Lifestyle

Issue: 139

JACK SUMMERSIDE TALKS SEX: More than an Occupational hazard?

When you're already HIV positive, you might think of sexually transmitted infections as just an occupational hazard. In this edition of PN we take another look at why other STIs are still something you want to avoid.

way back in the dark ages of 1995 when I was diagnosed with HIV, 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 just 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 programmes of recent International Aids Conferences, and of HIV prevention and sexual health conferences, 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. And that's not least because of the increasing burden of evidence that certain STI epidemics are affecting HIV positive people more than our HIV negative counterparts.

For many of us, and I'm only here talking about those of us for whom unprotected sex has an emotional and sexual value, it can often seem that 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 HIV 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 really can be a bigger deal for us than you might think. And we're not just saying that to scare you into behaving yourself to avoid passing HIV on to other people.

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 and hepatitis C, 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 don't believe it, or 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 chose 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. You can 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.

I'm ready for my close up, Mr. DeMille
It's not just ‘acute' or newly caught STIs that can be a concern for us as HIV positive people. 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. Few HIV clinics have screening programmes for anal warts and pre-wart and pre-cancer tissue changes, but some do. It's worth asking about it, especially if you're long-term diagnosed.

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 worked. The 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 after that...
- 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. PN

What shall I do instead? Knitting?
Having sex too often, and spending too much time looking for it, is a form of addiction, just like gambling, smoking or repeatedly scrubbing the kitchen floor. It might be worth seeking counselling or other support to deal with your addiction. There are numerous workshops and groups that can help.

Breaking the sex habit
- Take up a hobby that gives you a sense of achievement (and yes I know how crass that sounds)

- Set aside at least one evening a week to spend romantic time with your partner, if you have one

- Spend time with friends you can talk to, and if you don't have them find ways to make those kinds of friendships. How about volunteering some time with an organisation whose aims you are interested in. It's a good way to meet ‘pre-screened' like-minded people

- Stop seeking ‘external approval' by avoiding places where you seek it. Log off from the internet chatrooms, stay out of bars and clubs for a while

- Talk to a nurse or doctor at your clinic about counseling or group support

- If it doesn't work 100 per cent at first, give yourself a break and try again.

There is always going to be someone who has more notches on their bedpost than you; so perhaps you need to ask yourself, who are you competing with? And if you still feel you need to be in the top ten, think about how unattractive that might be to other people. After all, who wants to date someone who everyone else has been with already?

Everyone needs to feel good about themselves, but getting that positive feedback from sex is ultimately pretty futile, and as you've just read, risky for your health and well-being. Sooner or later it is likely to be something you'll feel uncomfortable with and might regret.

This feature is an update of material that first appeared in previous editions of PN

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