Sex and HIV

Sex and sexuality

People with HIV want the same things as other people — love, affection and the pleasure you can get and give by having sex. Sex can be a really positive way to feel good about yourself and your partner. Having sex can make you feel desired and valued, happy and fulfilled. HIV-positive people can enjoy a healthy and fulfilling sex life.

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It’s not unusual to feel less interested in sex during stressful times or periods when you feel unwell. An HIV diagnosis can make you feel differently about yourself. Some women also experience body image issues, feeling less than happy about how their body looks or feels. Many HIV-positive women lose interest in sex after diagnosis but the good news is that for most women, sexual desire does return. Just remember, you are a woman with a right to your own sexuality.

It can be hard to feel relaxed about sex when you have HIV. It can also be a challenge to talk about HIV and negotiate sex with your partner. Talking to a counsellor or to other women living with HIV can be useful.

U=U (Undetectable = Untransmissable)

Undetectable = Untransmissible

U=U (Undetectable = Untransmissable) has transformed the sex lives of people living with HIV. U=U means that when you are on successful antiretroviral treatment and your viral load has reached an undetectable level, you cannot pass HIV on to your sexual partner.

When someone first contracts HIV, the amount of HIV in their blood usually climbs to very high levels.

This, combined with the fact that the person is often unaware of their HIV status means that HIV transmission is more likely to happen at this time.

This is one of the reasons why regular testing is so important. And why starting treatment as soon as possible is a good idea.

Fortunately, we have a variety of strategies to avoid HIV transmission. As well as U=U, we have PrEP, PEP and safe sex.

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 through sexual intercourse. Used in combination with (male or female) condoms, undetectable viral load means the risk of HIV transmission is virtually zero.

A viral load test measures HIV in blood but your viral load can be higher in other body fluids such as vaginal fluid, 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 reason for not using condoms.

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 (male or female) condoms and other prevention methods to maximise protection.  Your HIV-negative partner will need to speak to their doctor about their eligibility for PrEP and how it should be taken.

Post-Exposure Prophylaxis (PEP)

PEP is a 4-week course of anti-HIV drugs that may prevent HIV infection after a sexual encounter during which HIV risk reduction strategies were not used or have failed (e.g., a condom broke). PEP is most likely to prevent HIV transmission when used as soon as possible after the potential exposure. If it is not started within 72 hours (3 days) it is not likely to work. Your HIV-negative partner can access PEP by speaking to their doctor. During the evening or on the weekend, you can access PEP at your hospital emergency department. For more information and details about where you can get PEP visit the Get PEP site.

Other safe sex practises

condom

Condoms (Male Condoms)

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

Most condoms are made from latex. They’re best used with a water-based lubricant such as Wet Stuff or KY because oil based lubricants like Vaseline or hand cream can damage condoms. 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.

woman

Condoms (Female Condoms)

Correct use of female condoms during vaginal or anal sex prevents HIV transmission. Female condoms also prevent transmission of most STIs, some of which can increase risk of HIV transmission and also compromise your health.

To be effective, female condoms must be inserted into the vagina before sex. Female condoms are made from polyurethane and are about 15cm long, with two flexible rings (one at each end). The ring at the end of the women’s vagina is closed. The other ring, which is open, rests outside. Female condoms are self-lubricated, although other, additional lube can be used. Female condoms must not be used at the same time as male condoms. For more information on how to use female condoms and explanation of their advantages and disadvantages, see Family Planning NSW’s female condoms factsheet.

Oral sex

There is only a very low risk of passing on HIV through oral sex because (as with semen) vaginal fluids contain low amounts of HIV and the mouth has very good protective immune mechanisms, including saliva. Risk of transmission increases if a person has cuts or ulcers in their mouth, has an STI or if the positive partner is menstruating.

To protect yourself, don’t let anyone perform oral sex on you if they have a cold sore or ulcer because they may infect you with an STI, like herpes. Your infection with an STI would then increase the risk of your passing on HIV to your partner.

There is no risk of infecting your HIV-negative partner by performing oral sex on them.

Hands

It is safe for another person to use their hands or fingers to penetrate your vagina or anus 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.

Sex toys

Penetrative sex toys like vibrators or dildos should always be washed or used with (male or female) condoms to prevent the spread of a range of infections. Always change the condom between users/partners.

Menstrual fluid

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

For women who have hepatitis C, it is important to prevent others having contact with your blood as the hepatitis C virus is easier to transmit than HIV, and is readily transmissible through blood. (It is also important not to share toothbrushes or razors to prevent Hep C infection.)

Sexually transmissible infections (STIs)

It is important to avoid sexually transmissible infections (STIs) if you have HIV. STIs increase the risk of HIV transmission. They can also cause more severe symptoms and be more difficult to treat in people with HIV. Sexually transmissible infections include herpes, syphilis, gonorrhoea, chlamydia and genital warts, but they also include hepatitis B and C (see STIs).