Is sex too much bother because you’ve
got HIV? Let’s see if we can change your mind with Jack Summerside’s
new monthly guide to a healthy, happy, positive sex life
Sex
is everyone’s favourite subject, whether they admit it or not. But while
the world is awash with advice on how to get laid and, to a lesser extent,
how not to get HIV, there is little on how positive people like us can play
safe and still have a good time between the sheets or in the backroom. Precious
little sexual health info is directed at us and if you are an HIV positive
woman or African there is even less.
Try putting ‘oral sex’ into Google and see what comes up. Most
results will be about oral sex involving the penis. And you’ll have
to travel a long way down before you get to pages discussing the vagina. More
to the point, you have to trawl endlessly before you find anything that talks
about what’s important to us HIV positive people.
OK, you can pull out what you need to know from reading about ‘The risks
to you of getting HIV from sucking cock’ by reversing the facts and
the flow of fluid. You may even be able to transfer some facts and make an
educated guess about cunnilingus (getting your vagina orally entertained)
from all the euphemistic references to fellatio (getting your cock sucked).
But it gets a bit tiresome always feeling like you’re on the sideline.
Time, then, for PN to fill the hole, so to speak, to put our sex lives back
on the agenda and get down to brass tacks. You’ve told us through letters
and emails that what you want is more about how we can look after own sexual
health and that of our lovers.
And God knows there are enough of us living with HIV to warrant some serious
sex talk that’s just for us. As positive people, our concerns about
HIV are different: the risk of passing it on rather than getting it. But we
also need clearer and better info on other STIs, getting pregnant safely,
HIV re-infection, and a whole list of things that complicate trying to balance
a life with HIV with a meaningful sexual and emotional life.
Our purpose with The Sex Pages is not to shock nor act as merchants of doom.
We won’t be dwelling on the downside of sex. We also won’t be
playing nanny and tiptoeing around mentioning certain kinds of sex. Frank
discussion of sex doesn’t have to be the sole preserve of gay men; other
people living with HIV have sex too, so we will be coming at it from all angles.
We all have a right to good sexual health, and the government agrees, so if
it’s good enough for them, it’s good enough for us.
‘Sexual Health is an important part of physical and mental health. It
is a key part of our identity as human beings together with the fundamental
human rights to privacy, a family life and living free from discrimination.
Essential elements of good sexual health are equitable relationships and sexual
fulfilment with access to information and services to avoid the risk of unintended
pregnancy, illness or disease’. Department of Health (England
& Wales) 2001
More
leads to more
Why do gay men and African people get HIV more than anybody else? The simple
answer is because more of us in those communities already have it. More people
have it, so more people get it from us. Those interesting people who study
epidemics call this ‘prevalence’. The more there is of something
in a population (higher prevalence) the greater number of chances of it being
passed on to someone else. This is true of all diseases that can be passed
on, from HIV to herpes to the flu.
So the way HIV spreads isn’t simply down to what we choose (or have
to do) in our sex lives, although high number of partners sometimes does play
a part. Are our sex lives really so different from the rest of the great British
public, in terms of numbers of partners or how we have sex? Probably not.
It’s HIV prevalence that’s different.
Coming Up...
In the next few months The Sex Pages will look at all kinds of sexual health
solutions, inspired by readers’ suggestions and experiences. This month
we take a broad look at sexually transmitted infections and next month we
get the low-down on unprotected sex. In future editions we will cover everything
from sperm-washing to vaginismus via a look at the relationship between HIV
viral load and the risk of infection to a negative partner.
We want to hear about what you want to see in The Sex Pages. This isn’t
an agony column; we want your opinions, comments, and even practical advice
to other positive people. You can make this feature a real reflection of positive
people’s needs and experience of having happy, healthy and successful
sex lives.
Email your ideas and thoughts to: thesexpages@positivenation.co.uk
Mind the clap trap
You might think of sexually transmitted infections
as just an occupational hazard. The first of Jack Summerside’s Sex Pages
takes a broad-spectrum look at STIs when you’re already HIV positive
When
I was diagnosed with HIV in 1995, I recall being asked at the clinic how and
when I thought I was infected, and whether I may have infected anyone since
then. But I have no memories of much advice on looking after my future sexual
health. This was in the days before protease inhibitors, so it’s probably
true that some of that old too-busy-dying-to-go-out-shagging mindset still
prevailed.
Things are very different now. Judging by a glance through the programme at
the recent International Aids Conference it seems there’s never been
more interest in the sex lives of positive people. At last, it seems our sexual
health needs, post-diagnosis, are starting to be recognised.
For many of us, and I’m only here talking about those of us for whom
unprotected sex has an emotional and sexual value, the only upside of getting
an HIV diagnosis was that it meant you didn’t have the worry of catching
it anymore.
