Enjoying Romance and Sex while Living with HIV/AIDS
At Lala’s Bedtime Tales, we believe in living healthy and safe lives as our authentic selves. Knowing how to reduce the risk of acquiring sexually transmitted infections, including HIV/AIDS, is essential in living a long and healthy life. In the past, HIV/AIDS was a terminal illness surrounded by social isolation and stigma. Nowadays, HIV isn’t seen as a death sentence; but a chronic, treatable illness; that doesn’t have a cure. There is no vaccine to prevent HIV. As medical research has advanced, now most people live with human immunodeficiency virus (HIV) and do not progress to Acquired Immune Deficiency Syndrome. Medications such as antiretroviral therapy (ART) and Pre-exposure Prophylaxis (PrEP) are essential in reducing the risk of transmission of HIV from an infected partner to a non-infected partner. Choosing lower-risk sexual behaviors and not using injectable drugs are highly important in preventing HIV. Serodiscordant couples or couples where one partner is HIV-positive and the other is not may decide to conceive and have children without infecting their partner or baby.
Understanding & Coping with the Effects of an HIV Diagnosis
Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). HIV enters the bloodstream through bodily fluids like blood or semen. Once in the blood, the virus invades and kills CD4 cells. CD4 cells are vital cells of the immune system. When these cells are destroyed, the body cannot fight disease.
According to the Centers for Disease Control, in 2019, 1,189,700 people of the 333 million people living in the United States have HIV. Of those people, 87% knew they had HIV (https://www.cdc.gov/hiv/basics/statistics.html) 65% of new HIV cases are through male to male transmission, and 23% of new cases are through heterosexual transmission. Young people ages 13-24 account for 21% of new HIV cases, with young, gay and bisexual men and Black/African-American men being more severely affected.
When one partner contracts HIV, the couple’s approach to sex, intimacy, and childbearing must change to protect the other. When one person in a couple contracts HIV, it has a significant impact on the couple’s romantic relationship. There is always the chance the infected partner can transmit HIV to their partner. The most dangerous time for HIV transmission is when a person is unaware they are infected. If you are HIV-positive, you can help protect your partner from becoming infected while still maintaining a close and intimate relationship by putting smart and safe sexual practices into place. Understanding the risks of sexual behavior can help people protect themselves from acquiring HIV. Having an open and honest conversation about STI and HIV status is imperative before beginning a sexual relationship with a partner.
Preventing the Spread of HIV to Sexual Partners
You should be tested for HIV if you have or are being treated for syphilis, gonorrhea, or herpes. If you get a sexually transmitted infection, you are more likely to acquire HIV. Sexually transmitted infections put you at significant risk for HIV because the behaviors and circumstances that put you at risk of getting an STI are the same behaviors that can lead to this illness, as well. If there is an open sore or break in the skin barrier, that is a portal of entry for HIV to enter the body. Women with bacterial vaginosis need to be treated to restore healthy vaginal bacteria, which reduces their risk of acquiring HIV.
Receptive anal penetration is the highest risk behavior for acquiring HIV. There is a 1 in 70 chance of becoming infected with HIV through receiving anal sex from an HIV-infected partner. This is because the rectum’s mucus membrane does not lubricate and can be easily damaged with micro-fissures that can allow HIV to be transmitted from semen into the body. The highest risk populations for acquiring HIV are men who have sex with men, sex workers and their partners, and people who use injectable drugs.
Listed below are examples of high-risk sexual behaviors:
Engaging in anal or vaginal sex without a condom
Having multiple sexual partners
Engaging in anonymous sex with strangers
Having sex while under the influence of drugs or alcohol can lower inhibitions and lead to greater sexual risk-taking behavior
Best Safe Sex Practices to Reduce Risk of Acquiring HIV from an HIV-Positive Partner
If your partner is HIV-positive, there are many different options for safer sex. Have an ongoing conversation with your partner about what you are comfortable with and how to keep safe during sexual activities.
Listed below are the suggested ways to reduce the risk of transferring HIV and practicing safe sex with an HIV-positive partner:
Not having penetrative sex is 100% effective in ensuring you don’t get or transmit HIV through sex.
Discuss the 5 Ps with your health care provider: Partners, Sexual Practices, Protection from STIs, Past history of STIs, and Pregnancy Intention
Know your status and that of your partner. Therefore, getting tested for HIV consistently, whether it be annually or every six months, depending on your level of sexual activity
Choose less risky sexual activities than anal sex, such as oral sex and mutual masturbation
Use a new condom every time you have sex, correctly and consistently, from start to finish of every act of anal, oral, or vaginal sex
Use a water-based or silicone lubricant to help prevent condom slippage or breakage. Don’t use oil-based or petroleum jelly-based lubes, which can break down the latex in the condom. Don’t use cooking oils, Crisco shortening, or hand lotions.
Reduce the number of lifetime sexual partners
Don’t have sex when using drugs or alcohol
Discuss PrEP with your health care provider
How PrEP and ART can help Prevent HIV Transmission Amongst Intimate Partners
Pre-exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) medications taken as prescribed are highly effective at preventing HIV infection from sex.
