Sex + HIV
Living with HIV means that you have to think carefully about how to best maintain good long term health, and this includes your sexual health. It is common for people who become infected with HIV to feel guilty or embarrassed, and so they avoid having sex. Usually this is temporary and the good news is that having HIV doesn’t mean an end to enjoying sex! You just need to think about the types of risks you could be taking with partners and how to prevent passing on the virus to someone else.
Usually the best way to stop transmission is to use a condom and lots of lube. It is important that the condom is used properly and using water-based lube can help stop it being damaged. Change the condom every 30 minutes if you’re having a long session, or are into rougher sex
Different sexual activities carry different risks. Being the active or insertive partner carries the highest risk of infecting someone if you don’t use a condom. If you are penetrated by a negative partner then the risk of transmission is lower but it still exists. Oral sex also carries a low risk but it can still result in the sharing of body fluids and so could potentially result in you infecting your partner.
If you find safer sex difficult you are not alone - many people have problems with this; but help is available from counsellors.
Talking to your doctor or nurse about counselling can be a good start
Both have HIV?
If your partner, like you, has HIV, then the issue may be whether to carry on using condoms or not. If you decide not to, you both need to consider the possibility of re-infection (one of you giving the other a different strain of HIV). Also talk about the risk of other infections being passed between you like herpes, syphilis, hepatitis C, gonorrhoea and Chlamydia.
If your viral load is high then you have a higher chance of passing on HIV to a sex partner, regardless of the type of sex you are having. Having an undetectable viral load can make it much less likely that HIV is passed on but this is not guaranteed – some people have become infected by people who had undetectable viral load. This is because undetectable means just that: it cannot be detected by tests, but the virus is still there.
Should I tell my partner?
Telling a sexual partner about your HIV diagnosis can be stressful especially as there may be concerns about HIV being passed onto them.
You may be in a long term or casual relationship or you might just have sex with someone once. In each of these situations the decisions you make about disclosure will be different.
It is helpful to think about the different reactions partners may have to hearing about your HIV diagnosis. Hopefully your partner will be supportive but it is always possible that they may react badly.
Whether someone tests HIV positive during a long term relationship or they are positive when the relationship starts, it is vital that each of you tests so that you can both be certain about your HIV status. It can be difficult for someone with HIV to say so, but not telling a partner can lead to problems later. The other person may be angry that they weren’t told sooner, or you may accidentally have unsafe sex – if a condom breaks, for example. Also, if a partner is not told and they subsequently contract HIV as a result of unprotected sex, they might take legal action (click the tab on the left - HIV & law)
One benefit of telling sexual partners about your HIV status is that if they are exposed to HIV when you have sex (if a condom breaks, for example) they can take treatment that may prevent them becoming HIV positive (known as Post Exposure Prophylaxis or PEP, click the tab on the left for more info about PEP) it has to be started within 72 hours of the time the person is exposed to HIV (but the earlier the better) and consists of them taking a very strong dose of anti-HIV medicine for a month.
Whether you tell previous partners can depend upon a number of factors such as what your relationship was like and whether the kind of sex you had posed a risk of HIV transmission.
Telling previous sexual partners can be difficult and you can ask staff at your HIV clinic to contact your ex-partners and sexual contacts for you. They can do this without giving any of your details away. This is called Partner Notification.
Remember, it’s natural to have worries about having sex if you are living with HIV or if your partner is living with HIV but the best thing to do is talk through your concerns with your partner and/or with the HIV specialist team or MOT team.