessity, much more than a physical act. It involves a plethora of cognitions, emotions, and meanings that may facilitate or interfere with sexual behavior. When the two individuals in question are of the same sex, sexual interaction becomes a stigmatized behavior. Furthermore, when only one of the partners is infected with the Human Immunodeficiency Virus (HIV), many issues related to health, medication, and risk of viral transmission come into play. In this chapter we focus on topics to be considered in the sex therapy of male couples of mixed (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 constitute the focus of the work. Yet, for the therapy to be successful—which we understand as a harmonious, negotiated, and mutually accepted resolution of the problems the couple brought to the consultation—it is essential that the therapist consider the wider context in which such sexual problems are embedded. We use verbatim quotes both from patients in our clinical practices with gay couples where one or both partners may be HIV-infected (Remien, Carballo-Diéguez, & Wagner, 1995; Remien, 1997; Remien, Wagner, Dolezal, & Carballo-Diéguez, 2003; Dolezal, Remien, Wagner, Carballo-Diéguez, & Hung, 2005) and from participants in behavioral research on sexual risk (Carballo-Diéguez & Bauermeister, 2004; Balan, Carballo-Diéguez, Ventuneac, & Remien, 2009) to illustrate some of the issues discussed.
