Sex & Living with HIV
An HIV positive diagnosis opens up a host of issues around sex and relationships, and while everyone responds differently to these concerns, many find it difficult to form relationships (both sexual and romantic) due to the prejudice they feel or experience. It is common for many men living with HIV to feel undesirable, especially in the first days and months after diagnosis.
Being diagnosed with HIV means dealing with many sexual issues: from regaining your sexual confidence, to addressing concerns that we might infect others. One part of this is having the right knowledge of how to disclose your status to others (See our article on Disclosure) and handling your relationships after the diagnosis. Another is about understanding the risks that come with the sexual acts you engage in, and how you can eliminate or reduce these risks.
The main point, though, is this: HIV is not a dead-end for your sex lives. We believe that everybody - regardless of HIV status - has a right to an enjoyable and fulfilling sex life.
Making sex safer
The reason why sexual activity is a risk for transmitting HIV and other sexually transmitted infections is because sex often involves the exchange of body fluids. Infections can be transmitted via blood, semen and vaginal secretions. However, researchers have also confirmed that the risk of HIV transmission varies according to our sexual practices. There is a degree of risk in everything we do in life, and sex is included in this spectrum of risks. Some sexual practices are less risky while others are more risky.
The facts about HIV transmission are the same for HIV positive and HIV negative men and women, but sometimes the tiniest bit of misunderstanding about how HIV is (or isn't) transmitted can lead to a lot of confusion and prejudice when it comes to making important decisions about safer sex.
There are a few basic facts to consider:
- Knowing your partner’s status
Knowing your partner’s HIV status also helps people negotiate safer sex practices and reduces the risk of sexually transmitted infections.
- Treating other Sexually Transmitted Infections
Having an untreated STI (such as syphilis, gonorrhea, etc.) can increase the possibility of an HIV-positive person transmitting HIV. Likewise, an untreated STI can increase an HIV-negative person's chance of acquiring HIV.
- Having an “Undetectable” Viral Load
Reducing your viral load through adherence to antiretroviral treatment is a significant form of protection for you and your partners. An HIV-positive person who is on regular antiretroviral treatment with an undetectable viral load has significantly less ability to transmit HIV to a sexual partner than someone with a detectable viral load, or someone who has never been tested for HIV. Read more about the Swiss Statement, a scientific declaration about the low risk of HIV transmission for people living with HIV who are on antiretroviral treatment
- Safer Sex Practices
Safer sex practices, including correct and consistent use of condoms with water-based lubricant for vaginal or anal sex, can reduce the spread of HIV and other STIs. Safer sex is not just about condom use. Masturbation (alone or with someone else), body rubbing, erotic massage and kissing - they're all fun activities with extremely low or no risk of STI transmission.
- Limiting intoxication
Getting intoxicated or “high” on drugs or alcohol can impair judgment and cause people to forget to take care of themselves and their sexual partners (read more about this topic in our drugs and alcohol section of LEARN). If you are injecting drugs, reduce health risks by avoiding sharing needles among partners.
Sex and antiretroviral treatments
First things first: any sexual act carries varying risks of transmission of HIV or other sexually transmitted infections (STIs). The risk of getting HIV is higher if anyone involved has untreated STIs. However, in the case of HIV, the risk of infection is increased if the person living with HIV (PLHIV) has a high viral load. A high viral load is likely when someone has been infected with HIV within the last 12 months and is unaware of his status, or is not on antiretroviral treatment.
Antiretroviral treatment (ART) helps a PLHIV to suppress the HIV in their body. It should be seen as an essential part of safer sex because it helps a PLHIV to stay healthier, thus providing protection for their sexual partners.
1. Oral Sex
Oral sex (commonly referred as “blow jobs” or “sucking”) presents a low risk of transmitting HIV and other STIs. The risk is higher if an HIV positive guy cums in the mouth of a negative guy. Pre-cum may also present a risk, but to a lesser extent. The number of cases of HIV being passed on through oral sex is small but there have been some cases.
Mouth ulcers, bleeding gums and sore throats can all present an opening through which HIV can enter. Rough oral sex or deep throating can damage the lining of the throat, which gives the virus a transmission pathway to enter the body. Using condoms during oral sex does make it safer, but it is only recommended when there are ulcers, cuts, or wounds in the mouth.
2. Anal Sex
Anal sex (commonly known as “fucking”) is the most common way HIV is passed on between men, and it is the most risky among all sexual acts. Being the “bottom” or the receiver during anal sex has a higher risk of transmission than being the “top” or inserter, since the anal lining can be easily torn, which gives the infected semen or pre-cum an entry point into the bloodstream. Using condoms with water-based lubricant helps to prevent transmission from happening.
An HIV positive bottom can infect an HIV negative top. HIV can be found in relatively high quantities in the lining of your ass, and during anal sex the virus can easily enter through the urethra or the opening of the penis. Whether you are top or bottom, the risk of transmitting the virus can be prevented through consistent and correct condom use with water-based lubricant.
Some gay men have female sexual partners. HIV can easily be transmitted to women through fucking without condoms, whether vaginally or anally.
3. Kissing & Touching
Provided that no cum or blood is present, kissing, licking and sucking any part of the body is safe, as are most forms of touching, feeling, rubbing, masturbating, and fingering. Risk increases if your partner has a cut or opening in their skin and your semen or blood comes in contact with that opening.
If you are into fisting (inserting your hand as a fist into the anus or vagina of your sexual partner), make sure you use gloves and a generous amount of lube. If you use oil-based lube for fisting, remember that condoms can break when they come into contact with anything oil-based, so if you intend to fist and fuck, use water-based or silicone-based lube only.
“Rimming” (licking someone’s ass) poses very low risk of HIV transmission but is an easy way to pass on parasites like Shigella, and infections such as hepatitis A. Washing or douching help to reduce the risk of transmission, but do not eliminate the risk. Kaposi’s sarcoma (KS) has also been linked to rimming. KS is a cancer that can be difficult to treat in some people with untreated HIV.
Urine (also known as “piss”) is sterile when passed from the body and does not contain sufficient viral load to successfully transmit HIV, so “watersports", a sexual fetish involving the exchange of urine during sex, presents no HIV risk. However if you have an infection with symptoms of urethral discharge (as with chlamydia or gonorrhea), it would be wise to take a break from watersports until you’ve been treated to prevent possible STI transmission[/tab]
7. Sex Toys
Sharing sex toys can transmit HIV and other STIs, including hepatitis C, if the toys are not cleaned with warm water and soap between partners. Some people use condoms on their toys. Others prefer to use only their own toys.[/tab]
Body piercing is regarded by some as a sexual act in itself and can present a transmission risk if strict hygiene standards are not met. Freshly pierced skin also provides an opening for HIV to be transmitted during sex.[/tab]
9. Playing “rough” or S&M
Sadomasochism, bondage, discipline (also known as S&M or BDSM) and “rough play” may include any or all of the practices mentioned above. Role playing between partners is often involved and as the name implies the sex during S&M or BDSM is rougher than usual, both physically and emotionally. It’s best for people to have agreed boundaries and have an agreed safety word or code as a signal to stop in case things are going too far for you.
Acknowledgement: This information has been adapted from the “Next Steps” booklet with permission from the Australian Federation of AIDS Organisations (AFAO).