Sex and HIV

Your sex life doesn’t have to change (for the worse!) simply because you are HIV positive.

What you’ll need to do, however, is familiarize yourself with the ways to protect your partner(s) and yourself against other disease-causing sexually transmitted infections (STIs) and possibly a second strain of HIV. And while it can be very difficult and scary disclosing your status or talking about safer sex with your partner, this sort of communication can also create trust and bring you closer together.

Different partners will be comfortable with different sexual activities and the risks they present. Some people “serosort”—choose partners with the same HIV status as themselves. But even between two HIV-positive people, condom use is recommended to prevent the transmission of other STIs or possibly a second strain of HIV. And while a person may think he or she is HIV negative, even if they’ve had a recent HIV test, there are no guarantees. There’s the chance that they were recently exposed to the virus. It’s also possible they’re still in the “window period” between initial infection and the time when antibodies to the virus can be detected (these  antibodies must be present for a positive HIV test).

“For me, having to tell my sexual partners about my infection has been a blessing in disguise,” says Hofmann. “I can tell a lot about a person’s intentions toward me by their reaction to the news. People looking for casual sex often hit the road. Others have formed a quicker and deeper emotional connection with me because they admired me for telling them. Not everyone I have told has been comfortable with the idea of being with me sexually, at least not immediately. Some people took a little time to become informed and comfortable with the idea that I am positive. Others were already knowledgeable about the disease and were not concerned.”

Good communication about what works for both of you is a key to great sex and intimacy. This is true whether or not you have HIV. If someone is not knowledgeable about HIV when you disclose, it can be helpful to give them some time and space to digest the news, and the opportunity to explore the facts of HIV and how they feel about it. “My health care providers have been very helpful; if someone is considering being with me sexually but is unsure about certain risk factors or general facts about the disease, I will take them to my doctor,” Hofmann says. “Sometimes it eases people’s minds to hear the facts from a neutral, third-party professional. Also, it takes the burden of HIV education off me; I never want the responsibility of feeling like I’m talking someone into being with me!”

HIV-positive people can get pregnant and have babies! Working with a doctor, you can greatly reduce the risk of passing HIV to your partner when trying to conceive—check out “Safer Conception and Pregnancy” to learn more. And for HIV-positive women who become pregnant, being on the right medicines and getting good prenatal care are essential. If you think you are pregnant, or are thinking about starting a family, let your health care provider know.

“The more you empower yourself with knowledge [about risk],
the more fun you can have and the more you can do. I have a far
better sex life knowing what I’m dealing with.”
—Bob Bowers
Diagnosed 1984


CONDOMS & BEYOND
•    Having a sexually transmitted infection (STI) can increase an HIV-positive person’s chance of transmitting HIV, just as it can increase an HIV-negative
person’s chance of acquiring HIV.
•    An HIV-positive person with a detectable viral load is more infectious—more likely to transmit the virus to somebody else—than an HIV-positive person who is receiving ARV treatment and has an undetectable viral load.
•    People with HIV can be infected with a second strain of the virus through sex with another HIV-positive person. While this isn’t common, it can happen.
•    Safer sex practices, including correct and consistent use of condoms for vaginal or anal sex, can greatly reduce the spread of HIV and other STIs.
•    Getting drunk or high can impair judgment and cause people to forget to take care of themselves—or their sexual partners.
•    Safer sex is not just about vaginal, anal or oral intercourse. Masturbation (alone or with someone else), body rubbing, erotic massage and kissing—they’re all fun, no-risk activities.


“You have to be committed to your own treatment before bringing another person into this world. It’s not about just having a baby, it’s about being there when he’s graduating from high school.”
—Chelsea Gulden
Diagnosed 2003


SAFER CONCEPTION AND PREGNANCY
Having children is definitely an option for HIV-positive women (and men), but it requires careful planning with a health care provider. Sexual and nonsexual conception options are available to positive and serodiscordant (one person has HIV, the other doesn’t) couples:

Unprotected intercourse
If the man’s positive and the woman’s negative—or vice versa—there’s a risk of HIV transmission. But if the positive partner’s viral load is undetectable, the risk of transmission decreases. Other ways to reduce the chance of transmission include pre-exposure prophylaxis (PrEP), a short course of HIV drugs given to the negative partner before intercourse to help prevent infection, and timed intercourse—engaging in unprotected vaginal sex only during times of peak ovulation.

Artificial insemination
In utero fertilization (placing a partner’s or a donor’s semen inside the vagina or uterus) or in vitro fertilization (mixing sperm with an egg in a test tube and then placing the fertilized ovum in the uterus) are options. Sperm washing, whereby HIV is removed from a semen sample, can also be done before IUF or IVF if the man is HIV positive.

Extra-special care is also needed during pregnancy, in order to protect the health of the woman and her baby. Log on to poz.com/women for more information.

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