It takes many people a long time after they are diagnosed with HIV before they regain sexual confidence, says Michael Wright, but the barriers can be overcome

Good sexual health is important to the overall quality of life. Sexual dysfunction, whether due to HIV, side effects of HIV treatments, or other factors, can dramatically reduce a person’s quality of life. Sexual dysfunction includes reduced sex drive, for example a loss of interest in sex, as well as physical difficulties such as loss of erection or difficulty reaching orgasm. There are many factors which can impede on your ability to have a quality sex life.

Sedatives, tranquillisers, and other medications can cause sexual dysfunction, as can smoking, alcohol, and recreational/illegal drug use, and stress related to relationships or work. Being
over 40 years of age, diabetes, fear of failure, hypertension (high blood pressure) can all cause changes in sexual function.

Although most research into sexual dysfunction associated with HIV has been carried out in men, when women have been included in these studies, a similar level of concern has been reported. For example, a study (conducted by anonymous questionnaire) in over 900 HIV positive people using combination therapy (80 percent men, 20 percent women) found that around one third reported less interest in sex.

HIV drugs

Sexual dysfunction is more common in HIV positive people who are not using HIV drugs compared to HIV negative people. For example, HIV positive men and women have reduced testosterone levels compared to HIV negative people. Although several reports linked this to protease inhibitors, sexual dysfunction is not generally reported as a side effect of HIV drugs. It is likely that sexual problems affect a lot of HIV positive people, not least because of the complex social factors. It takes many people a long time after they are diagnosed before they develop or regain sexual confidence.

With new partners, the decision to discuss HIV (perhaps before you even know very much about a person) can be difficult not disclosing your HIV status even when your partner is not at risk because you use condoms, can be a difficult barrier to overcome later on in any relationship.

In longterm relationships, fear and concerns about risk might never be discussed or resolved in detail. With an HIV negative partner, either or both partners might become preoccupied with a risk of transmission during sex, however small the risk and however safe the sex.

Low Risk

This is a pity, given that having an undetectable viral load on ART makes it difficult to transmit HIV. The risk becomes so low that post exposure prophylaxis (PEP) is no longer recommended when a person’s viral load is undetectable.

Also, if both people are HIV positive, they might worry about resistance or reinfection even though this risk is close to zero if both partners have undetectable viral loads while on ART.

Many people find it difficult to talk to their doctor about their sexual health and it is something that doctors rarely ask patients about directly. Now that treatment has given us the possibility of living a natural life span, it is important to try and resolve sexual problems. This is something that your clinic can help with, but it is something you might need to directly ask about.

This article comes from Positive Now, a group of men and women living with HIV in Ireland, and was first published in GCN’s December 2016 Issue (Issue 324). Find out more at www.positivenow.ie