Since testing positive two years ago, I’ve lost all desire for sex. Iavoid putting myself in sexual situations, and the few times I’ve metsomeone, I’ve become anxious and gone through the paces for their sake.Will I ever have a normal sex life?  
—Sexless Sam

Dear Sam,
Sexualanxiety and dysfunction are common among both rookie and veteranHIVers. Left unchecked, the condition can last several years. But youcan prevail if you discover what causes your anxiety before trying toplease a partner.

If diagnosed recently, you may haveunresolved feelings of self-blame for being infected through apotentially controllable behavior. What’s more, you could feel“diseased” or like damaged goods, and your resistance to sex could be aguard against rejection. Counseling and support from other HIVers canclarify these feelings and help you realize you are sexy—and deserve afulfilling sex life.

Fear of infecting your partner can causeanxiety, too. Calm yourself with an honest discussion about the riskyou’re both willing to take, and share responsibility—safe sex is theduty of both partners. Couples therapy can help with both same- andmixed-status issues.

Your low sex drive may be physiological.HIV meds can cause anxiety and deplete libido. HIVer men have lesstestosterone—and therefore less desire. Hormone treatments and exercisecan enhance endorphins and desire. Erectile dysfunction meds can be aquick fix but won’t resolve underlying feelings.

And beware: Impotence meds can interact with protease inhibitors and can cause heart trouble or prolonged erections.

Sexis important and life-affirming. If you face your fears and find acentered place, you’ll be able to give and get more emotionally andphysically.

Perry N. Halkitis, PhD, is a professor at New YorkUniversity and Director of the Center for Health, Identity, Behavior& Prevention Studies.

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