Breaking the HIV stigma.
When talking to patients about HIV testing and treatment as a clinician, I often hear patients express concern or fear and automatically associate HIV infection with the HIV epidemic in the 1980s in the United States which was shrouded in stigma and misinformation. Luckily, major advances in medical treatment and research have now made HIV a manageable condition. Getting tested, treated, and talking with a healthcare provider is the best way to find out what options make sense for you - whether you have an HIV infection or you might be exposed to HIV in the future. With the right treatment plan, people with HIV infection and their partners can and should be able to lead long, happy, and healthy lives - sex lives included!
What is HIV?
Let’s start with the basics! HIV, also known as the Human Immunodeficiency Virus, is a virus that attacks the immune system, weakening the body’s ability to fight infections and diseases. This virus can be spread between people through certain bodily fluids, most often during vaginal or anal sex. It can also be transmitted by sharing needles that have been used by others or during pregnancy. Remember - though it can’t be cured or totally eliminated from the body, HIV can be treated and managed with the right plan, similar to high blood pressure or diabetes. We luckily live in a time where treatments are available that potentially make the virus undetectable and even untransmittable in the body!
Debunking HIV myths.
As stated above, the rise of HIV in the 80s caused a surge of harmful misinformation about HIV/AIDs. Not only did it cause widespread misunderstanding around HIV, but it targeted the LGBTQ+ community (specifically gay men) and further perpetuated their marginalization. Unfortunately, even though we have more access to information than ever before, there are still lingering stigmas and shame that surround HIV. So let’s take some time to clear up these myths and finally learn the truth about HIV (spoiler: it’s not as big of a deal as you think!):
Myth #1: Only gay men contract HIV.
Nope! People of all sexes, genders, and sexualities can contract HIV. The truth is HIV in women and people with vulvas, and cis-heterosexual couples has risen in recent years
Myth #2: You can get HIV from touching someone with HIV.
We often hear people ask questions like ‘Can I get Hiv from touching someone with HIV?’ and ‘Can HIV be transmitted through kissing?’ and the answer is: no. This myth is similar to the ‘STIs from a toilet seat’ myth in that it confuses the ways STIs are transmitted…and it’s wrong. HIV is strictly spread through the exchange of bodily fluids through activities like sex and sharing needles. So you do not contact them by simply touching someone with HIV.
Myth #3: You can tell when someone has HIV.
Unless they’re carrying around a sign that says ‘I have HIV,’ you’ll never know someone has it by looking at them. People with HIV can live completely normal lives and show no physical symptoms at all.
Myth #4: Only promiscuous people get HIV.
This is the type of STI stigma that we’re trying to break down! Anyone can contract HIV. It doesn’t matter how many people you’ve had sex with or who you’ve had sex with; HIV can happen to any sexually active individual.
Myth #5: Your sex life is over if you have HIV.
Not at all! HIV-positive individuals can (and should!) have healthy and happy sex lives. Luckily we live in a time where HIV treatment can make the virus undetectable and untransmittable in the body. There are also other safer sex methods that can be implemented, like condoms. So now, people with HIV can enjoy a sex life full of pleasure.
Pleasure and HIV.
As we mentioned above, people with HIV can have thriving sex lives! Having HIV does not change how deserving you are of pleasure, who you are as a person, or your worth. Unfortunately, due to lingering stigmas surrounding HIV and sex, they can experience anxiety surrounding sex and even stop having sex after an HIV diagnosis. We’re here to tell you it shouldn’t be this way. When proper precautions are being taken, and open communication is being practiced, there is no reason why someone with HIV shouldn’t enjoy an active sex life.
However, if there is some anxiety around having sex after diagnosis, people with HIV can ease back into exploring their pleasure by talking with their partner(s) about their desires, engaging in self-pleasure, and using toys before going back to penetrative sex. There are also many other kinds of sexual activities that can be explored, such as mutual masturbation, exploring erogenous zones, fingering, and so much more! It’s all about what’s most comfortable for people with HIV and their partner(s).
