Having sex

Getting an HIV-positive diagnosis is a lot to deal with, and people’s feelings about sex can vary greatly. It may be the last thing on your mind. You may feel “infectious”, angry or depressed, which can result in loss of sex drive (regardless of your partner’s HIV status). Alternatively, you may feel like having a lot of sex. However you are feeling right now, your feelings about sex will probably change over time.

It’s important to remember that HIV-positive people can enjoy a healthy and fulfilling sex life. Lots of HIV-positive Australians do. There are many people out there who will find you desirable regardless of your HIV status.

The most common form of HIV transmission in Australia is anal or vaginal sex without a condom but there are numerous ways to reduce HIV transmission risk (see below). If you are not ready to have sex, there are many other intimate sexual activities you can enjoy that involve little or no risk such as kissing, massaging, mutual masturbation and oral sex.

A note on STIs (Sexually Transmissible Infections)

If either you or your partner has a sexually transmissible infection (STI) the risk of HIV transmission is increased. You or your partner could have an STI even if you have no symptoms. Common STIs include herpes, syphilis, gonorrhoea, chlamydia, genital and anal warts, and hepatitis B and C.

It is important to protect yourself from STIs because they can cause more severe symptoms and may be more difficult to treat in people with HIV. Syphilis can progress to severe symptoms more rapidly, and genital warts and herpes can be resistant to treatment. Herpes outbreaks can also be more frequent. If you have regular herpes outbreaks, you may want to discuss herpes suppression therapy with your doctor.

Condoms offer the best means of protection against STIs but they do not offer absolute protection against all STIs because a condom may not cover all of the infected area. Even if you always use condoms, sexual health check-ups are important. Generally, the more partners you have, the more regular check-ups you’ll need.

Sex with a partner who does not have HIV (or you don’t know their status)

There are a number of options that substantially reduce the risk of HIV transmission during sex.

Condoms

Correct use of condoms during sex prevents HIV transmission. Condoms also prevent transmission of most STIs which can increase risk of HIV transmission and also compromise your health.

Male condoms: When people refer to condoms, they are usually referring to male condoms, which are highly effective at preventing the transmission of HIV and most STIs.

Most male condoms are made from latex and experts recommend you always use a water based lubricant such as Wet Stuff or KY with them because oil based lubricants like Vaseline or hand cream can damage the condom. Lube can also make sex with condoms more fun! If you are allergic to latex there are also condoms made of polyurethane. Polyurethane is stronger and thinner than latex and oil-based lubricants can be used with them.

Female Condoms: Although not as widely known, female condoms (Femidom) may be a good option for some women with HIV. Female condoms are made from polyurethane. They are about 15cm long and have two flexible rings, one at each end. A female condom is inserted into a woman’s vagina before sex. The closed ring rests inside the woman’s vagina. The other ring, which is open, rests outside.

Female condoms are not readily available in Australia but are available at some sexual health clinics, some family planning clinics, selected women’s health clinics and pharmacies. They can also be ordered over the Internet. To find out more about female condoms see Family Planning NSW’s female condoms factsheet. Note: Female condoms and male condoms should not be used at the same time. You will need to decide with your partner which option suits you best.

Undetectable viral load

Effective HIV antiretroviral treatment can significantly reduce a person’s viral load until it is ‘undetectable’. Having an undetectable HIV viral load greatly reduces the risk of HIV transmission.

If you have had a stable undetectable viral load for at least 6 months, take your treatment consistently, and you and your partner have no other STIs, you can be confident you will not pass on HIV. For a variety of reasons, including emotional ones, some people prefer to take additional measures such as using condoms.

A viral load test measures HIV in blood but your viral load can be higher in other body fluids such as semen and vaginal fluids particularly if you have a sexually transmissible infection. Talk to your doctor about your particular circumstances if you are thinking of relying on low viral load as a substitute for safe sex.

Pre-Exposure Prophylaxis (PrEP)

PrEP describes the use of HIV antiretroviral medication by people who are HIV-negative to prevent HIV infection. If used effectively, PrEP can dramatically reduce the risk of HIV infection. PrEP can also be combined with condoms and other prevention methods to maximise protection.

Understanding of PrEP effectiveness is growing. Your HIV-negative partner will need to speak to a specialist PrEP prescriber (doctor) about their eligibility for PrEP and how it should be taken.

Oral sex

There is hardly any risk of passing on HIV through oral sex, however this risk increases if a person has cuts or ulcers in their mouth, has an STI or if the positive partner is menstruating.

Penetration using hands

It is safe for another person to use their hands or fist to penetrate your anus or vagina providing the person has no cuts, sores or scratches on their hands. If they do have any cuts, sores or scratches, it is advisable to use latex gloves.

Menstrual fluids

Having sex when you have your period can increase the risk of HIV transmission so it’s a good idea to consider using condoms during vaginal sex or dams during oral sex.

If you think your partner has been exposed to HIV

If you have sex and think your partner may have been exposed to HIV, there is a course of treatment available to minimise the likelihood of them becoming infected with HIV. This is called post-exposure prophylaxis (PEP). It involves prescription of antiretroviral drugs taken for a period of four weeks. Your partner will need to visit a doctor and commence PEP within 72 hours although treatment is more likely to be effective the sooner it is started. A national list of PEP prescribers is available here.

Sex with a positive partner

If you and your partner are both HIV positive, you may not want to use condoms.

Even if you both have HIV, it is important to protect each other from STIs. STIs can be more difficult to treat in people with HIV, and the STI symptoms can be more severe. Some STIs can increase your viral load. Syphilis can progress to severe symptoms more rapidly and can be more difficult to treat. Genital warts and herpes can also be resistant to treatment. Herpes outbreaks may occur more often in people who are HIV positive. If you have herpes, you may want to discuss herpes suppression therapy with your doctor.