There are two different medications used as PrEP:
Truvada is used for anyone at risk of getting HIV through sex or injection drug use
Descovy is for people at risk from sex, except for females at risk from vaginal sex
These are safe medications. Some people experience medication side effects such as diarrhea, headache, nausea, fatigue, and stomach pain which usually go away over time. You may want to take PrEP if you have had receptive anal or vaginal sex in the past six months, have not consistently used a condom, have had an STI, use injectable drugs, share needles or equipment to inject drugs, or have an HIV-positive partner. If you are considering becoming pregnant with an HIV-positive partner, PrEP may be an option to prevent HIV in you and the baby while trying to conceive, during pregnancy, and while breastfeeding. PrEP reduces the risk of HIV transmission through sex by 99% when taken as prescribed. It is 74% effective at reducing HIV transmission in people who use injection drugs. After seven days of taking PrEP, it effectively protects people who bottom or receive anal sex. Maximum protection is achieved in 21 days for injection drug use and receptive vaginal sex. Most insurance plans and state Medicaid plans cover PrEP. Post-Exposure Prophylaxis needs to be taken within 72 hours of high-risk sexual behavior to be effective.
Starting a Family While Living with HIV
There are ways to become pregnant while reducing the risk of infecting your partner. For an HIV-positive woman with an HIV-negative male partner, uterine insemination with your partner’s semen timed with ovulation does not expose the HIV-negative male partner to any infected body fluids from the HIV-positive woman. Another approach is for the HIV-infected woman to take anti-HIV drugs, which reduce her viral load to undetectable levels. By having sex without a condom during ovulation, a couple has an increased possibility of conceiving while minimizing the risk of transmission. The male partner may also take PreP medication.
For an infected male partner having sex with a non-infected female partner, the risk of transmission is lowered by having sex without a condom during the time of ovulation and continuing to use condoms at all other times. Sperm washing with in vitro fertilization or intrauterine insemination are other possible considerations.
With careful planning and risk reduction strategies, HIV-positive women can have healthy, non-infected babies. It can take months or years for HIV to develop into AIDS. Unless a woman is tested, she may not know that she has HIV and is at higher risk of passing the infection to her baby. Opting into HIV testing early in pregnancy helps you and your health care provider make a plan to reduce the risk of passing HIV onto your baby. HIV can be transmitted through the placenta and infect the fetus. During labor & birth, the baby may be exposed to the virus in the mother’s blood. When the amniotic sac breaks in labor (water breaks), the risk of transmitting the virus to the baby increases. Most babies who get HIV from their mothers become infected around the time of birth. HIV can also be passed through breastmilk.
You can reduce the risk of transmitting HIV to your baby by taking a combination of anti-HIV drugs during pregnancy as prescribed. These medicines reduce the amount of HIV in the body. This helps protect your health and prevent passing HIV to your baby. If your HIV viral load is high, you can have a cesarean birth. Take anti-HIV drugs during labor & birth as needed. The baby can take anti-HIV medicines after birth. In the United States, HIV-positive women are not recommended to breastfeed since the U.S. has access to safe water and infant formula. By following these guidelines, 99% of women will not pass HIV onto their babies.
Babies born to HIV-positive mothers are tested for HIV infection several times in the first few months of life. If two of these blood tests are positive, the baby is HIV-infected. Another test is done at 12-18 months old.
Hope for Living an HIV- Positive Life of Love
If you have HIV, your partners are at lower risk for infection if you start and stay on antiretroviral therapy (ART). This medicine reduces the viral load of HIV, reducing the virus in your body and body fluids. It can reduce your viral load to undetectable levels. At undetectable levels, your risk of transmitting HIV to a non-infected partner is almost zero.
Being concerned for your personal health is important. Don’t let the desire to have a child push you past what is comfortable for you in preventing yourself from acquiring HIV. Negotiating with a sexual partner, using lubricants and alternative sexual activities, using condoms, and reducing the number of sexual partners can decrease the risk of infection.
Having HIV doesn’t mean your romantic life has to be anything less than happy. HIV may be complicated, but your dating life doesn’t need to be. Dating takes time and is difficult for everyone, but maintaining a positive attitude of “it’s just one date” and not getting hung up on getting too serious too quickly. Informing a potential partner of your HIV status at the first opportunity is important. Being open and honest with your sexual partner before becoming intimate is necessary. This does open you to hurt and rejection if the partner feels they are not ready for this level of responsibility in the relationship. By disclosing your HIV status early in the relationship, your dating partner has all the information they need to decide to move forward. Dating an HIV-positive partner may be easier and comforting as it is a shared experience. Don’t settle and open yourself up to intimate partner violence because you feel insecure about yourself or experience stigma about HIV. You are worthy of love and deserve to be loved by the right person.
You are more than a medical diagnosis. So, don’t let that stand in your way of living a fulfilling life! Lala is dedicated to providing insightful and educational information to help create healthy and happy relationships which play a major role in your sexual health. Subscribe to Lala’s Bedtime Tales Newsletter and follow @LalasBedtimeTales on social media to never miss any sexual education to help you live the healthiest life possible. Also, check out the Lala's Bedtime Tales Podcast and Lala's Oh So Exclusive Patreon account for even more content! If you’re browsing for sexy pleasure products or cute giftable items, then check out Lala’s Pleasure Shop.
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