Living with HIV in the Philippines: Email 705: Sex for Mixed-Status Relationships

Call me Mrs m.

pag may sket ang isang babae na hiv, ano ang mga pnagbbwal s tungko sa sex. gusto ko pong mlan.gusto kong mlman. kc nung ngkroon aq ng sket na hiv, iba ang kc ang sex ng partner ko sa aken.

TRANSLATION

Call me Mrs m.

If a woman has HIV, what are the precautions when it comes to having sex? I would like to know because ever since I was diagnosed with HIV my partner is have sex with me differently.

POZZIEPINOY’S RESPONSE

Hi Mrs. m.

Thank you for your email.

Sex is very important to a healthy relationship. In your case, we call this as a "mixed status relationship" since you are HIV positive and your partner is HIV negative. I believe that the changes in your sexual relationship is based on the fear of transmission rather than you guys having intimacy. On your part, you are longing for the same things as before you got diagnosed. Of course, there will be changes and you need to understand this. The premise here is to still have intimacy despite restrictions to prevent HIV transmission to your negative partner. For me, what is more important is the bond between the partners even with restrictions with sex.

Now to answer your questions, I researched about mixed status relationships and how they deal with sexual intercourse.

(Source: http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/mixed-status-couples/)

For mixed-status couples, the possibility of HIV infection is a constant reality. There is always a risk, but you can minimize it.
If you are in a mixed-status relationship and you have sex (anal, oral, or vaginal), you can protect against HIV and other sexually transmitted infections by using condoms and dental dams consistently and correctly.

If you are part of a mixed-status couple, it is important that you and your partner communicate openly and often about safer sex practices and HIV prevention. Healthcare providers and local HIV/AIDS organizations can be important sources of information and support for you and your partner.

If you are the HIV-positive partner in a mixed-status relationship, you can lower the risk of transmitting HIV to your partner if you are on antiretroviral therapy. Taking all your medications, on time, will help to lower the viral load in your body fluids and decrease the chance that you will transmit HIV to your partner. But remember, even if you have a low viral load, you can still transmit HIV to your sex partner. So it is important to always use a condom and practice safer sex. And, if you inject drugs, never share syringes, water, or drug preparation equipment with others since HIV-infected blood can be transmitted through them.

If you are the HIV-negative partner in a mixed-status relationship, talk with your partner about condoms and safer sex practices. If you are in an ongoing relationship with your partner, support him/her in taking all of his/her HIV medications at the right times. This "medication adherence" will lower his/her viral load and reduce the risk that HIV can be transmitted. You may also want to stay up-to-date on developments about pre-exposure prophylaxis (PrEP). Though researchers are not recommending PrEP be immediately used to prevent HIV infection, recent research findings suggest this may someday be another prevention method to be used with – not instead of – condoms, safer sex practices and other HIV prevention methods.

Now let us go back to the basics of sex and discuss the risky sexual activities and the safe activities:

(Source: http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/sexual-risk-factors/)

All sexual practices can be made "safer"—meaning you can lower your risk of transmitting/contracting STIs and HIV—but some activities are much safer than others. Here's a list of sexual activities and the risks they pose for transmitting HIV or other STIs:

Receptive Anal Sex (Bottoming)

The odds of getting HIV from "bottoming" without a condom are higher than any other sexual behavior.
HIV has been found in pre-cum (pre-ejaculatory fluid), so having your partner pull out before he cums (ejaculates) may not decrease your risk.
Do not douche before sex. Douching irritates the lining of your rectum and this can increase your risk for getting HIV. If you are concerned about cleanliness, clean the rectum gently, with a soapy finger and water.
If you are bottoming, always use plenty of water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize damage to the rectum during sex and to prevent the transmission of STIs (including HIV).

Insertive Anal Sex (Topping)

"Topping" without a condom is considered a high-risk behavior for transmission of HIV and other STIs.
Your partner may have sores or other signs of infection in his/her rectum that you can't see. If you have tears or cuts on your penis, HIV can enter your body this way.
It is possible for blood and other fluids containing HIV to infect the cells in the urethra of your penis.

Receptive Vaginal Sex (Risks For Women)

Vaginal sex without a condom is considered a high-risk behavior for HIV infection.
During vaginal sex, HIV is transmitted from men to women much more easily than from women to men.
The risk for transmission is increased if you currently have another STI or vaginal infection. Many STIs and vaginal infections are "silent"—meaning you don't have any symptoms, so you may not be aware that you are infected.
Many barrier methods that are used to prevent pregnancy (diaphragm, cervical cap, etc.) DO NOT protect against STIs or HIV infection because they still allow infected semen to come in contact with the lining of your vagina.
Oral or hormonal contraceptives (i.e., birth control pills) DO NOT protect against STIs or HIV infection.
Female condoms DO prevent against HIV infection, if you use them correctly and consistently.

Insertive Vaginal Sex (Risks For Men)

Unprotected vaginal sex is less risky for the male partner than the female partner—but there is still a risk that the male partner can contract HIV and other STIs.
Some STIs are "silent," meaning that a woman may have an STI but not have any symptoms. Your partner may not know she has an infection, so it is important to use a condom.
Use a new condom with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner, although the risk is not as great as it is with unprotected anal or vaginal sex.
You are also at risk for getting other STIs, like chlamydia and gonorrhea.
Your risk of contracting HIV is reduced if your male partner does not ejaculate (cum) in your mouth.
Your risk of HIV is reduced if you do not have open sores or cuts in your mouth.
Using condoms for oral sex reduces your risk of getting HIV or other STIs.

Receiving Oral Sex If You Are A Man

There is less associated risk for HIV infection with this sexual activity.
Your risk of HIV is reduced if you do not have open sores or cuts on your penis.
There is a risk of contracting other STIs, including herpes.

Performing Oral Sex On A Woman

HIV has been found in vaginal secretions, so there is a risk of contracting HIV from this activity.
It is possible to contract other STIs from this activity.
There are effective barriers you can use to protect you from contact with your partner's vaginal fluids. You can cut open an unlubricated condom and lay it over your partner's vulva. You can also use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (Plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV this way is significantly lower than for unprotected vaginal sex.
There is still a risk of contracting other STIs, like herpes, and bacterial infections.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of getting HIV by rimming is very low—but this kind of sexual contact comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
Use medical-grade gloves and lots of water-based lubricant to eliminate this risk.

Sex Toys

Using sex toys can be a safe practice, as long as you do not share your toys with your partner.
If you share your toy with your partner, use a condom on the toy, if possible, and change the condom before your partner uses it.
Clean your toys with soap and water, or a stronger disinfectant if indicated on the cleaning instructions. It is important to do this after each use!