Every person living with HIV deserves sex -- not just those on HIV meds. Yes, it's important to celebrate meds and messages like "Undetectable = Untransmittable," particularly at a time when so much misinformation abounds. Being undetectable is a testament to where science and activism have brought us. But many HIV-positive folks are not undetectable, and some of our discourse runs the risk of demonizing them for the same virus we all have.
There's nothing sinister or predatory about going off meds. After my year break, I was nervous to restart treatment for fear of what my doctors would say. They met me only with welcome and understanding, and that is what I hope to deliver here.
If you choose to delay or discontinue treatment, your doctor will likely object. Regardless, here are some risk reduction tips to keep yourself and others safe and healthy.
1. First things first: Make sure your info is correct.
Twenty years ago, antiretroviral therapy involved intense cocktails with harsh side effects. The task of timing pills and doses throughout the day discouraged many people from starting treatment. That reality has changed.
Today, single-pill regimens have effectively eliminated these hardships. The meds are safer, more accessible and effective, and easier to take now than ever before.
Be equipped with the most accurate information about what HIV treatment is like today. There are still many reasons people go off meds: adherence challenges, drug use, depression, homelessness, economic stresses, personal choices, and distrust of medicine are just some of them. But let's rule out misinformation.
2. Explore non-penetrative sex. Your options are endless.
One problem with most sex media is its hyperfocus on penetration, which is something that many people do not or cannot enjoy.
Many queer men, for example, do not enjoy anal sex or are unable to have anal sex due to various conditions, and the undue attention bottoming and topping receive in gay culture tends to make them feel left out, alone, and "wrong."
It's time to expand our understanding and appreciation of what the body can do and feel.
There are so many ways to experience pleasure and intimacy without penetration. A few examples: Up your kissing game; master oral; celebrate the beauty of simple, passionate touch.
3. Communicate thoroughly with everyone you play with. It's the right thing to do.
You're not barred from penetrative sex, but it's a good idea to talk to your playmates about the fact that you're not on meds. The risk of HIV transmission is higher, so keep them informed.
4. Explore non-penetrative kinks and fetishes.
A common phrase among kinksters (kinky people) is that there's a fetish for everything under the sun, including the sun. (It's true: Actirasty is arousal from sunlight.) This means there are limitless kinks and fetishes to be enjoyed and explored which have nothing to do with penetration.
Have a tickling fetish? You'll never know until you try. Masochists (people who receive pleasure from pain) actually enjoy some of the most harmless sex out there. Spanking, flogging, nipple torture, and various other forms of BDSM pose virtually no risk of transmitting HIV (or any other sexually transmitted infection, for that matter).
5. Feeling hardcore? Fisting and other extreme kinks are fair game.
Some interesting AIDS history: There was a time in the '80s when gay men into fisting were blamed by some as the originators of the disease. At the time we knew relatively little about HIV, and fisting was considered so shocking (and was so heavily associated with heavy drug use, which is unhealthy) that some believed us (I'm a fister) to be the cause. If you scour vintage sex magazines like Honcho and Drummer, you can find letters and op-eds about this.
We now know that fisting is much safer than bareback sex in terms of transmission risk. Its major risks are anatomical (tears and injuries), not infectious. Extreme kinks like ball-busting, mummification, suspension bondage, breath play, and others pose virtually no risk of transmitting HIV.
6. Elevate masturbation to the high art it is.
Our culture tends to downplay masturbation as a "lesser" sex craft; going home alone is often seen as a sign of defeat. But here's a fact: My hand (as well as a nice medley of toys -- more on those next) can make me feel better than most people can, and the same is true for most of us.
Spend time exploring your body. Ritualize the experience and create space to please yourself.
7. Try toys.
Another misconception is that those who enjoy sex toys do so because they can't get "the real thing." This assumes all sex toys are insertables (they're not) and that human parts always feel better than products (they don't).
My early days with HIV left me nervous of human connection, and in that time I discovered my love of sex toys, from plugs to nipple clamps, and everything in between. I no longer fear sex with others, but many nights I still choose a nice solo session with my favorite toys.
8. Dial back the anonymous play.
Yes, it's thrilling, but it poses problems. Every time you have an anonymous hookup, which is sex with someone you don't know, with minimal or no talking before or after, you assume the risk that the person you fuck has some communicable infection (which may be anything from HIV to the common cold).
Protect yourself. Communication does more than keep them informed -- it keeps you safer, too. If you're not on meds, your immune system doesn't need the added stress of whatever they may have.
Keeping a steady pool of regulars will keep you safer, as a regular hookup is more likely to let you know if you should cool it for a couple of weeks because they have chlamydia (or a bad cough).
9. Recognize the danger of sex drugs.
It's just a fact: A major medication adherence barrier recognized by HIV activists is drug use. There's a correlation between crystal meth use and folks going off meds.
Drugs are incredibly unhealthy for the body and can lead to dependency and addiction, which will make it harder for you to get back in the medical system should you feel you ever need to. I won't demonize drugs, as I have my own history with them (as do many people living with HIV), but it's important to recognize their dangers.
You don't want to get stuck in a place where you can't trust yourself to take care of yourself. Going off meds depends on you making cognizant decisions for your health and having the ability to recognize when you might be getting sick. Drugs tend to erase this ability. They will make you of two minds on how to live: by urge and impulse or by reason. The former is how people get lost.
If you think you might have a problem, call The National Drug Helpline, a 24/7 service that can connect you with treatment centers, recovery programs, and other resources. The number is 1-888-633-3239.