The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol

Sex and the Poz Gay Man

On Building Good Sexual Health

Spring/Summer 2010

Sex and the Poz Gay Man
If being HIV positive raises a million questions, being poz and sexually active raises a million more. In his article "Law & Disclosure" in The Positive Side, Glenn Betteridge wrote about one such question for people living with HIV/AIDS (PHAs): When are you required by law to inform your sexual partner of your HIV status?

Even if you've managed to keep the courtroom out of your bedroom, plenty of other uncertainties remain. Does having an undetectable viral load mean you're no longer infectious? How do sexually transmitted infections (STIs) affect people with HIV? How do you initiate sex if you think your prospective partner may be poz-phobic?

HIV-positive gay men may find these questions especially pressing. Gay culture can put a lot of value (and pressure) on having sex. How can a poz gay man feel healthy and horny when sex seems so fraught with potential landmines? Here are some issues that you might consider as you chart your course.

First, you can begin by acknowledging that just as your life didn't end when you were diagnosed with HIV, your sex life doesn't have to end either. Sexual health is an important part of your overall health; it means taking care of yourself as well as your partner's well-being -- physical, mental and emotional -- while still getting hot and heavy.

Second, there are countless shelves of material describing how to lower HIV transmission risk through safer sex. Check out some of these for yourself at, or better yet, call CATIE's HIV information line at 1.800.263.1638 to get all the info you need. But a worthwhile sexual health discussion certainly shouldn't begin and end there. Poz gay men need to hear that they are still sexual and sexually desirable, despite the homophobia and AIDS-phobia that may surround them. They need to know how to discuss HIV openly and honestly with their partners. And they need accurate facts -- not just about HIV transmission risk, but about STIs, hepatitis C, recreational drugs and more.

One of the most recent controversial questions is whether an HIV-positive person on antiretroviral treatment and with an undetectable viral load can pass on HIV to another person through sex. While it's impossible to do justice to this question in just a few words, the short answer is yes -- it is still possible to transmit the virus. Although there is convincing evidence that an undetectable viral load can lower the risk considerably, there are too many variables to be certain and there has been very little study of this issue in gay men (see "Sex, Drugs and Viral Load" in the Winter 2008 The Positive Side).

Third, sexually transmitted infections other than HIV may require special attention if you are HIV positive. Some, such as herpes, can be more severe in people with HIV. Others, such as syphilis, can require more aggressive treatment (currently, while a single dose of intramuscular penicillin is the standard treatment for early-stage syphilis, some experts may prescribe a stronger course of treatment for PHAs). Additionally, certain types of STIs -- such as syphilis, herpes and gonorrhea -- can increase the risk of transmitting HIV during sex. Take-home message: Sexually active poz gay men should get tested for STIs regularly.


Finally, all of this assumes that you're willing and able to have sex in the first place. But this can sometimes be a challenge. For many poz gay men, being positive creates a lot of anxiety and guilt, and there may not be the desire to have sex at all. Some men may wish they were more interested in sex; others have the desire but have trouble getting or keeping an erection. Many things can conspire to lower your sex drive and/or your ability to get hard -- low testosterone, depression and anxiety, and using prescription or recreational drugs, to name a few. But very often there are steps you can take to overcome these challenges. (For some personal and medical perspectives, see "Sexual Healing" in the Fall / Winter 2005 The Positive Side.)

Like many other aspects of HIV, sexual health is a big and often complex subject. By talking about some of the million questions that arise for poz gay men, we can come to realize that being HIV positive and "sex positive" can, in fact, go hand in hand.

The publication Pozitively Healthy: a gay man's guide to sex and health in Canada (CATIE Ordering Center catalogue number ATI-26083) was developed by and for gay men living with HIV across the country. Its brother publication is HIV and Disclosure: a legal guide for gay men in Canada (ATI-26081). Both publications, produced in partnership with Ontario's Gay Men's Sexual Health Alliance, HIV & AIDS Legal Clinic (Ontario) and Toronto PWA Foundation, can be found at and copies can be ordered through the CATIE Ordering Centre. People in Ontario should refer to the Ontario versions of these guides. (Ontario version of HIV and disclosure guide.) In Ontario, contact your local ASO to obtain a copy.

Derek Thaczuk firmly believes that gay men and all PHAs have the right to bring sexy back.

Poz Prevention

While HIV prevention usually only targets HIV-negative people, there's a growing understanding that everyone -- positive, negative and those who don't know their status -- can help prevent new HIV infections, without blaming or demonizing those living with the virus. Lovers of buzzwords call this poz prevention. After all, many poz gay guys know a great deal about HIV and safer sex, and we often end up educating other people, including the ones we have sex with. Some AIDS service organizations (ASOs) now feature poz prevention programs.

More From This Resource Center

Undetectable Viral Load and HIV Prevention: What Do Gay and Bi Men Need to Know?

Do HIV-Negative Gay Men Need Condoms if They're on PrEP? Here's What I Tell My Patients

This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
See Also
More on Sex, Dating & HIV for Gay Men

Reader Comments:

Comment by: Joe (San Diego, CA) Thu., Oct. 28, 2010 at 4:36 pm UTC
Hi, I'm a gay man that will be engaging in regular sexual activity with an HIV+ gay man, as soon as he is released from prison later this year. I thoroughly enjoy rimming a man. It's just one of the sexual activities that excites me truly. I know that I could use a dental dam to rim my man, but I'd rather not. Couldn't he just clean his anus and that would be sufficient. Also, there is still some confusion about pre-cum. I give really good head, and would like to do this to my partner without a condom. I've heard it many times that with regards to pre-cum, your saliva acids and stomach acids would kill the virus. Is this 100% factual? Need to know.
Reply to this comment

Comment by: Daniel Reeders (Melbourne, Australia) Sat., Jun. 5, 2010 at 5:14 pm UTC
In this day and age it really isn't acceptable to take the L out of PLHIV and keep the A, when so many will never experience an AIDS-defining illness because they take treatments and live with HIV.
Reply to this comment

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read's Comment Policy.)

Your Name:

Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:


The content on this page is free of advertiser influence and was produced by our editorial team. See our advertising policy.