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. But sometimes, during stressful times, periods in which you are unwell, or while adjusting to an HIV diagnosis, you might become less interested in sex. This isn’t at all unusual. Research suggests that positive women often lose interest in sex for the first year or so after diagnosis, but the good news is that for most women, sexual desire does return.

For some women, especially during the period of early HIV infection, intimacy may be more important and play a more meaningful role than sex. Other kinds of physical affection and emotional connection are also rewarding and fulfilling. This can make it easier for you and your partner, and may compensate for a lack of interest in sex.

Safer sex

It can be hard to feel relaxed about sex when you have HIV because you may be afraid of transmitting the virus to your partner. Learning to talk about sex and negotiate safe sex with a partner may be difficult. Talking about your feelings to a counsellor, or to other women living with HIV/AIDS, may help you find ways of exploring your sexuality safely. Understanding the ways in which HIV can be transmitted may help you decide which sexual activities are safe, and which ones pose a risk. HIV can only be transmitted if:

• there is a way for the virus to enter someone’s bloodstream or lymphatic system; and
• HIV is present in a high enough quantity for transmission to occur.
  

The question of how much virus needs to be present for transmission to occur can be confusing. You may have heard, for example, that it is impossible to transmit HIV to a sexual partner if you have a very low or undetectable levels of virus in the blood. Unfortunately, while this may seem a reasonable assumption, there is not enough evidence to support it. There are plenty of sexual activities, however, which you and your partner can continue to enjoy.

Kissing

Kissing is extremely safe. There is not enough HIV in saliva to cause infection and in any case, saliva harms HIV. The mouth is not a good way for HIV to get into the body.

Oral sex

Licking or sucking the vagina, or vaginal lips is very safe in terms of HIV. There is very little HIV in a woman’s vaginal juices, and saliva damages the virus. Dental dams are not necessary for protection against HIV but may help prevent the transmission of other sexually transmissible infections like herpes. There are no reliable reports of anyone getting HIV from oral sex on a woman with HIV. Likewise, there is insignificant danger of a positive woman infecting a man by sucking his penis. Condoms can prevent both partners from other sexually transmissible infections.

Vaginal or anal sex with condoms

If you are having vaginal or anal intercourse with an HIV negative male partner it is recommended that you always use condoms with a water-based lubricant. This could be the male condom, or the new female condom (available from most Family Planning clinics), which is inserted into the vagina and covers the labia. When using condoms, it is important to choose a water-based lubricant such as Wet Stuff or KY, since oil-based lubricants like Vaseline or hand cream can damage latex and cause the condom to tear or break. If both you and your partner are HIV positive it is still important to consider condoms or other barrier protection. If you are thinking of having sex without such protection, you may wish to discuss the potential health risks (such as other STIs) and weigh these up against the pleasure many people get from unprotected sex.

Hands & fingers

There is no risk to your partner if he or she penetrates your vagina or anus with fingers or hands — unless there are cuts, sores or scratches on your partner’s hands. If there are, he or she should consider using latex gloves for barrier protection.

Sex toys

Penetrative sex toys like vibrators or dildos can spread a range of infections. To prevent this, always wash them or change the condom between users.

Negotiating sex

Of course, all of the above presumes that you and your partner (regular or casual) communicate well, respect each other’s rights and safety during sex, and that your partner(s) is prepared to wear a condom. But it’s not an ideal world. It can be difficult to convince some men to use condoms. If this is the case, you could consider seeking some kind of support or counselling. If you have a regular partner, he may be prepared to be part of this process. Family Planning clinics across Australia or a general practitioner (GP) you feel comfortable with, may be able to assist, or refer you to an appropriate service.

Menstruation and sex

Menstrual fluid does contain HIV, although there has been little research about the levels of virus present. Menstrual fluid is composed of blood, uterine tissue and other substances, so having sex during your period could increase the risk of transmission. Consider using barrier protection such as condoms or dental dams to reduce the risk that your partner will be exposed to blood or menstrual fluid during sex. Some women use a diaphragm during menstruation, as it prevents the menstrual fluid entering the vagina during sex.

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