Although it’s not certain to happen, you may find that your feelings about sex change after you find out you have HIV. It could be that your interest in sex dips or disappears altogether for some or all of the time – or, conversely, that your interest in sex becomes stronger, more intense. Either of these changes could be due simply to natural fluctuations in your desire for sex, of course. But such feelings could cause you problems, particularly if they make you unhappy or interfere with other aspects of your life.

Finding out that you have HIV can make you feel differently about yourself. The diagnosis may well come as a shock to you, and it could make you go off sex – at least temporarily. Some people with HIV say they feel less physically and sexually desirable than they did before, and that they have less confidence with their sexual partners.

Having HIV can make you look at yourself and sex in a negative light. It can make you feel bad about the kind of sex you had or are having, or angry with the person or people who could have infected you.

An HIV diagnosis might feed wider negative feelings you have about who you are. HIV has been used as a moral and political tool to criticise and stigmatise the groups most affected in this country – gay men, Africans and drug users.

You may feel anxiety about infecting your sexual partners with HIV, and this can cause your desire to have sex or your sexual performance to dip.

The thought of telling your past, present or potential sexual partners that you have HIV can also cause anxiety. You need to decide for yourself whether you will tell none, some or all of your sexual partners.

Although many HIV-positive people have HIV-negative long-term partners or casual partners, sometimes people can be rejected because they have HIV. This can be very hurtful (or even, in some circumstances, put your personal safety at risk) and it is important that you develop strategies to help you cope if it happens to you.

You could discuss this with a health adviser or counsellor. They could help you think about how and when you might tell people that you have HIV, and how you would respond if any of them react badly.

Often, HIV-positive people have partners who are HIV-negative. Many couples are able to have protected sex all the time, but others find this difficult or impossible and are willing to accept the risk of the uninfected partner contracting HIV. In some circumstances, power imbalances in a relationship can mean that even though one partner wants to have safer sex, the other partner insists that condoms are not used.

HIV can also lead to a loss of sexual intimacy in relationships. Learning to enjoy and value intimacy that isn’t sexual can be valuable if this happens.

Some HIV-positive people choose only to have sex with people who also have HIV. Sometimes this is because they don’t want to take any risk of infecting someone else. Another reason might be that they want to have sex without using condoms. This can be very pleasurable and intimate, but both partners in this situation are taking risks – the risk of catching another sexually transmitted infection or hepatitis C, for instance, which can have a negative affect on your HIV and its treatment. And there is also the risk, thought to be much smaller, of re-infection with another (and possibly drug-resistant) strain of HIV. These issues are discussed in greater detail in the following pages.