In this section:

• Sex and a new HIV diagnosis
• Transmitting and preventing HIV
• What is safe sex?
• Post Exposure Prophylaxis (PEP)
• Sex and menstruation
• Sexually transmitted infections
• When both of you are HIV positive 

Sex and a new HIV diagnosis

You’ll probably have a lot to deal with when you receive an HIV positive diagnosis. Maybe sex is the last thing on your mind or you might choose to have a lot of sex. You might feel “infectious”, angry or depressed, and this may result in a loss of sex drive, regardless of your partner’s HIV status. However you are feeling right now, your feelings about sex will probably change over time. It’s also important to remember that HIV positive people have the right to enjoy a healthy and active sex life. There are many people out there who will find you desirable regardless of your HIV status.

If you’re in a relationship with someone who isn’t HIV positive, you might not want to have sex because you’re afraid of infecting your partner, husband or wife. These feelings are completely normal. You might also be feeling frightened and scared of getting sick, which can have an effect on your libido. It might help to talk to your partner, husband or wife about your feelings, which could lead to greater intimacy. It’s worth pointing out that many people who have chosen to tell their partner, husband or wife have received support.

If you are not ready to have sex, there are many other intimate sexual activities you can enjoy that involve little or no risk such as kissing, massaging, mutual masturbation and oral sex. If you are planning to have penetrative anal or vaginal sex, the safest way to prevent transmission of HIV is to use condoms and water-based lube. Condoms can also protect you from other STIs. Dams and gloves can also be used for protective sex (see page 33 for more information). If you’re considering having casual sex with someone you don’t know, you might have similar concerns about whether or not to disclose your status.

In some states it is illegal to have sex with someone without disclosing your status. However, some people choose not to tell people they have sex with. Others decide to tell people up front. The choice is an individual one. Deciding how and when to tell someone you’re HIV positive – whether it is a long-term partner or a casual partner – is a personal and sometimes difficult decision. There is no easy way to disclose your HIV status. Talking to a counsellor, peer support worker or other HIV positive people can be helpful.

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Transmitting and preventing HIV

HIV is present in semen (cum), pre-cum, blood, vaginal fluid and breast milk. It is also present in the fluid lining of the rectum and anus (this may also contain small amounts of blood). The most common ways it can be transmitted are through unprotected sex (sex without a condom) and sharing needles. HIV is also present in some other body fluids including saliva and tears, but not the amount necessary to transmit the virus to another person. Neither urine nor sweat contains HIV. It is not passed on through kissing, hugging, sharing cups or plates, touching, rubbing, massage, or from toilet seats.

If you are having penetrative anal sex (receptive or insertive) or vaginal sex, using condoms and water-based or silicon-based lube is the most effective way to prevent passing on HIV to your partners. If you use needles, always using a clean fit and never share mixing equipment including spoons, filters, rinsing water, tourniquets or glasses to avoid passing on HIV.

Clean fits are available at needle exchanges and some AIDS Councils. You can also contact the Australian Injecting and Illicit Drug Users League (AIVL) www.aivl.org.au to find out about where to get clean fits in your area. If you do need to share a fit, it’s advisable to clean it first. AIVL can provide you with information on cleaning fits. You can also contact your local AIDS Council or PLHIV Organisation for more information.

If you cut yourself, it is a good idea to clean up any blood and cover the wound.

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What is safe sex?

HIV positive people have the right to a full and active sex life. You can still enjoy sex regardless of your HIV positive status. Safe sex is any sex that avoids semen, blood, vaginal fluid or the fluid from the lining of the rectum from getting into the bloodstream of another person. HIV is not transmitted through kissing, sucking, touching, rubbing, massaging or using hands or fingers to penetrate your anus or vagina providing the person has no cuts, sores or scratches on their hands. If they do have any cuts, sores or scratches, it’s advisable to use latex gloves.

Using condoms during insertive anal or vaginal sex can help to minimise the risk of passing the virus on to another person. It is recommended that condoms are always used with a water based lubricant such as Wet Stuff or KY or a silicone-based lubricant. Oil based lubricants like Vaseline or hand cream can damage the condom.

