When opposites attract: as hard as relationships can be, it's sometimes doubly so when your partner's HIV status is different from your own.

At age 32, Michael Mayhew thought he'd never meet a mate. Recently divorced and the father of an 8-year-old daughter, he didn't think he could rind a man who shared his family values and desire for a committed relationship. "I always wanted to be in a family and have a family with a man--kind of like a modern version of The Brady Bunch," he says.

Then one night, after reluctantly joining his friends out on the town in Washington, D.C., he met "Jim," a gay father who seemed to be everything Mayhew thought he would never find. Soon the two of them were comparing wallet-size photos of their children. And before long they were a couple.

As quickly as they became boyfriends, Mayhew realized that there was a lot he didn't know about Jim. Consequently, there were things that troubled him about their relationship, such as Jim's insistence that they practice safe sex--even though they were strictly monogamous.

Eventually, Mayhew's concern led him to ask Jim about a subject they had never discussed with each other. "It's not possible that you're HIV-positive," he said. "You would have told me, right?" And after a prolonged silence, Jim acknowledged that he was indeed HIV-positive.

He and Jim stayed together for about another year after that, but Mayhew says the the strain of their different statuses--referred to as being "serodiscordant"--eventually led to their breakup. "The dynamics were too challenging," he says. "And I needed time to sort through all the things we faced."

No good statistics exist regarding gay people involved in serodiscordant relationships. And the people in such relationships often keep their situations private, making it difficult to guess how many there are. However, given that as many as 30% of gay men in the urban areas of the United States are HIV-positive and that those people who are infected are living longer, it's safe to say that nearly every gay man will come face-to-face with the issues of serodiscordancy at one point in his life.

Mayhew and Jim's experience illustrates many of these challenges. Among them, for HIV-positive men, is knowing when to disclose their status and the fear of infecting partners. For HIV-negative men, the fear of getting infected might lead the list, and as the relationship progresses, that fear is often overtaken by anxiety about a partner's death.

Aside from health concerns, one of the biggest challenges for HIV-positive men is establishing new relationships, says David deBoer, a clinical psychologist who works with young HIV-positive and -negative patients at the CORE Center in Chicago. And when an HIV-positive man's potential relationship involves an HIV-negative partner, disclosure often becomes a difficult issue. "The sad fact is that disclosure will often make the negative partner break it off," deBoer says.

For those HIV-positive men already in serodiscordant relationships, there is a big struggle to overcome negative feelings about sexuality, which some times stem from the fear that they can transmit the virus to their loved ones. Often couples find themselves with emotional intimacy but gradually diminishing sex lives or no sex at all. "I see some partners deal with it by not being sexual," DeBoer says. "In some cases they find sex elsewhere, and in others they shut down sexually."

Curiously, experts say, it is often the HIV-negative partner in a serodiscordant relationship who, perhaps lulled by a false sense of security, pushes the envelope toward unsafe sex. "It often becomes up to the positive partner to say, 'No, this is a line I will not cross,' " says Terje Anderson, the executive director of the Washington, D.C.-based National Association of People with AIDS.

Looking back at his own relationship, Mayhew remembers wanting to take sexual risks. "There were moments I lived in denial. I dreamed the disease would simply go away, "he says. "And there were moments when I wanted myself to have the virus instead of him. I wanted to take the disease from him because I could not bear to lose him and see him suffer."

Planning for the future also can be a tricky endeavor--putting established couples at odds with one another. "There can be a discrepancy of how they may think about the long-term future and what their long-term life goals are," says Robert Remien, a clinical psychologist at Columbia University and one of the foremost researchers on serodiscordant couples. The positive person, for example, may want to live in the moment. The negative person may want to save for retirement and a vacation home.

Of course, all of these issues are significantly different than they were for serodiscordant couples in the early days of the epidemic, when couples grappled primarily with caretaking and coping with impending death. But experts' advice has not changed. It's most important, they say, that partners talk to each other.

"There is a tendency to avoid talking about the many issues that HIV raises," Remien says. "Couples feel like they want to protect their partner from worrying about it or letting them know they are worried, so each is in his own silence about his concerns."

Though experts generally agree that there are probably not enough services devoted to serodiscordant couples, they say many local AIDS organizations have support groups for people in such relationships. They also suggest traditional counseling to help the couples increase their communication skills.

As long as people are living with HIV and AIDS, HIV-positive and -negative partners are going to have to work through these issues, Remien says. "Until there is a cure," he adds, "this is not going away."

RELATED ARTICLE: The lesbian lowdown on HPV.

Researchers at the University of Washington have found the cancer-causing human papillomavirus in lesbian and bisexual women who do not have sex with men. But even more alarming, they say, is that most lesbians are not getting Pap smears to check for it.

"It's a combination of women feeling that if they're not sexually active [with men], they don't need to get Pap smears, and a lot of physicians feeling that women who don't engage in straight sex don't need it," says Ken Haller, MD, president of the Gay and Lesbian Medical Association. "But according to these findings, there's clearly a reason for it."

In addition to vaginal Pap smears, many doctors are now recommending that all women, both gay and straight, get anal Pap smears. "HPV, like any virus, can often be spread locally," Hailer says, "and because of a woman's anatomy, it can migrate [to the anus]. So it's probably a good idea to get Pap smears on both areas."

Gay men, he says, should also get regular anal Pap smears, as they too are at risk for contracting HPV.

RELATED ARTICLE: Handling the syphilis threat.

San Francisco health officials are not taking a dramatic reemergence of syphilis among the city's gay and bisexual men lightly. They've joined forces with gay leaders to create a prevention plan that includes an expansion of the city's syphilis testing facilities and increased educational outreach to gay men and their doctors.

"This plan was generated by the best ideas of community leaders," says Jeffrey Klausner, director of STD prevention and control services for the San Francisco Department of Public Health. "It shows ownership and responsibility about the problem--something recently lacking in prevention. We hope that by rolling out a community-generated plan, we can get a greater community-level response with increased awareness, education, and testing."

The number of syphilis cases in San Francisco vaulted 1,000% from 1999 to 2002, with another 50% jump expected for 2003. Other large cities also have experienced recent spikes in syphilis cases among gay men, and are unveiling their own community-based programs. In Chicago, for example, the Syphilis Elimination Task Force has activated a new $500,000 campaign using advertising and the Internet to heighten awareness about the disease.

--Dan Allen