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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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transparent imageRemember
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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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transparent imageWhat about pre-exposure prophylaxis (PrEP)?
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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.

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.

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.

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."

Other times, 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.

Talking to former partners

With people you have had sex with in the past or people you have shared needles with, it can be very difficult to explain that you have HIV. However, it is important that they know so that they can 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.

Remember

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

Decide 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.

Think 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.

Imagine 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.

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 and hepatitis. 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.

Protecting your partner

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 avoid infecting them with another sexually transmitted disease you may be carrying.

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.

Some people with HIV have found that people who love them think that unsafe sex is a sign of greater love or trust. If someone offers to have unsafe sex with you, it is still up to you to protect them by being safe.

"Being safe" usually means protecting yourself and others by using condoms for the highest-risk sex activities, specifically for anal and vaginal sex. When done correctly, condom use is very effective at preventing HIV transmission. In recent years, "being safe" has come to include two other important strategies for reducing HIV infections; these are HIV treatment for HIV-positive people and PrEP for HIV negatives (see below). Both of these are very effective at reducing the risk of HIV transmission. One or more of them is likely to be appropriate for you--be sure to ask your health care provider about them.

What about pre-exposure prophylaxis (PrEP)?

Some HIV-negative individuals may, under the supervision of their health care providers, take anti-HIV medications every day to prevent themselves from becoming infected. We call this pre-exposure prophylaxis, or PrEP. Usually these are persons who are at relatively high risk of becoming infected with HIV (for example, because they have an HIV-infected partner, they have risky sexual exposures, or they share injection drug equipment). The medication used for PrEP is Truvada, a combination tablet containing tenofovir and emtricitabine. PrEP appears to be very effective if it is taken every day, and is not effective if it is taken irregularly. Your VA health care provider can tell you more about the potential benefits and shortcomings of PrEP for HIV-negative persons.

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 or anus and rectum (ass). The protective tissue there is thin, and is easily torn, which makes it easier for the virus to enter your body. Saliva (spit) and tears aren't risky.

In general, vaginal or anal sex without a condom is the most risky. Here is a list of sexual activities organized by level of risk to help you and your partner make decisions:

High risk

Anal sex without a condom (penis in the anus)
Vaginal sex without a condom (penis in the vagina)

Low risk

Sex with a condom when you use it correctly
Oral sex, but don't swallow semen (cum)
Deep kissing (French kissing or tongue kissing)
Sharing sex toys that have been cleaned or covered with a new condom between uses

No risk

Hugging, massage
Masturbation
Fantasizing
Dry kissing
Phone sex
Cyber sex
Using sex toys that you don't share

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:

Find a time and place outside the bedroom to talk.
Decide what are your boundaries, concerns, and desires before you start to talk.
Make sure you clearly state what you want. Use only "I" statements; for example: "I want to use a condom when we have sex."
Make sure you don't do, or agree to do, anything that you're not 100% comfortable doing.
Listen 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.
Be positive. Use reasons for safer sex that are about you, not your partner.

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 and 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.

Birth control options that DO protect against HIV:

Abstinence (not having sex)
Male condom
Internal or female condom

Birth control options that DO NOT protect against HIV:

Oral contraceptive ("the pill")
Injectable contraceptive (shot)
Contraceptive implant
IUD (intrauterine device)
Emergency contraception ("morning-after pill")
Diaphragm, cap, and sheild
Vasectomy (getting your tubes tied if you are a man)
Tubal ligation (getting your tubes tied if you are a woman)
Withdrawal

Safe methods of birth control for HIV-positive women with an HIV-positive partner include:

Using a diaphragm
Tubal ligation (getting your tubes tied)
IUD (intrauterine device)

Use only after checking with your provider (these may interact with your anti-HIV medications):

Birth control pills
Contraceptive injection (eg, Depo-Provera)
Contraceptive implant (eg, Norplant)

Resources

Evading the Virus Fertility, technology, and HIV. Radio programs on parenthood and HIV, from American Radio Works, Minnesota Public Radio.
Forum on Mixed-Status Couples The Body's online forum, hosted by clinical psychologist Dr. Robert Remien.
Nursing Your Relationship Tips for when a partner is seriously ill, from the Partners Task Force for Gay & Lesbian Couples.
San 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.
Society for Human Sexuality: Sexuality.org Features an in-depth guide to safer sex. Also offers a concise version.

Information on Using Condoms

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