There's nothing wrong with having lots of sex, or no sex at all. The information here may help you decide to change the kind of sex you have. You don't have to give up things which give you pleasure, but you may decide to weigh up the pleasure and the risks involved. We've all got a responsibility to protect ourselves and others. This applies to everyone, regardless of their status - positive, negative or untested.
SEX
For a time after being diagnosed HIV+, many men don't have sex. There's nothing wrong with that. Maybe they've lost their libido, are feeling depressed, are still coming to terms with their diagnosis, or sex represents the way in which they were infected.
In time, most positive men restart an active sex life. However, some choose never to have sex again because they believe that having sex will put their partner at risk. There's nothing wrong with this - it's all down to personal choice.
If you're an HIV+ man who's sexually active, you need to know about the risks involved in certain kinds of sex, and what you can do to minimise those risks. Then you can make your own informed decisions about what you're prepared to do, while still getting the most pleasure possible. How safe, secure, and happy you feel about the sex you're having can have a big effect on your general well-being.
CONDOMS
It's not a very good idea for anyone, regardless of their HIV status, to have unsafe sex with someone whose status they're unsure about, or don't know. Using condoms and water-based lube for fucking is still the best way to protect yourself, and others, in most circumstances.
Even if your viral load is undetectable, you still have HIV and it can still be passed on during sex. Some men decide to give up condoms when they have sex with men they know to be positive. This may be because they enjoy it and might have already decided that they can't get anything worse than HIV. For these HIV+ men, the intimacy and pleasure of fucking without condoms far outweighs the potential risks.
This has to be an individual choice where both of you weigh up the benefits of not using a condom against the possible medical risks. Fucking without condoms may mean that you could catch, or even pass on, other types of HIV. These may already be resistant to some HIV treatments (see Different Types of HIV). It could also mean you're more likely to catch sexually transmitted infections (STI's). There's more information about STI's later.
Research shows that gay men often make the wrong assumptions when they're trying to guess someone else's HIV status. For instance, some positive men may think that people who don't want to use condoms must be positive too or because someone is healthy and good looking, that they must be negative.
However, it's also been shown that HIV+ men are usually more aware of the risks involved, and are great educators on safer sex issues.
But this doesn't place the sole responsibility for safer sex on the shoulders of HIV+ gay and bisexual men. Safer sex is everybody's responsibility.
A SAFER SEX GUIDE
In any given situation, we've all got choices and responsibilities. They should depend on what you know about yourself and your partner, and not on assumptions that you may both make about HIV status. No one should pressurise you into having sex you don't want and you'll need to think about all the options open to you before you make your decision. Whatever you decide, you may find it useful to talk through your decisions with someone with HIV knowledge, a counsellor, or someone else with HIV.
The following is a guide to the most common kinds of sex, the risks involved, and what you can do to ensure a safer and healthier sex life.
Kissing, cuddling, stroking and wanking are safe.
The following kinds of sex all carry some degree of risk:
Fucking: Unprotected fucking can expose you and your partner to a wide variety of sexually transmitted infections (STI's), hepatitis, and different strains of HIV. Using condoms and water-based lube greatly reduces those risks. You don't have to stop fucking if you're HIV positive, and if you take care you'll reduce the risk of exposing negative partners to HIV.
Sucking: For HIV+ men there are more risks involved in sucking than there are for negative men. This is because the diseases you can get from oral sex can be more serious for people with weakened immune systems.
Although it may be tempting, it's better not to brush your teeth before you have oral sex. This lowers the amount of saliva in your mouth, which may be quite good at killing the virus, and also increases the chances of damaging your gums.
As far as HIV transmission is concerned, sucking carries a much lower risk than fucking without a condom. Sucking becomes more dangerous if you've got bleeding gums or ulcers/open sores. Similarly, if the person being sucked has cuts or sores on his cock, infections can be passed on.
Although sucking is relatively low risk, it's safer not to cum in one another's mouths. The man doing the sucking is at most risk, but some infections (other than HIV) can be passed to the man being sucked.
If sucking makes you anxious, you may prefer to use flavoured condoms for oral sex, and this'll help to prevent other infections such as herpes or gonorrhoea.
Sex toys: Don't share them unless they've been thoroughly washed with soap and hot water. However, if you're sharing dildos and you're unable to wash them, then you can use condoms provided that you use different condoms each time you use the dildo on a different person.
Rimming and scat: This can carry a higher risk of infection for HIV+ men, mostly because of the possible exposure to bacteria and other infections such as cryptosporidium and salmonella, which can be very dangerous. Rimming and scat can also expose you to Hepatitis.
If you want to lick someone's arse, you could try a dental dam (a square of latex) or a cling film barrier which can prevent the transmission of infections. Both rimming and scat carry a risk of HIV if blood is present, although sometimes you may not be able to tell.
Water sports: They don't carry any significant risk in terms of HIV or other infections, but you should take care not to get shit or piss in any open cuts or sores. Drinking piss carries a higher level of risk as you may catch infections such as Hepatitis.
Fisting: Go gently! Your fingernails should be short and clean, the skin clean and unbroken. Rubber gloves can protect the skin and help prevent infection from HIV, hepatitis and other STI's. The risk of HIV transmission greatly increases if you fuck without condoms after fisting.
DIFFERENT TYPES OF HIV
Because the virus mutates, new types of HIV are always developing. Some of these are stronger than others. The danger is that you can become infected with new types of the virus by having unsafe sex with another positive man, and these can attack the immune system in different ways which then overload it. Some types have already shown resistance to AZT and other antiviral medications such as protease inhibitors. Recent research in America and Europe has shown that between 10% and 25 % of new HIV infection is resistant to some HIV treatments. Infection with drug resistant HIV can lead to your treatment options being severely reduced in the future. It's still not clear what the long term effects of drug resistant HIV are, but it probably means that some drugs may not work very well or even at all.
