It's important to remember that HIV-positive people have the right to enjoy a healthy and active sex life. There are many people out there who will find you desirable regardless of your HIV status.
Although you are not obliged to tell anyone your status, the law may require you to tell people under certain circumstances. In some states, you are legally required to tell any sexual partner, even if you intend to have safe sex. These laws vary from state to state so it's best to check with the HIV/AIDS Legal Centre, your local Legal Aid Centre, AIDS council or PLHIV organisation to see how the laws in your particular state might impact on your decision, especially given that some cases of non-disclosure have ended up in court.
Visit the Sex and Relationships pages of the AFAO for more information on about sex in the context of HIV.
Viral Load & Infectiousness
HIV is still present, even if you have an undetectable viral load. The virus remains in very small amounts, which are unable to be accurately measured by current blood tests.
Recently, the results of a large study among couples where one partner is HIV positive showed that early antiretroviral treatment (where viral load is suppressed) reduces the risk of passing on HIV by up to 96%. This study was largely among heterosexual couples so it is not known if treatments reduce transmission among gay men to the same extent, where the route of transmission is anal sex.
Contraception and HIV
Women living with HIV can continue to use all existing hormonal contraceptive methods without restriction. If you are a woman living with HIV, speak to your doctor about which method of contraception is most suitable for you.
What you can do to live well:
Use condoms with a water based lubricant to avoid passing on HIV and protect you and your partners from some STIs. There is a very low risk of passing on HIV through oral sex, but using a condom or dental dams will also protect you and your partners from other STIs.
Remember PEP is available. Accidents can happen. If you think you may have exposed another person to HIV, find out where they can get PEP treatment to prevent HIV infection taking hold. PEP (post-exposure prophylaxis) is a 4-week course of anti-HIV drugs that may prevent HIV infection, provided the treatment is started as soon as possible after the potential exposure. PEP must be started within 72 hours of exposure, but within a few hours is best. For more information about PEP and where it is available, call your nearest major hospital, call your AIDS Council, or go to www.getpep.info
Get regular sexual health check-ups (blood and urine tests as well as throat, vaginal and anal swabs) for other STIs.
Talk to your doctor about vaccinations, including those for hepatitis A&B.
If you are a women living with HIV, speak to your doctor about this if you are considering hormonal contraception.
Having another infection when you are HIV positive places further stress on your immune system as well as makes the other infection more serious.If you have a sexually transmissible infection (STI) as well as HIV, then both the STI and HIV can be easier to pass on to your partners. Some STIs can also increase your viral load and decrease your CD4 count. Many STIs do not have symptoms.
Having hepatitis can have a significant impact on your liver health. There is an increased risk of hepatitis B transmission through anal sex. The number of gay men and other men who have sex with men getting Hep C is on the rise, particularly among those men living with HIV. Most of these men have gotten Hep C through sex.
If you and your partner are HIV positive and do not use condoms, there is a possible risk of being exposed to a different strain of HIV. Being infected with a different strain (reinfection or superinfection) can limit your treatment options. Speak to your doctor or AIDS council or PLHIV organisation for more information.