When it comes to penetrative sex, there are plenty of things you can do to both increase pleasure and focus on safety. This includes using lube (which both increases pleasure and reduces the risk for microtears), engaging in dirty talk (which can signal that both partners are comfortable, ‘Oh yeah, just like that’ and it’s SO sexy), and trying textured condoms (which reduce the risk for HIV/STIs and offers new sensations). It’s all about getting creative and discovering what feels best for each unique individual!
Most importantly, what matters is that they are enjoying their sex life and prioritizing their pleasure!
Safe sex with HIV.
When it comes to safer sex, there are many steps that can be taken to protect individuals with HIV and their partners. While everyone’s experience is unique and valid, here are a few general tips to help increase safety during penetrative sex.
For people with an HIV infection: Helping protect your partners.
By taking care of their own health, people living with HIV can help to care for the health of their partners. In recent years, we have learned that “Undetectable = Untransmissible”. Based on years of research, this means that when someone living with HIV infection has the right treatment, they can reduce their HIV viral load to “undetectable” and low levels. When their viral load is undetectable, they cannot transmit HIV to their partners - even without a condom. This is a major breakthrough - taking care of your health with regard to your HIV treatment can help give your partner peace of mind as well!
For those with an HIV infection, maintaining a happy and healthy sex life first involves creating a care plan with your medical team. Treatment usually starts with regular check-ups with your medical provider, often someone who specializes in infectious disease or has received additional training in HIV. Usually, this might involve getting tested for the viral load (the amount of HIV virus in the blood), the impact on your immune system and particularly the CD4 cells, the presence of any other major infections, and testing for things like kidney function, to make sure that there are no major side effects of the medication.
Along with those regular check-ups, most people with an HIV infection are recommended to have antiretroviral therapy (ART). This typically includes daily oral therapy (meaning pills) and/or injections to help decrease the viral load (amount of HIV virus detected in the blood) and therefore prevent the growth of the HIV virus in the body. These treatments are highly effective when used as directed and typically have very few side effects. In fact, people with HIV infection now have a similar life expectancy as people without an HIV infection (as long as they keep up with their treatments and their medical care)!
In addition to getting treatment, people living with HIV can help protect their partners through responsible and open communication. You can share with your partner what your treatment plan looks like and whether your viral load is low enough to help minimize the risk of transmission. You can also discuss measures that can help reduce the risk of HIV and other STI transmission, like condom use. Remember, communication is the key to great sex!
For partners of people with a known or possible HIV infection.
If you have partners that may be living with HIV, there is no need to panic. People in relationships with someone living with HIV can take proactive steps to safeguard their own health. Regular screening, such as in-person testing or at-home HIV testing like with TBD Health, for all partners ensures early detection of any potential infections and, therefore earlier treatment. Discussing where your partner is in their treatment process is also important - remember that if they keep up with their treatment plans and HIV levels are undetectable, they cannot transmit HIV infection sexually. It’s also important to discuss the use of condoms - which cuts down the risk of any sexually transmitted infection (including HIV!).
Another thing to consider is HIV PrEP treatment or preexposure prophylaxis. This is a prescription treatment option for HIV-negative people that - when taken as prescribed (usually daily pills or monthly injections), helps reduce your risk of getting an HIV infection. This is a really effective way to help reduce your risk of getting HIV infection! PrEP treatment is often covered or at least subsidized by health insurance. You can talk to your local health care provider about this or consider a program like TBD Health which allows you to get PrEP treatment and monitoring from the privacy of your own home.
Embracing a life beyond HIV stigma.
In closing, it’s essential to emphasize that an HIV diagnosis does not diminish one’s worth or ability to enjoy a fulfilling sex life. The stigma surrounding HIV persists, but it’s crucial to recognize that individuals living with the virus can have meaningful, intimate, safe relationships and long, healthy lives. HIV education, awareness, and breaking down stereotypes contribute to dismantling the shame associated with HIV.
Living with HIV requires resilience, but with proper medical care, communication, and mutual respect, individuals can cultivate happy, healthy, and satisfying sexual relationships.
TBD Health is a US-based sexual health clinic striving to help us all have great sex. They provide at-home STI testing nationwid, emergency contraception, telemed consultations. They have IRL clinics in Colorado and Nevada, go check them out!