Ask the Sexpert
Your sex life doesn’t have to change—for the worse—because you are HIV positive.
Your sex life doesn’t have to change—for the worse—because you are HIV positive. What you’ll need to do, however, is familiarize yourself with the ways to protect your partner(s) against HIV and yourself against other sexually transmitted infections (STIs) and possibly a second strain of HIV. POZ checks in with Rachael Ross, MD, PhD, sexologist and founder of DrRachael.com for tips on safer sex.
Should I only have sex with other HIV-positive people?
If you practice safer-sex techniques, you can have an intimate and sexual relationship with anyone. However, unprotected vaginal or anal intercourse with another person, whether he or she is positive or negative, is not advised. Even if your partner is also positive, you’re both still at risk for other STIs and possibly becoming infected with a second strain of HIV, including a drug-resistant form.
When you have sexual contact with another person you should always think to protect yourself and avoid reckless sexual behavior. The only way to really take good care is to take precautions to ensure that you don’t do anything that could negatively affect your health. In order to do that, you have to practice safer sex with each and every sexual partner.
Do I have to worry about other STIs?
Yes you do. Certain STIs, such as chlamydia and gonorrhea, are more likely to cause serious pelvic inflammatory disease in HIV-positive women. And human papillomavirus (HPV), another STI, appears more likely to cause precancerous anal and cervical lesions in people living with HIV. What’s more, these and other STIs can be more difficult to treat if HIV is also present.
Also know that certain STIs—like herpes, chancroid and syphilis—can make it easier for you to transmit the virus if either you or your partner has them.
Can I really be infected with a second strain of HIV?
Yes. There have been reports of HIV-positive people becoming infected with additional strains of HIV, including drug-resistant forms of the virus. While it’s not known how frequently such “superinfections” occur, there is a risk with potentially serious consequences.
If I keep my viral load undetectable using HIV medications, can I have unprotected sex?
If you’re infected with HIV, you can transmit the virus to your partner(s)—period. That said, studies indicate that maintaining an undetectable viral load while on antiretroviral therapy greatly reduces the risk of HIV transmission. But while the risk might be lower, it’s still a risk.
Is it true that I need to disclose my HIV status to someone before we have sex?
Yes, you should. A number of states in America have HIV disclosure laws that make it illegal to have sex without first disclosing your HIV status. There have even been cases where people have been prosecuted for not disclosing their status despite the fact that HIV was not transmitted. And sadly the number of criminal cases due to failure to disclose is growing.
Even though it is the responsibility of both partners to protect themselves, the U.S. government currently places the burden of protection on the infected partner—so be careful.
Search: sexologist, safe sex, STI, second strain, partner, disclosure, viral load, medication, intercourse
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comments 1 - 3 (of 3 total)
Mark S King, Baltimore, 2016-01-22 11:56:24
There ha not been a single confirmed case of someone with an undetectable viral load transmitting HIV to someone else. So I think the relative odds are zero, not "very low."
If we are to speak candidly with people about having a healthy an pleasurable sex life, let's get real about it. I understand erring on the side of caution, but the answer on this topic above is overly so, and certainly does not translate into real world experience, which is something we should strive for.
AT, Rural USA, 2016-01-07 08:00:35
Since this is from 2009 shouldn't some of it be considered dated? Research from 2015 shows that people on meds with an undetectable viral load basically cannot transmit the virus. Also, the risk of a "superinfection" is almost zero especially for someone on meds which act as PREP. A very common theme with HIV education is to focus on the most recent information available since research is advancing quickly.
Zena, , 2011-08-06 17:40:12
comments 1 - 3 (of 3 total)
Dr. Rachel should have mentioned HSV. The majority of women who have HIV also have HSV. This further complicates sex.