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Pozitively Healthy: A Gay Man's Guide to Sex and Health in Canada


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Pozitively Hot: Being an HIV Positive Gay Man

Sex Positive, HIV Positive

When we talked to gay men about living with HIV and having sex, many of them said HIV brings a lot of responsibility. There is no cure for HIV. So many of us will take HIV medications for the rest of our lives. And there is a risk that we will pass on HIV during sex. But your life didn't stop when you got your HIV diagnosis. Like many of us, you were probably shocked and stressed out for a while after you found out you had HIV. Maybe you even felt some shame or guilt. But you went on living. Your sex life can go on too.

What Is "Sexual Health"?

Sexual health means having sex and sexual relationships that are as hot and satisfying as possible. Sexual health also means taking care of your health and the health of your sex partner(s). To be sexually healthy you will probably need to take care of your body, your mind and your emotions. It is important for gay men, including gay men living with HIV, to have the information we need to make informed decisions about our sexual health.

Living Positively and Gay

Homophobia, AIDS-phobia and sex-phobia can affect how we think, feel and behave. Sometimes people direct their phobias and negative attitudes at us. At other times these phobias and negative attitudes might bubble up from inside us. No matter how thick-skinned or "out" we are, these negative attitudes can make us feel ashamed or guilty. Or can cause us to suffer from low self-esteem. Those of us from minority ethnic and racial communities may feel guilt, shame and low self-esteem more intensely. We may have experienced racism and hostility towards our culture on top of homophobia, AIDS-phobia and sex-phobia. Society also judges what it means to be a "normal" man or a "normal" woman. So guys who are effeminate or transmen are judged harshly and may have a hard time feeling good about themselves and their sexuality. You may not always realize how these negative attitudes and feelings affect your health and the decisions you make. But it is important to recognize and deal with the negative effects of homophobia, AIDS-phobia and sex-phobia. This can help you live a proud life and have a fulfilling emotional and sexual life.

HIV Positive People and HIV Prevention

We can reduce the spread of HIV in the gay community if all of us -- HIV negative, untested, and HIV positive -- take responsibility for our sexual health. Most HIV prevention messages are aimed at people who don't have HIV. But people living with HIV also play an important role in HIV prevention. Many of us know a lot about HIV. Many of us educate other people about HIV, including the guys we have sex with. You can take better care of your sexual health when you have useful information about sex, communicating with sex partners, and HIV and other sexually transmitted infections (STIs). We hope that the information in this guide will help you make decisions that are right for you. We hope that you can use the information to have a fulfilling emotional life and a hot and satisfying sex life. And to help reduce the spread of HIV and other STIs.

Your Sexual Health, From Top to Bottom

You might run into challenges in your sex life. But there are ways to overcome the challenges.

Your Sex Drive

Your sex drive is affected by your physical, mental and emotional health.

Sometimes you might not feel very interested in sex. That's not necessarily a problem. Your sex drive is affected by your physical, mental and emotional health. Many of us feel less interested in sex when we're stressed, tired, sick, or just dealing with other things in life. Here are some other things that can lower your sex drive:

  • Smoking cigarettes, drinking a lot of alcohol, or taking a lot of party drugs.
  • A low level of a male hormone called testosterone.
  • Anxiety or guilt about being gay, being HIV positive or having sex.
  • Depression or feelings of sadness.
  • Feeling bad or uncomfortable about your body.
  • Some prescription medications.
  • Getting older.

If you are not interested in sex for a long time, and that bothers you, you may want to talk to your doctor. There are probably things you can do to get your sex drive back.

Hard-On, Not Hard Up

If your cock is not getting or staying hard you can do something about it. Prescription medications -- like Cialis, Levitra and Viagra -- can help you get a hard-on. Only a doctor can prescribe these erection drugs for you. They're pricey and your drug plan may not pay for them.

Be careful when you take erection drugs.

