HIV and Sexual Health

SEX WITHOUT REGRETS

What is safe for you?
Very few things we do when having sex are likely to result in HIV. When you know the basics of how HIV can be passed on, you can decide what sex without regret means for you. For a sexual activity to pass on HIV there has to be:

• a HIV+ person
• a bodily fluid with HIV in it (semen or blood)
• enough HIV in that fluid to be passed on
• another person
• a way for the HIV to get into the other person’s bloodstream

Without all of these things, it is impossible for HIV to be passed on. The amount of HIV in the blood and semen of a HIV+ person varies over time. The more virus there is, the more chance there is of being able to pass on HIV. This is called viral load. A person has the greatest viral load and is most able to pass on HIV immediately after they have just gotten HIV themselves (and may not even know they have HIV). So let’s look at what we enjoy doing and how to reduce the chance of HIV being passed on.

Kissing and cuddling
HIV cannot be spread by saliva. There is no evidence that kissing or cuddling could lead to HIV being passed on. However, try to avoid deep kissing if both you and your partner have:
• open mouth sores
• open cuts in the mouth
• bleeding lips or gums as these involve blood and there’s a small chance of HIV being passed on.

Mutual Masturbation
HIV is NOT passed on by:
• masturbation, either alone or with someone else
• massage and body stroking
• ejaculating on somebody (if there are no open cuts or sores). Avoid using someone else’s semen as a lubricant. It might enter the tip of the penis, or small abrasions on your penis. This might allow HIV to be passed into the blood stream.

Oral Sex
HIV is not passed on from the mouth to someone else’s penis. There are a small number of recorded cases of people getting HIV from taking semen into their mouth. In almost all of the cases the person had herpes sores, cuts or infections in their mouth. It isn’t easy for HIV to enter the bloodstream via the mouth or throat. If you’re HIV+ and there is any bleeding in your mouth, or if you have a gum disease or other oral infections (such as a sore throat) take extra care. Brushing your teeth before oral sex can give you bleeding gums. To be really safe, you can pull his penis out of your mouth before he ejaculates, so that you do not get semen in your mouth. A condom on the penis you’re receiving orally is an ultra-safe strategy.

Rimming: Licking out
Rimming, licking another person’s anal opening, does not pass on HIV. However, some other serious illnesses such as viral hepatitis are easily passed on this way. You can use sheets of clear plastic food wrap or a dental dam as protection.

Passive Anal Sex
If you’re HIV-, having receptive anal sex without a condom is the most likely way of getting HIV, if you’re not 100% certain of your partner’s HIV status, or if you know your sex partner is HIV+. Semen that carries HIV can easily enter the bloodstream through the lining of the rectum and through small cuts or abrasions that occur during sex. Having your sex partner use a condom with a water-based lubricant is the best way to reduce the chances of getting or giving HIV or other STDs.

Active Anal Sex
If you’re HIV-, having active anal sex without a condom on your penis is another likely way of getting HIV, if you’re not 100% certain of your sex partner’s HIV status, or if you know your sex partner is HIV+. Many men think that because they’re the one doing penetrative anal sex, the HIV can’t enter their body. However, it can enter the penis through the opening at the tip (the meatus), or through tiny cuts or scratches on the penis. Reduce the chances of getting or giving HIV by using a condom and a water-based lubricant.

Condom Hints 1
Try experimenting with condoms before using them for sex. Get yourself used to the feel of them. Masturbate with them on. Try tearing one or two while you’ve got them on, so that you can feel what that’s like. You can feel the difference, so that if a condom tears when you’re having sex, you’ll know when to pull out.
• Put the condom on before starting to penetrate, not just before you’re about to ejaculate.
• When putting the condom on, squeeze the air out of the tip first. Roll the condom all the way down to the base of your penis to prevent it slipping off.
• If you’re uncircumcised, pull your foreskin back before fitting the condom on. You might need to practice to find out how to get a condom to stay on.
• Choose a brand of condoms that suits your penis size and shape.

Withdrawal: Pulling out
Withdrawal (pulling out before ejaculation) does not protect you from giving or getting HIV. Some men do this as a way to have the thrill of having sex without using condoms, thinking that if the person penetrating pulls out in time, this counts as safe sex. This isn’t true. Withdrawal can still lead to HIV being passed on because:
• if you’re the active partner (the one doing the penetration) blood from your partner’s anal opening can still enter the hole at the tip of your penis, or get into tiny scratches or cuts on your penis.
• if you’re the passive partner (the one being penetrated), there’s no guarantee that your partner won’t ejaculate in your anus. Withdrawal before orgasm is a very difficult thing to time perfectly! Again, using condoms and a water-based lubricant can prevent this risk. Many gay men who have recently tested HIV+reported that they thought withdrawal was safe.

