4 things you need to know about having sex when you’re HIV positive

4 things you need to know about having sex when you're HIV positive

HIV certainly complicates sex, but if you take the right precautions, there’s no reason why HIV-positive women can’t enjoy a healthy sex life without passing on the virus.

If you’re living with HIV, you can still have a satisfying sex life — you and your partner just need to take certain steps to prevent transmission.

Beverly Franklin, 46, is doing exactly that. She’s been HIV positive for 13 years, and as she puts it, condoms are a must. For her, refusing to use a condom is a deal-breaker. “Even if you also have HIV, it could be a different strain,” she says. “If you want to [have sex without a condom], you can do that by yourself.”

Franklin, a mother of two from Norfolk, Virginia, has “undetectable” levels of HIV, which means that the viral load in her blood is below what a lab test can find — or, in other words, less than 40 to 75 particles, or copies, of the virus per milliliter, according to AIDS.gov.

“I have come to terms with my diagnosis,” says Franklin. “It doesn’t define me.”

She became infected with HIV when she and a partner, in a committed relationship, stopped using condoms. They have since separated, and for the past six years, Franklin has been working with East Virginia Medical School as an outreach worker to help other people who have HIV and to educate those who are at risk. “If I can stop one person from getting what I have, it’s worth it,” she says.

1.Be honest with your partner

The first things you need to consider are “issues of disclosure – how to protect your partner and assess their HIV status, plus what to do if things go wrong,” says Dr Francois Venter, deputy director at Wits Reproductive Health and HIV Institute and associate professor in the Department of Medicine at Wits University.

These need to be tackled before you find yourself in the moment so you can approach them with careful thought.

“Plan how to have the conversation, negotiate safe sex and encourage your partner to get tested. And have a handy plan B in place in case there’s a condom break, such as taking post-exposure prophylaxis (PEP), which prevents HIV transmission,” says Dr Venter.

2.Use condoms – they work

There are a lot of myths around condoms not being safe enough to protect against HIV transmission. But if used correctly, and if they don’t burst or come off, they’re 100% safe.

Unfortunately, they occasionally slip or tear, in which case a small risk is present and it’s advised to get PEP from your doctor or clinic. Risk also increases during your period.

3.Stick to your treatment

With the advent of safe and effective antiretrovirals, your health returns to normal and your ability to pass on the virus is reduced almost to zero. So, accidents with condoms, or anything else, are much less likely to have consequences for your partner.

4.Oral sex is low risk for passing on HIV

Dr  Venter says, “You’ve got a bigger risk of getting struck by lightning than getting HIV from oral sex.”

However, you can still catch other STIs from unprotected oral sex, so proceed with caution.

Have Safer Sex With HIV

If you have HIV, you can take these precautions to protect your partner:

  • Tell your partner you have HIV. “Sharing your status gives [your partner] the power and the knowledge to make their choice as well,” says infectious disease specialist Catherine Derber, MD, assistant professor with the East Virginia Medical School in Norfolk. In many states, you are required by law to tell partners if you have HIV, according to the Centers for Disease Control and Prevention. Talk to your doctor if you aren’t sure how to have this conversation.
  • Encourage your partner to be tested at least once a year. “There’s a lot of fear about getting an HIV test,” says infectious disease specialist Nicholas Van Sickels, MD, assistant professor of clinical medicine at Tulane University and director of the Tulane CD4 Clinic in Alexandria, Louisiana. But sexually active people should be tested annually, says AIDS.gov.
  • Take your medications. “One of the best things people with HIV can do is take antivirals and get their viral load undetectable,” says Dr. Derber.
  • Always wear a condom during sex. Even if the virus isn’t detectable in your blood, it can be present in your genital fluids. That’s why people with HIV should use a new latex condom with every type of sexual encounter — vaginal, anal, or oral, says AIDS.gov. (Some people with HIV may have unprotected sex without disclosing their status because they believe that taking their medications and keeping viral load down means they can’t transmit HIV, according to a survey of HIV status and sexual behavior published in August 2015 in the Archives of Sexual Behavior.)
  • Consider PrEP (pre-exposure prophylaxis) for your partner. People who do not have HIV but may be at risk for infection can take a daily oral medication called PrEP to help reduce their risk of getting HIV, according to the CDC. Let your doctor know if cost is a barrier to using this medication. “If we want it for someone, we are always able to find a way to get it,” says Dr. Van Sickels.
  • Don’t share needles. Injection drug use accounts for 1 in 10 HIV infections, according to AIDS.gov. Sharing needles for any reason can expose your partner to HIV.

The bottom line: Living with HIV doesn’t have to end your sexual relationship with your partner — but you do need to take precautio