Sex has always been a topic that people shy away from talking about, whether HIV+ or negative. Few people want to talk about how to make sex safe and fun. I've often heard positive women tell me, "Everyone thinks that because I am HIV+ I don't need or want to have sex." That is so far from the truth. Sex is an important part of life and an activity that is good for our mental, spiritual and physical health. But to protect those we love and ourselves, we've got to do it safely. This brief article is dedicated to those of you who want to take pleasures in being with your partner(s) ... and protect each other.

Safer sex is not only about preventing new HIV infections; it's about protecting yourself and your partner. One important reason to practice safe sex is to prevent other infections such as herpes, or human pampilloma virus (HPV). Because HIV+ people have weakened immune systems, it's harder to fight off these infections. Diseases that can be transmitted sexually include Herpes, HPV, Chlymydia, Gonnorrhea, Cytomeglovirus (CMV), Hepatitis B and C and Syphilis. If your partner has one of these he/she can transmit that to you if you are not practicing safe sex.

For those of you whose partner is also HIV+, you may be asking the question "What's the point? We're both in this together." Well, the point is that re-infection with a strain of HIV that is resistant to HIV drugs is possible. Reinfection could occur if you're taking anti-HIV therapies, which you've become resistant to, and then, transmit the drug-resistant strain of HIV to your partner. It can also happen the other way around in which your partner transmits a drug resistant strain of HIV to you. This could cause your current HIV regimen to stop working and reduce your treatment options later on.

It's important to remember that HIV levels are in vaginal secretions and semen. The viral load test measures the amount of HIV in your blood not your vaginal secretions or semen. HIV is also present in your menstrual blood. So having an undetectable viral load does not make you or your partner less likely to transmit HIV. If you have a gynecological condition such as herpes or vaginal inflammation there are high levels of HIV in your vaginal secretions. This can increase the risk of HIV infection to your partner or for yourself.

Negotiating safer sex is not easy. There are a lot of factors that make practicing safer sex difficult for anyone. It can take away from the pleasure and heat of the moment, or your partner may not see the importance. However, the first step is knowing how and what can make sex fun and safe.

Here Are a Few Guidelines:

  • Use a barrier every time! Barriers can include condoms (both male and female) latex gloves, plastic food wrap (don't use the microwave-safe style plastic wraps) and dental dams.

  • Use a latex condom and lots of water-based lubricant (lube) to prevent the condom from breaking. It's best not to use oil-containing lubricant products (such as Crisco, Vaseline or baby oil) as they can destroy the latex, making them break easier.

  • For oral sex with a man, it's safest to use a condom. For oral sex with a woman or oral-anal sex (rimming) it's safest to use a dental dam, plastic food wrap, a condom, or latex gloves cut into a flat sheet.

  • You can use latex gloves for hand jobs or fisting. If your partner is sensitive to latex you can use powder free latex or polyurethane gloves. Little tip: If you add a little lube to the outside of the gloves it will increase your partners' pleasure.

  • If you are sharing sex toys, be sure to put a fresh condom on for each user AND when you are going from anus to vagina.

  • Clean your toys with bleach alcohol or soap and water between uses.

  • When having anal or vaginal sex, avoid getting semen in the body by having the man pull out before cumming.

  • When having oral sex without a condom, finish up with the hand or spit the semen out and rinse out with a dental wash rather than swallow.

  • Avoid brushing or flossing your teeth up to two hours before or after oral sex to minimize abrasions. Be aware of bleeding gums, cuts or sores on or in the mouth.

  • Limit the time and frequency of penetrations.

  • Avoid using any products that contain nonoxynol-9 (a spermicide), as this can cause irritation and increase your risk for STDS. Most condoms do not have non-oxynol anymore, but read the label and check with your doctor.

This is about you and your body. No one is going to protect your body as well as you. Communication is key and if your partner is not ready to talk with you about safe sex, then maybe he/she is not ready for sex. Talk with other positive women in your community and see what has worked and not worked for them. Ask your doctor or case manager. More importantly, protecting yourself will help you stay healthy and happy longer, so play it safe!

Shalini Eddens, M.P.H., is with Project Inform.

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