There is a very low risk of passing on the virus through oral sex. However, if you’re HIV positive and the insertive partner, the safest oral sex involves using a condom because any cuts or ulcers in the mouth of your receptive sexual partner can allow the virus to enter their bloodstream. Oral sex for women also poses little risk. There is not much HIV present in women’s vaginal fluids and dental dams (thin square pieces of latex to cover the vagina or anus during oral sex) are not necessary for protecting against HIV unless you are menstruating. However they may protect from other sexually transmitted infections which may be common and adversely affect people with HIV.

If you and your partner are both HIV positive, you may not want to use protection, however there is debate around the risks posed by HIV positive people having sex and exposing their partner to a different strain of HIV. Becoming infected with a different strain can result in reinfection (superinfection) which may limit your treatment options if you acquire a drug-resistant strain. Talk to your doctor or contact your local AIDS Council for more information about the different strains of HIV and how this may impact on the decisions you make around sex.

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Post Exposure Prophylaxis (PEP)

Accidents can happen. If the condom breaks or if you think you may have exposed another person to HIV, find out where they can get PEP treatment to prevent HIV infection taking hold. PEP is a 4 week course of anti-HIV drugs which may prevent HIV infection, provided the treatment is started as soon as possible after the potential exposure. PEP must be started within 72 hours of exposure, but within a few hours is best. To get PEP contact your local sexual health clinic, hospital emergency department or go to www.getpep.info for more information.

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Sex and menstruation

HIV is present in 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 condoms during anal or vaginal sex or dams during oral sex at this time (the risk of passing on HIV during oral sex remains very low, however).

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Sexually transmitted infections

A sexually transmitted infection (STI) is an infection that is passed on through close body contact or sex. Even if you do not notice any changes in your body, it’s still possible that you could have an STI without knowing it. Some of the more common STIs include herpes, genital and anal warts, hepatitis A and B, crabs (pubic lice), gonorrhoea, syphilis, and Chlamydia.

If you are HIV positive, it’s advisable to take extra care of your health, including trying to protect yourself against STIs. As with any infection that places stress on the immune system, an STI can allow HIV to produce more copies of itself with the result that more damage occurs to the immune system. Prompt detection and treatment of curable infections such as Chlamydia and gonorrhoea will remove extra stress from the immune system and allow it to function as well as possible to control HIV.

Among people with HIV, some STIs can cause more severe symptoms, and be more difficult to treat. For example: Syphilis can progress to severe symptoms more rapidly, and genital warts and herpes may be more resistant to treatment. Herpes outbreaks can also be more frequent. If you have herpes, consider discussing herpes suppression therapy with your doctor.

Some STIs make it easier to transmit HIV to a negative partner, even when you have no symptoms. If you are sexually active, you should have regular sexual health check-ups. Extra check-ups are advised if you experience any rash, sores, irritation, or genital discharge following sexual contact. Condoms can protect you from most, but not all STIs so even if you always use condoms having regular checks should be discussed with your doctor. As a general guide the more partners you have the more often you need checkups.

See also www.thedramadownunder.info. This site was designed for gay men, but has information that may also be useful for other people.

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When both of you are HIV positive

If your partner also has HIV, then you may prefer to have unprotected sex. However this could expose you to additional risks:

• Sexually transmitted infections (STIs) can put additional strain on your immune system

• There is a risk of re-infection with a different strain of HIV. This is also called ‘superinfection’. There is even a possibility of getting a strain of HIV that is resistant to the drugs you are taking—if you are currently on antiretroviral therapy. Although re-infection does not seem to happen on a widespread scale, it has happened to some individuals

• Hepatitis C. It is more common in men who are HIV positive and it can have a large impact on your health if you have both HIV and Hepatitis C

• There is now an increasing number of cases of Hepatitis C occurring among gay men and other men who have sex with men (MSM), particularly among those men living with HIV

Although some of these cases relate to sharing of injecting equipment, it would appear that the majority of cases are related to sexual transmission. It can have a large impact on your health if you have both HIV and Hepatitis C.

It would be a good idea to talk through these issues with your doctor or counsellor, before you and your partner make a final decision about safe sex.

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