Like a lot of positive people you may feel having HIV already means you have
the last word in sexually transmitted infections;
anything else is just inconvenient and pales by comparison. But gonorrhoea,
syphilis, chlamydia, herpes, hepatitis C and genital warts can be a bigger
deal for us than you might think.
The bottom line is that prevalence of some STIs is higher amongst diagnosed
positive people, with some infections high in certain groups and rare in others.
The prevalence of syphilis, for instance, is high among some groups of positive
men (men into fisting, sex groups and what you might call ‘unconventional’
relationships), but not among positive gay men across the board or other positive
people.
Have a look at the statistics from the Health Protection Agency (www.hpa.org)
if you’re interested in numbers. Sometimes it’s unclear that it’s
people already living with HIV who have become infected, because the term
‘co-infected’ is often used. This can be confusing as it can mean
‘infected with at the same time’ or ‘infections caught one
after the other’ which are different things altogether.
Not just hard to shake off
Gary, 38, is a gay man who often chooses to have condomless sex with other
men with HIV. He’s thought a lot about that since he discovered the
hard way that HIV ain’t the only nasty bug in town.
“I’d heard something about syphilis being harder to treat when
you’re positive, but I’d pretty much dismissed that as political
correctness trying to scare us off. I’d no idea that syphilis can be
harder to identify by the medical tests because of having HIV. By the time
I got a positive syphilis diagnosis, after previous tests came back negative,
I’d lost the sight in one eye, had a mouth full of ulcers and lost about
a third of my body weight.”Syphilis is like putting petrol on a fire
when it's mixed with HIV. False-negative test results aren’t uncommon
because of the way the two infections interact. Also, in people with HIV,
syphilis can advance to neurosyphilis (affecting the brain, spinal cord and
nerves) at any stage, whereas in HIV negative people this normally happens
after someone has had syphilis for years and is in the later stages.
We’ll be looking more at syphilis in future Sex Pages, as well as at
hepatitis C. Warts it all about?
Marion has been HIV positive since 1998 and already had HPV, the virus that
causes genital warts. Positive women are, on average, twice as likely to have
HPV as their negative sisters, with a greater risk for women like Marion who
are under 30.
“I go for regular smear tests now to check that nothing has changed,
like cancer or pre-cancer developing. I’ve been told the risk of that
is much lower since I started ARVs because my immune system’s recovered
quite a lot.”Genital warts are a concern for a lot of positive women,
because of the greater risk of them being a trigger for cervical cancer due
to having HIV. And there’s increasing evidence about anal warts having
much the same effect, and that is something that men and women need to be
aware of.
STIs:
what’s the big deal?
• Your viral load may rise as your body fights off the new infection
and cannot focus on HIV as it used to.
• Your HIV treatment might stop working too.
• Some STIs are hard to diagnose in positive people, so they progress
to a more serious stage.
• STIs like syphilis can worsen some HIV-related health problems that
a lot of us have like neuropathy and joint and muscle pain.
• Infections that cause sores or broken skin on your hands, mouth, vagina,
penis or anus can provide a direct route out of your body for any STI or HIV,
making you more infectious to a partner.
• If your partner has an STI too then this can create a direct route
into their body for your HIV.
Sometimes treatment for STIs has to be more aggressive, and therefore more
unpleasant when you’re HIV positive, as Gary discovered.
“I thought the multiple injections in my behind were just a story put
out to teach me a lesson. It wasn’t until I read up* about it that I
realised the standard treatment just wasn’t going to shift the syphilis
and there was a reason for it, other than giving me a sore arse.”
Do something practical
• Get yourself down for a sexual health screen
• Get any treatable infection treated
• Don’t have sex until the treatment has workedThe last point
is not just a social nicety; it’s bad form (and bad karma) to pass on
something. Think of your ‘sexual career break’ as an investment
in the future. Pass your STI on and it may well come back to you. It almost
certainly will if you pass the infection to a regular partner. Putting it
about might even mean you end up in a prison cell these days so “think
on and look sharp”, as they used to say on Coronation Street.
And finally...
• Make sure the treatment has worked; go back for follow-up tests.
• Using condoms (predictable but true) can help reduce the risk of getting
infected.
• Remember, infections that live in cum and vaginal fluid can be spread
from person to person and to different parts of your own body, by touching
before and after penetration; not just during the in-and-out bit of sex.
A condom can be a downer if using them is something you really can’t
face because of your cultural or religious beliefs, or because you just like
cum without a condom. So it’s a toss up between what you prefer and
what you risk. Your call. Your choice.
*Gary read up about syphilis treatment in the BASHH (British Association for
Sexual Health and HIV) clinical effectiveness guidelines for STI treatment
in people with HIV. See www.bashh.org
