Sex in the Age of AIDS

Physical intimacy is as essential to well-being as proper nourishment. All human beings need to touch and be touched -- and people with HIV may need that contact more than most, because all too often they are denied their fair share of physical intimacy. Sometimes it is the HIV-positive individual who shrinks from direct contact with others, for fear of inadvertently transmitting the virus. More often, it is others who draw back, out of ignorance, uncertainty, or apprehension.

The most intimate forms of human contact are sexual, and in the age of AIDS unprotected sexual relations are not just moments of great intimacy, they are also moments of great potential peril. The vast majority of the estimated 20 million people worldwide who have HIV were infected during sex (and the vast majority of these were infected during heterosexual intercourse). Most sexually-active Americans know these basic facts, and most people with HIV are acutely aware that HIV can be transmitted through sexual contact.

What should they do? It is reasonable to ask people with HIV to avoid infecting others. It is unreasonable to ask them to avoid having sex -- which is too primal, too pleasurable, and too central to human identity for most people to give up. For all individuals with HIV, and for all of their sexual partners, the answer is: Have sex... but have considerate, careful, consensual sex -- with condoms.

In this issue, Dr. Joshua Schechtel of San Francisco's Center for AIDS Prevention Studies describes the full range of human sexual activities in straightforward, simple-to-understand language -- and he discusses the degree of risk involved in each of these activities. As Dr. Schechtel avers, "It is possible for people with HIV to have sexual relations that are stimulating and gratifying, emotionally saturated and erotically charged -- all while keeping the risk of transmission to a minimum." But to achieve this desirable objective, all people with HIV -- and all of their sexual partners -- need to understand the risks involved. Dr. Schechtel's clear, concise, candid article is a good place to begin that process.

Some forms of sexual activity are essentially risk-free, while others carry considerable risk that the virus will be transmitted. In the end, it is up to both partners to negotiate the degree of risk that they are willing to assume in order to attain the degree of stimulation and gratification they need. These negotiations require communication, cošperation, and consideration. And the ensuing sexual activities usually require condoms.

Several generations of Americans have come of sexual age since birth-control pills replaced condoms as the primary means of preventing conception. As a result, most sexually-active Americans have little experience with condoms -- and many misapprehensions about them. They regard condoms as cumbersome, sensation-blunting, and unreliable -- when, in fact, condoms need not be any of these things. To be effective in preventing HIV transmission, however, condoms do need to be used correctly and consistently. The special four-page Pull Out and Save section in this issue explains the proper use of condoms, including a new condom that can be worn by women.

Paul A. Volberding, M.D., is Editor-in-Chief of AIDS Care and AIDS Program Director at San Francisco General Hospital.