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Sex and Sexuality
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Overview
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Talking to your doctor
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Informing your sex partners
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transparent imageTalking to your main partner
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transparent imageTalking to new partners
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transparent imageTalking to former partners
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What is 'safer sex'?
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transparent imageProtecting yourself
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transparent imageProtecting your partner
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What is risky sex?
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Talking about safer sex
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Birth control and HIV
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Resources
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Information on Using Condoms
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Overview

If you just tested positive for HIV, you may not want to think about having sex. Some people who are HIV infected feel guilty or embarrassed. These are common reactions, especially if you got HIV through sex. Chances are, however, that you will want to have sex again. The good news is that there is no reason why you can't. People with HIV enjoy sex and fall in love, just like other people.

You can have a good sex life, even if you have HIV.

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If you are having a hard time dealing with negative feelings such as anger or fear, you can get help. Talk to your doctor about support groups or counseling. Sex is a very tough topic for many people with HIV; you are not alone.

By reading this information, you are already taking a good first step toward a healthy sex life. Having good information will help you make good decisions.

Talking to your doctor

Your doctor or other members of your health care team may ask you about your sexual practices each time you go in for a checkup. It may feel embarrassing at first to be honest and open with your doctor. But he or she is trying to help you stay healthy.

Your doctor is not there to judge you. It's OK to tell your doctor the truth. It will help your health care team take better care of you, so try to develop a comfortable relationship with your doctor.

Make sure you set aside time to ask your doctor questions about safer sex, sexually transmitted diseases (STDs), questions related to having children and contraception, or any other questions you might have. If you feel that you need help dealing with your feelings, ask about support groups or counseling.

Many people with HIV ask their doctor or nurse to talk with them and their partners about HIV and how it is transmitted. The health care team can answer technical questions and address the specifics of your situation. If you live with someone, he or she may have questions about everyday contact as well as sexual contact.

Informing your sex partners

This may be one of the hardest things you have to do. But you should consider telling your sex partner(s) that you are HIV infected, whether you have a primary partner such as a spouse or girlfriend or boyfriend, have more than one partner, or are single or only casually dating. This may not be possible if you fear your sex partner will react with violence or retribution.

What follows are tips for talking to your main partner, other partners, and former partners.

Talking to your main partner

If you are in a relationship, one of the first things you will probably think about after learning that you have HIV is telling your partner or partners. For some couples, a positive HIV test may have been expected. For others, the news will be a surprise that can bring up difficult issues.

Your partner may not be prepared to offer you support during a time when you need it. Your partner may be worrying about his or her own HIV status. On the other hand, if you think you may have contracted HIV from your partner, you are probably dealing with your own feelings about being infected from him/her.

If your partner is not already HIV positive, he or she should get an HIV test right away. Don't assume that the results will come back positive, even if you have been having unsafe sex or sharing needles. Until he or she has been tested, your partner may assume the worst and may blame you for possibly spreading the disease. It is important that you discuss these feelings with each other in an open and honest way, perhaps with a licensed counselor.

Before telling your partner that you have HIV, take some time alone to think about how you want to bring up the subject.

Remember:

transparent gifgrey bulletDecide when and where would be the best time and place to have a conversation. Choose a time when you expect that you will both be comfortable, rested, and as relaxed as possible.
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transparent gifgrey bulletThink about how your partner may react to stressful situations. If there is a history of violence in your relationship, consider your safety first and plan the situation with a case manager or counselor.
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transparent gifgrey bulletImagine several ways in which your partner might react to the news that you are HIV positive. Write down what she or he might say, and then think about what you might say in response.
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If you or your partner is uncomfortable with sex after learning that you have HIV, keep in mind that you can both enjoy hugging, kissing, and touching. These actions carry no risk for HIV infection, and will definitely make you both feel better. Your partner's feelings may change with time and as he or she learns more about HIV and sex. Some people find it helpful to talk things over with a professional or in a support group.

Talking to new partners

Talking with someone you are dating casually or someone you met recently about HIV may be difficult. You might not know this person very well or know what kind of reaction to expect. When telling a casual partner or someone you are dating, each situation is different and you might use a different approach each time. Sometimes you may feel comfortable being direct and saying, "Before we have sex, I want you to know that I have HIV."