So even if you're having sex with another HIV+ man, there are reasons to keep using condoms. Practising safer sex is the only way to protect yourself against other STI's and new types of HIV. The main way in which HIV drug resistance develops depends on how well you take and monitor the treatments you are on. To make treatments most effective, the correct doses should be taken at the correct time and in the right way. Even missing the treatments a small percent of the time can have a significant effect on resistance. It's also important that you monitor the effectiveness of your treatments by having regular appointments at your clinic, where the levels of HIV in your blood can be measured. Remember, even if these results show very low, or undetectable, amounts of the virus in your blood, HIV can still be passed on by fucking without condoms. If you've given up using condoms, then this information about drug resistance might mean that you want to reconsider and start using condoms again so you can keep your treatment options open.
However, if you have any worries about this issue, or any questions about drug resistant HIV, then it's advisable to see a doctor or health adviser at the Sexual Health clinic as soon as possible.
TELLING SEX PARTNERS THAT YOU'RE HIV+
If you're HIV+, it's difficult to know whether or not to reveal your status to sexual partners.
On the gay scene there's often discrimination from other gay and bisexual men, based on their own unfounded fears and prejudices. This stops more positive men from being open about their status, and it causes a lot of distress.
Most of this prejudice is aimed at men who are known to be positive. This is unfair and illogical, since other men who are assumed to be negative can easily be positive or untested - but often nobody thinks twice about having sex with them.
Positive men may feel there's a difference between revealing their status to sexual partners they know well, and telling men they have casual sex with.
Many positive men worry that their partner (casual or long-term) will be angry or distressed, that they'll be rejected - which is difficult to cope with at the best of times. When it comes to telling your sex partners, there's no easy solution, and you may find that it's a skill you acquire over time by judging the reactions of different men. To come to terms with this, you may find it helpful to talk to a counsellor for advice and support.
HIV is a very personal subject. It's perfectly all right for you to wait until you feel that the circumstances are right before you tell someone. During this period, safer sex protects yourself and your partners, and safeguards against other sexually transmitted infections.
SEXUALLY TRANSMITTED INFECTIONS (STI's)
Safer sex for HIV+ gay and bisexual men isn't just about HIV. It's also about protecting yourself from potentially dangerous illnesses you can get from having sex.
Because of your damaged immune system they can have far more serious implications for you than they would for HIV- men. By practising safer sex you can seriously reduce your chances of getting one of these illnesses.
For HIV+ men, STI's can be more difficult to get rid of. Another danger is that you could be exposed to other infections which speed up the rate of the disease and cause HIV to reproduce itself more quickly, increasing your chances of developing AIDS.
Using antibiotics to treat STI's can also weaken some of the body's natural defence systems and may cause problems with other medication you might be taking. Repeated infection with STI's can damage your immune system, again making you more susceptible to other infections. HIV transmission is also greatly increased if you have or get an STI.
It's possible to have an STI without any symptoms. If you're sexually active, regular check-ups at your local Sexual Health clinic are the best way to maintain your health and early treatment may help reduce problems later.
HEPATITIS B
Hepatitis B can be picked up by rimming, water sports and unprotected fucking and sucking. It's a serious illness which can lead to permanent liver damage.
You can be vaccinated against Hepatitis B, and it doesn't harm you if you're HIV+, although for some positive men it may not work. Advice, and the vaccination, which is free to gay and bisexual men, are available at most Sexual Health clinics.
GET SET FOR HIV TREATMENT
NAM has launched a new interactive tool - Get set for HIV treatment. It is designed to help people with HIV think through how they feel about starting treatment, and identify any questions or concerns they might have. It explains the factors that determine the need to start treatment and will help people decide whether they are ready to take that step.
The tool takes users through a series of questions related to their health, lifestyle, and feelings about treatment. It provides people with an individual report, based on the answers given, which they can use to find out more information, or share with a healthcare worker, support organisation, or family and friends to talk over the issues raised.
This tool is a timely addition to the range of information support resources NAM provides for people with HIV. This tool has been designed to help people with HIV play a greater role in their treatment and care, and talk to their doctors and other members of their healthcare team about how they feel and what they understand about starting treatment.
Visit the tool today at www.aidsmap.com/getset
TALKING POINTS - A CHECKLIST FOR YOU AND YOUR DOCTOR
Talking points is designed to help you talk to your doctor about HIV treatment. Having the right information available to you and your doctor will help you get the best out of HIV treatment, and reduce the chances of problems developing in the future.
Not all HIV drugs are suitable for everyone, and some will work better for you than others.
By answering the questions you will be able to build up a list of important issues to talk to your doctor about, so that the treatment you receive is right for you.
Start the questionnaire to produce your checklist HERE!
PEP=72 HOUR HIV EXPOSURE TREATMENT
PEP - POST EXPOSURE PROPHYLAXIS is available from Sexual Health Clinics and most Accident & Emergency centres across the North East.
PEP could stop someone from catching HIV as long as the treatment is started within 72 hours (3 days) of unsafe sex or condom breakage occuring.
PEP involves taking anti-HIV drugs for 4 weeks and can have side effects. PEP is also not guaranteed to work.
If you would like more information contact MESMAC on 0191 233 1333 or go to our P.E.P page.
FREE HIV TEST SERVICE IN NEWCASTLE
A FREE HIV testing service open to everyone regardless of gender or sexuality is available in Newcastle and runs by an appointments service.
Appointments are available Monday to Friday morning with a later slot on a Tuesday evening all depending on staff availability.
More information can be found on our website HERE!
The service is free and runs from the MESMAC office in central Newcastle.
For more details please contact MESMAC on 0191 233 1333.
