Dr.Fawcett,

l am a 60 year old gay man with HIV, undetectable for a few years with a t-cell count over 600. l experience a lack of erections when l have sexual relation. Is there anything, besides the blue pill, that l can do to solve this situation? This concerns me when I consider looking for another lover. l will wait for your answer. Thank you.

Several factors you mention, including the HIV virus and age, can affect one's ability to get or maintain an erection. Erectile dysfunction drugs such as Viagra (the "blue pill"), Cialis, and Levitra can greatly help, although they can have serious complications when used with blood pressure medications and poppers. Discuss this with your physician to be certain your testosterone levels are normal. You may want to consult with a urologist who could discuss other medical options, including injectables or mechanical devices. The brain is a vital part of sexual arousal and you might also benefit from a few sessions with a sex therapist. Sometimes there are subconscious negative beliefs that can have an impact, or you could be experiencing ever-increasing anxiety about sex caused by worrying if you will get an erection or not. It is often useful to focus less on getting an erection (and orgasm) than on other pleasurable aspects of an erotic encounter. Sometimes, if you focus on other sensual feelings, the erection will take care of itself. Sex is an important part of physical and emotional health - good luck.

These two organizations can provide directories of sex therapists: AASECT and ABS.

-David