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 www.catie.ca, 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 www.catie.ca 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.
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.