  • High doses of erection drugs can damage your cock. Some HIV medications can boost the dose of erection drugs you take. So you may end up getting a higher dose than you actually took. Be especially careful if you are taking the HIV medication called ritonavir (Norvir).
  • Avoid poppers. Poppers cause a very sharp drop in your blood pressure. Erection drugs lower your blood pressure too. Combining the two can be dangerous, especially if you have heart or blood pressure problems. Some guys who take erection drugs use poppers and don't have any problems. But your body may react differently.

If you still get a hard-on in the morning, erection drugs are probably not the answer. Taking care of your emotional or psychological health may be the answer. You can start by finding a doctor, other health professional or counsellor you feel comfortable talking to about your sex life.

Coming Clean on Butt Play

For many gay guys it is important to have a clean ass when we have sex.

For many gay guys it is important to have a clean ass when we have sex. HIV might make that a challenge. HIV and HIV medications give some guys diarrhea. If you have diarrhea, here are some things you can do to stop it:

Diarrhea that comes on suddenly can be a sign of an infection. Go see your doctor. You may need medications to get rid of the infection.

  • HIV medications, and other medications, can cause diarrhea or make it worse. You might be able to switch to different medications that won't cause diarrhea. Ask your doctor.
  • Medications like Imodium and Lomotil can help stop diarrhea. You can buy Imodium without a prescription at your pharmacy. (The active ingredient in Imodium is loperamide HCl. Most drug plans will cover some or all of the cost of Imodium if your doctor writes a prescription.) You can only get Lomotil with a prescription.
  • Natural treatments may also help you. You can get natural treatments at a pharmacy, health food shop or grocery store.

    • Psyllium fibre can bulk up your shit.
    • Pro-biotics like acidophilus restock the healthful bacteria in your gut and reduce diarrhea. Many yogurts and some other foods contain pro-biotics. Read the label to find out.
    • Calcium can also help. You can take a calcium supplement pill and eat foods rich in calcium.

Some guys clean their ass out with water -- called douching -- before ass play or getting fucked. Douching can make the inside of your ass more sensitive and easier to damage. So you may not want to douche, or douche too much. It's up to you to figure out what works best for your body.

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This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
See Also
More Resources Related to Gay Men and HIV/AIDS

Reader Comments:

Comment by: Walker (Australia) Wed., Dec. 21, 2011 at 2:35 am UTC
Hi look i came across to your page as a suprise to me that HIV can affect your sex performance for everywhere i go to my GP or calling the HIV hotline they are telling me the oppisite, i am a 27 year old female and have been with my husband for 5 years and only found out he had HIV which he knew about but did not tell me. I have noticed that my husbands sexual performance was changing, he was getting erections but as soon as he will insert his penis it would go down, before we use to have sex for hours but now he only last's 10 minutes, his medication is Atripla and his viral load is low but i have noticed that he sleeps alot and he eats less but when he does eat he never puts on weight (his really skinny), his got red blood shot eyes and his sexual performance has changed where he does get a erection but does not last long, would you know what this is caused from?
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Comment by: Trevor (RSA) Fri., Jan. 15, 2010 at 1:25 am UTC
This guide is excellent in my view! It is informative,frank,clear and to the point. Many of these issues are the same everyone in this position has to work through. Had I known of the resources provided on this site and in particular this guide, it may have saved me so much time, mental anguish and pain. I am however still a proponent that if you can persuade yourself to use condoms at all times it is really worthwhile for you and anyone you have sex with.
HIV replicates astronomically quickly if even slightly out of control and so mutations that are ARV resistant are very likely.

According to Prof Racaniello, “because over 1016 HIV genomes are produced daily, thousands of potentially resistant viral mutants arise for any combination of ARVs. The HIV-1 genome can exist as (10 with 6020 zeros) different sequences. In perspective: there are (10 with only 11 zeros) stars in the Milky Way."
So in order to ensure effective control of viral activity and future effectiveness of ARV’s for persons that may still be infected it is essential to keep one’s own virus strains quarantined as far as possible and not to allow even remote re- or co- infection to be possible. For this reason I believe condoms and other safe sex practices are also not negotiable.
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