If you are living with HIV there are a number of issues that you need to think about when it comes to sex. You can still have a positive sex life, but it might be different from the one you had before you had HIV.

Treatments might affect your sex drive, or it might be affected by the pressures of coping with your diagnosis. It’s all part of managing your sex life and we can help and support you to do this.

You can find information and advice about other aspects of living with HIV here.

Considerations and decisions

These are some of the things you need to think about:

• telling others about having HIV
• what to do if either you or your partner is living with HIV and the other is not
• using condoms or femidoms
• re-infection
• how your viral load affects your actions
• having children
• avoiding other sexually transmitted infections (STIs).

Telling others about having HIV

Bringing up the subject of your status, and the status of your partner, can be a very difficult thing. There might be all kinds of things to consider and implications that are worrying you. Before you rush headlong into it, maybe it’s worth talking it through with us and getting some advice. You can find more discussion about disclosure here.

What to do if you or your partner is living with HIV and the other is not

Where either you or your partner is living with HIV and the other is not, this is called a sero-discordant relationship. You can find advice about being a sero-discordant couple in our publication When opposites attract?  For gay men we have a website with more information Vive la Difference.

Condoms and femidoms

It’s very unlikely a condom will break if it's used properly, and unless it does there’s very little risk of HIV transmission. You can find out more about condoms here. Even if it does break transmission is not automatic and if it does happen there’s always the option of Post Exposure Prophylaxis (PEP).

Re-infection

Some couples think that if they’re both living with HIV then there’s no need to practise safer sex. This isn’t the case and that’s because of re-infection. Research is now suggesting that there are different strains of the HIV virus. So if you have unprotected sex with another person who has HIV you could become infected with another strain of HIV; and that might be one that is resistant to the medication you’re taking, or that will affect your immune system more dramatically.

Viral loads

If you have a high level of the HIV virus in your bloodstream (a high viral load) then your HIV is more likely to be transmitted to someone else if you don't practice safe sex than it is if you have a low viral load. But having an undetectable viral load does not mean that you can’t transmit the virus. Undetectable means just that: it can’t be detected by tests, but the virus is still there.

Pregnancy 

If you have HIV it is still possible to have children without them having HIV.

If a man is living with HIV then his sperm can have the HIV virus removed from it in a process called sperm washing before being used in artificial insemination.

For women living with HIV the risk of transmission to the baby (known as vertical transmission) is greatest during birth. If the mother is taking combination therapy and gives birth by caesarean section then this risk is reduced. Breastfeeding can transmit the virus so bottlefeeding is advised.

Other sexually transmitted infections (STIs)

People with HIV are more likely to contract STIs than those who are not. This is because their immune systems are weakened. So if you have HIV you should take extra care with your sexual health.