Paying attention to sexual health when you’ve got HIV doesn’t just mean taking steps to prevent passing on the infection to someone else. It doesn’t just mean trying to avoid picking up any new sexually transmitted infections yourself, either. Good sexual health is about more than just your physical health.

The World Health Organisation’s definition of sexual health says that it is ‘a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity…[sexual health] requires the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence…[and] the sexual rights of all persons must be respected, protected and fulfilled’.

Your sexuality is part of you; part of what makes you human. Having sex and relationships in your life is as important for you as it ever was. Living well with HIV means looking after yourself – and that means your emotional self, too. Cutting yourself off from positive, pleasurable experiences isn’t good for you. You could easily become depressed, and that could affect your health in a negative way.

Obviously it’s fine to be single or celibate if you choose to be – but don’t choose it because of your anxieties about transmitting the infection to someone else, or because you feel you aren’t desirable.

It is important to remember that HIV is an infection – a virus, like the common cold, or flu. It is not a moral judgment or a punishment.

Sex feels good. That alone is reason enough to continue to enjoy it as often as you wish. But there are other, well-documented health benefits too: sex helps you to relax and to sleep better, sex can be very good exercise, and sex can relieve pain, improve circulation and lower cholesterol levels!

For all of the above reasons, it’s worth trying to sort out any sexual problems, difficulties, questions or anxieties that you may have as soon as you can. Please don’t hesitate to raise sexual matters with your HIV doctor or the team at your treatment centre. They won’t be shocked – and if they don’t have the expertise to help, they’ll refer you to someone who does.

HIV, sex and the law

Several people in the UK have been sent to prison after being convicted of grievous bodily harm (GBH) because they infected their sexual partners with HIV through unprotected sex, without having first told them they were HIV-positive. The police are investigating other cases, and it is thought that there could be many more prosecutions.

It is important to remember that condoms, when used properly, provide excellent protection against HIV and most other sexually transmitted infections. Lawayers think that if you use of condoms every time you have sex and for the entire duration of sex then you would have a good defence if transmission did occur. But this has not yet been tested in court.

Ultimately, it is your decision whether to tell your sexual partners that you have HIV. You may want to consider whether the kind of sex you are having involves a substantial risk of HIV transmission – unprotected anal and vaginal sex have the highest risk, but there is good evidence that there is also a (much smaller) risk from giving oral sex.

If you do decide to tell your sexual partners, you will need to consider how and when you will do this. In particular, think about what you will do if you are rejected, or if you are verbally or physically threatened or attacked.

Often, sex happens in the heat of the moment. You may not get an opportunity to mention that you have HIV, or your partner might not want to discuss it. You may also find that your partner initiates unprotected sex. Think in advance about how you would respond to these situations. Don’t assume, just because your partner doesn’t want to talk about HIV or is willing or even eager to have unprotected sex, that he or she is HIV-positive.

Just as HIV-positive people have a responsibility to look after their own health and not pass on HIV, HIV-negative people have a responsibility to look after their own health and not catch HIV. But the law as it now stands means that the balance of responsibility has shifted to people with HIV.

The criminalisation of HIV transmission is an evolving and controversial area of the law, which has had consequences for doctor-patient relationships.

The recent convictions have led some healthcare professionals to believe that they have a responsibility to tell their HIV-positive patients that they must disclose their status to all their sexual partners – before they have sex. Some professionals fear that if they fail to do so, they will have been negligent and could themselves be prosecuted. The British HIV Association, the professional organisation of the UK’s HIV doctors, has produced a briefing paper for healthcare staff about HIV transmission and the law.

The briefing paper covers the following areas: 

• What constitutes appropriate advice from healthcare workers to people with HIV about the implications of HIV for themselves and others. This includes providing information about disclosure of HIV status to sexual partners, the availability of post-exposure prophylaxis, and the circumstances in which prosecutions have occurred*
• What constitutes appropriate support for people with HIV. This includes a recognition of how difficult disclosure can be for some people, and how it is likely to be a process, rather than a one-off event.  There is also information on how police enquiries should be dealt with.
• Confidentiality. The briefing paper states that the guidance of the General Medical Council should be followed.

There are regular news updates on the criminalisation of HIV transmission on NAM’s website, www.aidsmap.com. If you want to speak to somebody in confidence, or are being investigated by the police for the transmission of HIV, contact THT Direct on 0845 12 21 200. THT also published an information leaflet on criminalisation, which can be read on their website, www.tht.org.uk.