Another time, you may want to bring it up by saying something like, "Let's talk about safer sex." Whatever approach you choose, you probably want to tell the person that you have HIV before you have sex the first time. Otherwise, there may be hurt feelings or mistrust later. Also be sure to practice safer sex (see below). Whatever way you decide to tell, these tips might help.

Before telling your partner that you have HIV, take some time alone to think about how you want to bring it up.

Remember:

transparent gifgrey bulletDecide when and where would be the best time and place to have a conversation. Choose a time when you expect that you will both be comfortable, rested, and as relaxed as possible.
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transparent gifgrey bulletThink about how your partner may react to stressful situations. If there is a history of violence in your relationship, consider your safety first and plan the situation with a case manager or counselor.
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transparent gifgrey bulletImagine several ways in which your partner might react to the news that you are HIV positive. Write down what she or he might say, and then think about what you might say in response.
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Also, don't assume that your partner is negative. He or she also may be wondering, "Is this the right time to say that I have HIV?"

Talking to former partners

It can be very difficult to explain that you have HIV to people with whom you have had sex or shared needles. However, it is important that they know so that they can decide whether to get tested.

If you need help telling people that you may have been exposed to HIV, most city or county health departments will tell them for you, without using your name. Ask your doctor about this service.

What is 'safer sex'?

We know a lot about how HIV is transmitted from person to person. Having safer sex means understanding how HIV is transmitted and taking precautions during sex such as using a condom and avoiding risky practices.

There are two reasons to practice safer sex: to protect yourself and to protect others.

Protecting yourself

If you have HIV, you need to protect your health. When it comes to sex, this means practicing safer sex to avoid sexually transmitted diseases like herpes, syphilis, hepatitis B and C, and even other strains of HIV. HIV makes it harder for your body to fight off diseases. What might be a small health problem for someone without HIV could be a big health problem for you.

Practicing safer sex can protect you from getting reinfected or "superinfected" with a different strain of HIV. Some strains are resistant to certain drugs, so getting a new strain of HIV could make the disease harder to treat. Experts believe that reinfection is possible but not very likely; researchers are continuing to study the issue.

Although many sexually transmitted infections can be easily treated with pills or injections once diagnosed, some infections cannot be cured and become lifelong infections (such as herpes) or can be much more difficult to treat, such as hepatitis B and C. Hepatitis C is increasingly recognized to be sexually transmitted between men who have sex with men and may be easier to acquire if you already have HIV infection.

Protecting your partner

Most people would agree that you owe it to your sex partners to tell them that you have HIV. This is being honest with them. Even though it can be very hard to do, in the long run you will probably feel much better about yourself.

Taking care of others means making sure that you do not pass along HIV to them. If your sex partners already have HIV, you should still consider using condoms to avoid infecting them with a different strain of HIV or with another sexually transmitted disease you may be carrying.

To protect yourself and others, the rules are pretty simple, but you might need to make some changes. Because anal and vaginal sex have the highest risk of transmitting HIV, it is important that you use a condom every time you have anal or vaginal sex.

What is risky sex?

HIV is passed through body fluids such as semen, vaginal fluid, and blood. The less contact you have with these fluids, the lower the risk. The most sensitive areas where these fluids are risky are in the vagina and anus (ass). The skin in those areas is thin, and is easily torn, which makes it easier for the virus to enter your body.

In general, vaginal or anal sex without a condom is the most risky. Kissing, touching, hugging, and mutual masturbation are very low risk. Saliva (spit) and tears aren't risky.

