Sexual Relationships When You're HIV-Positive

Don't worry: You can have good sex and a healthy relationship with your partner, even if one of you has HIV.

You'll have to use protection when you're physically intimate, whether you're in a mixed-status couple (one person has HIV and the other doesn't) or you're both HIV-positive. But HIV doesn't have to get between you.

A Healthy Sex Life

Most kissing is perfectly safe, since HIV isn't in saliva. There's a tiny risk that if either of you has a mouth sore or cut, French kissing could spread HIV. But it's extremely unlikely, experts say.

Contact like cuddling and hugging is safe.

Unprotected sex is the most common way of spreading the virus. Male and female condoms dramatically lower the chances of passing HIV to your partner. If both of you have HIV, you still need to use protection. You could catch a different type of HIV from your partner, which could make your disease worse or mean that you need to change medicines.

You should use protection with oral sex, too -- a condom or dental dam.

What about everything else? HIV is only in certain bodily fluids: blood, semen, and vaginal and anal secretions. To infect someone else, those fluids have to get into that person's body, usually through a mucus membrane or cut. So you can sexually satisfy each other safely, using your hands or your bodies, as long as you're careful about where those fluids are going.

You're more likely to spread HIV when you have multiple sex partners, have other STDs, or use injectable drugs.

Treatment as Prevention

One of the most important ways you can protect yourself and your partner is to stick with your HIV medicines. Antiretroviral therapy (ART) can make it hard for the virus to make copies of itself and spread in your body. It can lower the amount of HIV so much that there's not enough of it to show up in tests.

If your viral load is down to an undetectable level, research shows there is little to no risk of transmitting HIV to someone else. Still, you shouldn't rely on treatment alone as protection.

"We always tell people to use more than one form of protection, like treatment along with a condom," says Brad Hare, MD. He's the director of the University of California, San Francisco HIV/AIDS Division at San Francisco General Hospital. While no one form of protection is 100% effective, combining them can strengthen your defenses.

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PEP and PrEP

Sometimes, it makes sense for the person without HIV to take HIV drugs, too.

PEP (post-exposure prophylaxis) is like a "morning-after pill" for HIV. If you think you've been in contact with HIV (if a condom broke, for example), see a doctor right away. You may be able to take antiretroviral drugs for 28 days to prevent the virus from taking hold. It's generally effective, but you have to start within 72 hours -- the sooner the better.

PrEP (pre-exposure prophylaxis) is antiretroviral treatment you take before you might be exposed to protect you from HIV in case you come in contact with the virus.

Who needs it? An HIV-negative woman who's trying to get pregnant with an HIV-positive man might, Hare says, to help keep her and the baby safe. If you and your partner sometimes have sex without a condom, talk to your doctor about PrEP.

Your Relationship

When it's a new diagnosis or a new partner, it's OK if sex seems scary at first. Focus on other ways to be intimate -- like holding hands, hugging, cuddling, and casual kissing. It's important that you have that connection.

Keep talking. Be willing to discuss your worries and concerns. You could schedule a visit to a doctor together to talk about what having HIV means for the two of you. Look for support groups in your area. Consider couples counseling if you're having a tough time.

Don't let HIV put your life together on hold. "If you or your partner have HIV, you have to plan for education, a family, a career, and retirement," Hare says, "just like everybody else."

WebMD Feature Reviewed by Minesh Khatri, MD on December 21, 2016

Sources

SOURCES:

John G. Bartlett, MD, professor of medicine, Johns Hopkins University School of Medicine; former director of the Johns Hopkins AIDS Service.

Brad Hare, MD, director, University of California, San Francisco HIV/AIDS Division, San Francisco General Hospital; associate professor of medicine, University of California, San Francisco.

Michael Melia, MD, associate professor, Johns Hopkins University School of Medicine.

AIDS.gov: "FAQ," "Partners with Different HIV Statuses," "Post-Exposure Prophylaxis," "Pre-Exposure Prophylaxis," "Sexual Risk Factors."

CDC: "HIV Transmission," "Oral Sex and HIV Risk."

New York State Department of Health: "Frequently Asked Questions About Condoms."

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