Condom Hints 2
Some people will tell you that condoms often break. However, often the mistakes that people make that lead to condom breakage can be easily corrected. Condoms aren’t 100% reliable, but using them correctly is the best way there is to make sex safe. Remember the following:
• Use lots of water-based lubricant such as KY jelly etc (examples). Some people mistakenly use oil based lubricants like Vaseline, baby oil, hand creams or other oil based lubes, without realising that these actually dissolve the latex of the condom, leading to breakages.
• Check the use by date on your condoms. Avoid using out-of-date condoms.
• Be sure to buy condoms made to national standards-check the outside of the pack.
• Never leave condoms out in the sun, or near any sharp objects that might damage them, or in the glove box of your car for a prolonged period of time.
• Don’t store your condoms near extreme heat or cold.
• Don’t use ultra-thin condoms as these are designed for vaginal sex. Anal sex puts more stress on condoms. Use extra strength condoms for anal sex.

Sex without condoms
Some people who share the same known HIV status choose to have anal sex without condoms. This can only be safe when you both know for certain that you’re both HIV- or both HIV+. Discuss with your partner how important it is for you to have anal sex without condoms. If it’s not that important, then keep using them. If you want to have sex without condoms, then here are some steps you could follow:

If you’re both HIV+
Talk with your doctor about the possible effects of being exposed to another strain of the virus. It’s your choice to enjoy unprotected sex with another HIV+ person if you both want to.

If you think you’re both HIV-
If you both want to have sex without condoms, then both get tested for HIV. Be completely honest about your results, or agree to go and get tested and collect your results together. What would it mean if one of you had HIV and the other didn’t? Talk about this first. If it would mean the end of the relationship then maybe you should just keep using condoms? Continue to use condoms every time you have sex for 3 months after either of you could possibly have come into contact with HIV. After 3 months, both get tested again.

If one of you has HIV and the other does not
Keep using condoms and water-based lubricant every time you have anal sex.

If you know you’re both HIV-
Discuss your future plans. Make a commitment to each other that you’ll avoid having sex outside of your relationship (this strategy is more successful) or that if either of you have sex with anyone else you will use condoms (this strategy is less successful). You will need to make a decision about trusting each other. Make a commitment that if either of you has a slip-up or an accident that results in unsafe sex outside of the relationship, you’ll agree to tell the other immediately. You’ll need to go back to safe sex until you’ve both been tested twice again 3 months apart.
• Talk with each other about how slip-ups or accidents might happen. Agree in advance that it won’t mean the end of your relationship. Don’t punish your partner for being honest.
• You might want to agree in advance that either partner can insist on using condoms again, without having to explain why.
• If all of this seems like too much to handle, then keep using condoms whenever you have sex.

Vaginal Sex
HIV can be passed on during vaginal sex. The virus is found in both semen and vaginal fluids. If you’re having sex with a woman the best way to prevent HIV being passed on either way is to use a condom with water-based lubricant. HIV is unlikely to be passed on in oral sex when a man is going down on a woman although the risk increases if there is menstrual blood. If there are cuts or sores on the man’s mouth sheets of clear plastic food wrap, or a dental dam, can be used to protect against HIV being passed on. Check out the range of heterosexual safe sex information available.

Drugs and Alcohol
Using drugs or alcohol might affect your ability to make sensible decisions about having safe sex, and your ability to let your partner know what you want. It’s a good idea to make the choice to be prepared for safe sex before using drugs and alcohol. Making sure you’ve always got condoms and water-based lubricant with you can make it easier decision to have sex without regret. If you inject drugs remember that each person should use a new clean needle and other equipment every time. Do not share needles, swabs, spoons, filters or tourniquets!

Slip-ups or Accidents
Being committed to safe sex all the time isn’t easy. There are always going to be times when it’s hard to stick to safe sex. It’s important to be able to talk about this with people we trust. We should not be judgmental if friends tell us that they have had a slip-up. Most gay men can remember or imagine what leads to an unsafe incident. Remember that slip-ups don’t mean we’ve gone off the rails or that we are bad. Just make the decision to have safe sex in future-for a long life enjoying sex without regret.

(This article is adapted from http://www.managingdesire.org, Developed by Clinic 275, Australia)

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