Having sex with someone can be an intense experience that can take a lot of emotional and physical energy.
The psychological and social effects of living with HIV can sometimes result in a loss of interest in sex. Some men may be unconcerned by this change. For others, sexual expression is a huge part of who they are.
Losing interest in sex or experiencing difficulties such as getting or keeping an erection are common. Often these can be heightened due to a HIV positive diagnosis.
Sometimes the cause can be physical such as tiredness or feeling ill. It may even be that your testosterone levels have decreased. Some men have problems using condoms, and the use of recreational drugs or alcohol can affect our sexual pleasure.
Sometimes sexual difficulties may be caused by our own thoughts and feelings, such as anxiety about passing infections on, or feeling self-conscious about body image.
Anxieties and pressures of disclosure, stigma and discrimination, and sexual rejection are challenges. All these kind of issues can get in the way of the kind of sex you desire.
At different times we desire different things from sex and from our relationships. Sometimes sex is not always about the emotional connection. Sometimes it’s about more basic desires.
Erection difficulties affect many men, including men living with HIV.
Problems can include:
Hard-on problems can prevent some men from using condoms. Others adopt the receptive (bottom) role to get around the problem.
If condoms interfere with your hard-on, it may help if you get the other person to put it on you, or to use a different size condom.
A cock ring can stop the blood leaving the penis once an erection happens, helping to keep you hard. Gripping the base of the penis can have the same effect. Getting more exercise, following a low fat diet, and stopping smoking can all help improve hard-ons.
Using erection drugs such as Viagra™ is not safe for everyone but can often help. They increase the blood flow into the penis, help you get an erection, and make it harder and longer lasting.
It’s important to be aware that the underlying cause of hard-on problems may be affected by your mental and emotional health. Erection drugs will treat the symptom, but not the cause. If, for example you still get a hard-on in the morning, erection drugs are probably not the answer. If you have erection difficulties that persist, consider talking to a doctor or another health professional you feel comfortable with speaking to about your sex life.
Viagra™ should only be taken when prescribed by a doctor.
Herbal hard-on drugs can be accessed via the internet and sometimes at saunas. It is important to be aware of the potential dangers of accessing drugs over the internet. Some drugs can interact with each other.
Knowing your sexual needs and planning ahead can be an important part of maintaining your sexual health.
Managing risk is also about managing your health. Be aware and keep informed of any health risks involved in having sex and how to minimise those risks while still getting pleasure.
Pleasurable safer sex starts with each partner taking mutual responsibility for protecting each other and himself. It can be further enhanced by understanding the risks involved in advance of having sex, then negotiating and consenting to the sex you both want.
Although condoms provide the best protection, it’s important to remember that what is regarded as safer sex for the prevention of HIV transmission may not protect against some other sexually transmitted infections (STIs) like Syphilis or Gonorrhoea, or gut infections like Shigella.
Men living with HIV may wish to consider sexual activities that decrease the risk of contracting other STI’s.
If you are sexually active, particularly with short term or casual partners, it is recommended that you get tested for STIs regularly.
Sexual pleasure can be influenced by many factors and circumstances – the kind of sex you desire, where you meet (home, online, sauna, cinema, backroom, club, pub, party), who you are with (whether having casual sex or a more intimate relationship), and whether you are drinking alcohol and/or using recreational drugs.
Whatever your sexual pleasure or desire, keep one basic principle in mind when you consider any sex act:
HIV-infected semen or blood has to enter the bloodstream of a person through an opening in the skin (or mucous membrane) for HIV to be transmitted.
Anal Sex without condoms remains the most common way HIV is passed on between two male partners, in particular if the HIV positive partner is ‘top’ (inserting).
If the HIV positive partner is ‘bottom’ (receptive), a HIV negative partner is still at risk of HIV infection if blood is present which can enter the body through the eye of the penis, or through cuts and sores if another infection is present, for example genital warts or syphilis.
Using condoms for anal sex is the best way to prevent HIV transmission and many other STIs.
Oral Sex presents a very low risk of transmitting HIV. However, if you are HIV positive and you are the ‘insertive’ partner, the risk is higher if you ejaculate into the mouth of an HIV negative partner especially if your partner has ulcers, bleeding gums and/or a sore throat.
Rough oral sex or deep-throating can cause small cuts in the lining of the throat increasing the risk. Brushing teeth can tear the flesh in the mouth causing gums to bleed also increasing the risk of infection.
Use a condom for oral sex to reduce the risk, and avoid brushing teeth before performing oral sex.
Rimming is only a risk for HIV transmission if blood is present. Rimming can be a higher risk activity for transmitting other STIs such as Hepatitis A or a gut infection like Shigella. Dental dams, or a flavoured condom cut into a square, can be used to reduce the risk by placing it over the anus for rimming.
Sex toys only present a risk of transmitting HIV and other STIs if shared and not cleaned properly (with warm water and soap). Some people use condoms on their toys and change the condom between sharing. Others prefer not to share and use only their own toys.
Fisting presents little risk of HIV transmission. Using latex gloves and plenty of lube can reduce the risks. It is safer not to engage in fisting prior to penetrative sex as this can cause bleeding and therefore increase the risk of HIV transmission during anal sex, particularly if a condom is not used.
Kissing, sucking, wanking, nipple pulling, touching, rubbing, massaging, spanking, stroking, water sports are all safe. Using hands or fingers (not shared) to penetrate the anus are also safe providing there are no cuts, sores or scratches on the hands.
Some bacterial infections, such as Shigella, that affect the gut and cause serious diarrhoea, are transmitted by getting bacteria into the mouth. Washing hands and showering can greatly reduce the risk of transmission and infection.
Some HIV positive men may prefer to only have sex with other men who are HIV positive.
This is sometimes referred to as ‘serosorting’.
You may decide not to use condoms because you are both positive.
Some men may feel that unprotected sex with other positive men is a way to maximise pleasure and to reduce HIV-related stigma.
It’s important to consider that there are still health issues which you may want to think about: