Sex and Relationship issues
Having HIV can affect the way you feel about sex and relationships
Common sexual problems
Passing on HIV
Condoms
Post Exposure Prophylaxis (PEP)
Sexual health check ups
Sexually transmitted infections
Reinfection
Pregnancy
Having HIV can affect the way you feel about sex and relationships
Most people with HIV do continue to form relationships and have sex.
However, having HIV can affect people’s feelings about themselves, their partners, and about sex and relationships in many different ways. Some people lose interest in sex, while others feel the opposite. Some people feel anxious about passing on HIV, while others may feel angry with the person they think may have infected them.
Some people find that negative feelings about themselves are increased and they feel less desirable and lose confidence in themselves. These feelings can be increased when HIV is used as a moral or political tool to criticise and condemn the groups most affected in our community – gay men and drug users.
It is important to be clear that HIV is an infection. It is a virus like the common cold or influenza. It is not a moral judgement or a punishment.
Anxiety about telling past, present or potential sexual partners that you have HIV, and the fear of rejection, can also cause problems.
Common sexual problems
Sexual problems are common in people with HIV but treatments are available and you should discuss any problems, anxieties or concerns with your healthcare team who will be able to help and advise you.
Problems that may arise can be summarised under the following three headings:
- Problems with desire
This usually means loss of interest in sex, but sometimes a person’s sexual desire can increase to such an extent that it becomes problematic.
- Problems with arousal
Difficulties in obtaining or sustaining an erection in men, or becoming lubricated for women.
- Orgasm problems
Not experiencing an orgasm, or for men, premature ejaculation.
Causes may be psychological, physical or the result of treatment side effects. The first step is to recognise and accept that you have a problem. The second step is to try to talk to your partner about what you are feeling or experiencing. The third step is to talk to your HIV doctor who will be able to help, or if not, refer you to a specialist, nurse, health advisor or counsellor who can.
Passing on HIV
HIV positive people can pass on HIV during sex.
The risks of passing on HIV are highest if you engage in unprotected anal or vaginal sex and you are the active or insertive partner during sex. The risks are particularly high if you have a high viral load, an untreated sexually transmitted infection, or you ejaculate inside your partner.
If you are newly infected you should know that you will be particularly infectious during the weeks immediately following your infection (Primary HIV Infection).
If you are the receptive, or passive, partner the risk of passing on HIV is reduced, but it is still there - especially if you have a high viral load or an untreated sexually transmitted infection.
The risk of passing on HIV through oral sex is much smaller.
Condoms
Condoms, when used properly and consistently, provide excellent protection against HIV and other sexually transmitted infections.
A water-based lubricant should be used with condoms as oil-based lubricants can weaken and make holes in condoms very quickly.
Used condoms should be wrapped in paper and put in a bin - not flushed the down toilet or discarded in the street, parks or fields.
See Condom Distribution Scheme for information about free condom distribution in Jersey.
Post Exposure Prophylaxis (PEP)
If you are worried that you might have just passed HIV on to someone (for example if a condom broke), an emergency treatment called PEP is available. See What is PEP?
PEP must be started as soon as possible after the risk has been taken in order to prevent transmission.
Sexual health check ups
If you are sexually active, it is wise to have regular sexual health check ups. These are free and confidential at the sexual health clinic. The doctor, or nurse, will ask you about the kind of sex you are having and whether you have any symptoms and will examine you.
It is important to be honest if you have had unprotected sex, so that you can be given the appropriate tests. Sexual health clinics are non-judgemental.
The examination will normally involve having swabs taken from the tip of your penis or inside your vagina and from the mouth and throat and anus if you have had oral or anal sex. You will also be asked to provide a urine sample.
Blood samples are also taken to check for infections.
Some results can be given at your visit but it may be necessary to telephone or return for other results.
All treatment is free and confidential.
Sexually transmitted infections
Bacteria, viruses or parasites can cause sexually transmitted infections.
Untreated sexually transmitted infections can increase the risk of HIV transmission.
Bacterial infections can be cured with anti-biotics, and anti-viral drugs can be used to treat some of the viral infections. Lotions can be used to clear infestations of scabies or pubic lice (sometimes called crabs).
Detailed information about the symptoms and treatment of sexually transmitted infections can be found in the NAM patient booklet hiv & sex, which is available from the ACET Information Centre.
Alternatively, you can download an electronic version at http://www.aidsmap.com/files/file1000887.pdf
Reinfection
In addition to sexually transmitted infections, unprotected sex can carry the risk of reinfection with another subtype or strain of HIV.
This can result in an increased viral load and a reduced CD4 count. In addition, treatment options may be limited if the new strain is resistant to some anti-HIV drugs.
It is not known how easy it is for someone to become reinfected with HIV. So far, only a few cases have been reported worldwide. It remains to be seen whether more cases will be reported.
Pregnancy
Until recently it was thought that pregnancy could have a negative effect on a woman’s health, as the immune system might be further suppressed by pregnancy. It now seems that pregnancy is only likely to have an impact on a woman’s physical health if she is already unwell, or has very low CD4 counts. There is no evidence that pregnancy accelerates the course of HIV infection in asymptomatic women.
If you are thinking about having a baby speak to your HIV specialist first, so that he can check that you are healthy enough to have a baby safely. He can also tell you about how to get pregnant without putting you partner at risk of infection.
Many women have given birth to healthy children by taking the following precautions:
- taking ant-HIV drugs during pregnancy
- having a caesarean section
- not breastfeeding
If you follow these recommendations, it is extremely unlikely your baby will be HIV positive.
Last updated April 2010