Sex & Relationships
expert advice on sex and HIV
Having Sex When He's HIV Positive
Being HIV positive or having a partner who is HIV positive does not mean that you can't have a great sex life. It's just about being safe...
Condoms effectively prevent HIV transmission if they are used correctly and consistently. Ensure you only use water-based lube with condoms because other substances can damage them. And never use spermicides – they increase the likelihood of HIV transmission.
Don't engage in high-risk activities like fisting and dry sex, as the trauma increases the transmission rate. Receptive anal sex is about 100 times more dangerous than receptive vaginal sex. And remember that unprotected oral sex is also not 100 percent safe – use condoms and dental dams to protect yourself.
If the HIV positive partner is on HIV treatment (ARVs) and their viral load is undetectable, the likelihood of transmission becomes extremely low. HIV treatment is one of the most effective ways to prevent HIV transmission. Circumcision also decreases your partner's chance of contracting HIV by about 65 percent.
If the condom breaks or you have an accident (these happen), the HIV negative partner needs to take Post-Exposure Prophylaxis (PEP) for 28 days. The drugs used for PEP should be different from the drugs the HIV positive partner is using – take the names with you to the doctor. You can even ask your doctor to prescribe you a "starter pack" – the first few dosages of PEP to keep with you to start taking as soon as possible after an accident. The sooner the better, but these have to be taken within 72 hours.
Pre-Exposure Prophylaxis (PrEp) is now also available – it has only been tested in homosexual couples, but looks very promising. The HIV negative partner takes a certain combination of ARVs on a daily basis to prevent HIV transmission. This is not 100 percent safe, but is better than nothing. There is also a new gel that is being tested for PrEP. In future, women will be able insert it vaginally before sex to prevent HIV transmission, without their partners knowing.
The take-home message is still: condoms, condoms, condoms. As you can see however, there is a lot more to consider.
About this blog

Dr Elna Rudolph is the clinical head of the Intercare Centre for Sexual Health and is one of only two doctors in South Africa with a masters degree in sexual health. Her work includes sexual health check-ups, contraceptive management, the treatments of STIs as well helping patients with sexual health issues such as low libido and those who experience painful sex. She also provides medical services for the LGBT (lesbian gay bisexual and transgender) community.










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