Here is a list of sexual activities organized by level of risk to help you and your partner make decisions:

Higher risk

transparent gifgrey bulletAnal sex without a condom (penis in the anus)
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transparent gifgrey bulletVaginal sex without a condom (penis in the vagina)
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Lower risk

transparent gifgrey bulletSex with a condom when you use it right
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transparent gifgrey bulletOral sex, but don't swallow semen (cum)
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transparent gifgrey bulletDeep kissing (French kissing or tongue kissing)
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transparent gifgrey bulletSharing sex toys that have been cleaned or covered with a new condom between uses
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No risk

transparent gifgrey bulletHugging, massage
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transparent gifgrey bulletMasturbation
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transparent gifgrey bulletFantasizing
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transparent gifgrey bulletDry kissing
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transparent gifgrey bulletPhone sex
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transparent gifgrey bulletCyber sex
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transparent gifgrey bulletSex toys you don't share
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You can find details on protective barriers such as condoms on the Resources page at the end of this section.

Talking about safer sex

You and your partners will have to decide what you are comfortable doing sexually. If you aren't used to talking openly about sex, this could be hard to get used to.

Here are some tips:

transparent gifgrey bulletFind a time and place outside the bedroom to talk.
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transparent gifgrey bulletDecide what are your boundaries, concerns and desires before you start to talk.
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transparent gifgrey bulletMake sure you clearly state what you want. Use only "I" statements, for example: "I want to use a condom when we have sex."
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transparent gifgrey bulletMake sure you don't do, or agree to do, anything that you're not 100% comfortable doing.
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transparent gifgrey bulletListen to what your partner is saying. Acknowledge your partner's feelings and opinions. You will need to come up with solutions that work for both of you.
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transparent gifgrey bulletBe positive. Use reasons for safer sex that are about you, not your partner.
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Of course, only you and your partner can decide what level of risk you are willing to take.

Birth control and HIV

The only forms of birth control that will protect against HIV are abstinence, or using condoms while having sex. Other methods of birth control offer protection against unplanned pregnancy, but do not protect against HIV or other sexually transmitted diseases. Some hormonal methods of birth control may be less reliable when taken with certain HIV medications--women on hormonal birth control (such as the birth control pill) should discuss this with their provider.

Birth control options that DO protect against HIV:

transparent gifgrey bulletAbstinence (not having sex)
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transparent gifgrey bulletMale condom (latex or polyurethane, not sheepskin or other "natural" condoms, which do not reliably protect against HIV and other sexually transmitted diseases)
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transparent gifgrey bulletFemale condom
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Birth control options that DO NOT protect against HIV:

transparent gifgrey bulletOral contraceptive ("the pill")
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transparent gifgrey bulletDepo-Provera (shot)
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transparent gifgrey bulletEmergency contraception ("morning-after pill")
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transparent gifgrey bulletImplanted birth control (such as Norplant, Implanon)
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transparent gifgrey bulletIUD (intrauterine device)
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transparent gifgrey bulletDiaphragm, cervical cap, vaginal ring
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transparent gifgrey bulletVasectomy (getting your tubes tied if you are a man)
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transparent gifgrey bulletTubal ligation (getting your tubes tied if you are a woman)
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transparent gifgrey bulletWithdrawal
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Resources

transparent gifgrey bulletEvading the Virus Fertility, technology, and HIV. Radio programs on parenthood and HIV, from American Radio Works, Minnesota Public Radio.
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transparent gifgrey bulletForum on Mixed-Status Couples The Body's online forum, hosted by clinical psychologist Dr. Robert Remien.
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transparent gifgrey bulletNursing Your Relationship Tips for when a partner is seriously ill, from the Partners Task Force for Gay & Lesbian Couples.
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transparent gifgrey bulletSan Francisco Sex Information Line (SFSI) 1-877-472-7374 (toll free) or 1-415-989-7374. A free information and referral switchboard providing anonymous, accurate, non-judgmental information about all aspects of sex, including safer sex. Hours are Monday - Thursday from 3-9 PM PT; 3-6 PM Friday; 2-5 PM Sunday; closed on holidays and holiday weekends.
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transparent gifgrey bulletSociety for Human Sexuality: Sexuality.org Features an in-depth guide to safer sex. Also offers a concise version.
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Information on Using Condoms

transparent gifgrey bulletSome solutions to the most common condom problems from HIV InSite
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transparent gifgrey bulletAvert.org article on "Using Condoms, Condom Types and Condom Sizes"
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transparent gifgrey bulletAvert.org article on "The Female Condom"
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