You can still have sex if you’re living with HIV — Here's how

Andrew and his wife had not had sex for two years by the time they came to the Sexology Clinic. Joy, Andrew’s wife, had not only refused to be intimate but wanted another partner.

“We have involved our friends and close relatives in trying to resolve this matter but to no avail. It has only made the situation more complicated,” Andrew explained. 

“My stand is not in bad faith, life happens and this calls for change in the way we do things; we have to adapt and move on,” Joy interjected.

Andrew was 40 while Joy was 38. They had been married for nine years and had two children. Andrew was a teacher and Joy an accountant. Trouble started when Joy got a new job that required her to do medical exams. Her HIV results came out positive. She felt the world crashing on her and her life stopped momentarily. Andrew decided to take the test too as they planned a new phase of their lives. Andrew’s test was negative. Through counseling, the couple was nearly back on their feet but one challenge remained: sex could not happen. 

“I do not want to infect him, our two children need him alive,” Joy explained “It would be a great tragedy if we both got infected.” 

So the couple was living in a discordant relationship, a situation where one of the partners in a relationship is HIV positive while the other is negative. Many such couples struggle with the issue of sex.

“For me, I would like to have sex with my wife and get one more child,” Andrew said ignoring Joy’s point of view, “I do not believe that HIV should enslave us, there must be a way out for couples to enjoy their sexuality irrespective of their HIV status.” I nodded in affirmation. A lot of progress has been made in HIV management making it possible for partners to enjoy their sexuality safely irrespective of their status.

For one, the good old condom still works. It has been the undisputed first line of defense for years now and its effectiveness is undisputed.

“No condoms for me!” Joy shoots in. Andrew threw his hands in the air, visibly frustrated and irritated. Joy had strong beliefs against condoms.

Beyond condoms, however, the use of anti-retroviral drugs remains a key intervention in curtailing the spread of HIV. When used as recommended, the drugs suppress the virus in an infected person to levels that cannot be detected in the lab. This does not mean that the HIV infection is cured though, it means that the number of viruses circulating in the body are so few that the available lab tests cannot detect them. A person with near nil viruses circulating in his system has very low chances of infecting others. This underscores the value of using antiretroviral drugs consistently and correctly if you have an infection.

At the same time, the partner who is not infected can use a special HIV drug treatment regimen for preventing infection. This is called pre-exposure prophylaxis. It is used by people who are HIV-negative and fear exposure to the virus through sex with a positive or untested partner.

Yet still, there is post-exposure prophylaxis. In this case, if a person who is HIV negative gets exposed to HIV, antiretroviral drug treatment is given to avert the infection.

“I have always told my wife that there are myriads of options for people in our situation,” Andrew quipped, “I believe HIV does not have to stop our sexual lives, we should not allow it to enslave us.” 

Joy was quiet. I noticed that her eyes were welling up. 

“And when it comes to HIV, there is more than meets the eye for the infected as well as affected persons,” I said, “the fear of death, the many unanswered questions about life, the uncertainty about the future, anxiety and sleepless nights, the stress can be unbearable and this takes away sexual feelings.”

“I do not have the energy to live any longer, I do not want sex” Joy said, tears rolling down her cheeks. Andrew hugged and held her to his chest unable to utter a word, his eyes fixed on the horizon. She cried out loudly and uncontrollably, a cry of desperation, questioning why life was so unfair to her. 

I scheduled counseling for the couple. They were yet to master their situation and take charge of it. In the resent past HIV counseling has faltered quite a recent past new ways of care such as home testing and provider-initiated testing have taken root. Inadequate testing has left people vulnerable to situations similar to Joy and Andrew’s. 

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