Talking about sex

It’s summer party season, historically the time of year when we think, want, and if we’re lucky, do sex. So, maybe it’s time we talked about it, too? David Menadue asked Darren Russell about the benefits of talking about sex.

Most of us don’t like talking about our sex life. What goes on between us and our partners, we like to keep between us and our partners. But maybe we shouldn’t be so reluctant to open-up?

“There are good reasons to talk to your doctor about sex,” says Professor Darren Russell, Director of the Cairns Sexual Health Service. “If they work in HIV and sexual health, they will likely be very knowledgeable about all things sexual.”

Darren has worked with people with HIV since the early days of the epidemic and says many of the health conditions that we experienced prior to the current era—low testosterone, erectile dysfunction, loss of sex drive—are less likely to happen to those newly diagnosed who go straight onto current treatment. The newer integrase inhibitors can get people to undetectable inside of a month, which took the old meds like Nevirapine up to six months to achieve.

 

Doctor Darren Russell

Doctor Darren Russell

Getting to undetectable

As well as providing protection, we often forget that becoming undetectable also improves our general health. It can boost energy, strength, mood and even sex drive. Of course, you need to exercise, eat well, and look after your heart health as well. Giving up smoking, watching your cholesterol, and avoiding gaining weight also goes without saying if you want to live to a ripe old age.

Those who have had HIV for longer also do better, but long-term HIV-positive men are more likely to need assistance with testosterone replacement and erection enhancements. It’s worth noting that treatments like Ritonavir and Genvoya (or any drug containing cobicistat) may boost drugs like Viagra and Cialis, causing unwanted side-effects. And using amyl nitrate (poppers such as “Rush”) with these meds is considered dangerous because of possible interactions.

Positive women are more likely to experience menopause at a younger age—maybe as young as the early forties—and may require help with estrogen supplements for a while.

Dealing with stigma

One of the most difficult times for people is at diagnosis. All the HIV-related stigma we’ve witnessed over the years returns en masse and can lead to real mental health crises for some people. Some blame themselves for unsafe sexual encounters, forgetting to use condoms or PREP, or for just making assumptions about another’s HIV status. It is at this time—and when a person resumes sex after having a break for a while—that people can really use a down-to-earth chat.

The daily pill-popping routine

Many newly diagnosed people benefit from counselling at this time so they can talk through their feelings about seroconverting, what emotions the daily treatment brings up for them and learn how to deal with any negative thoughts about taking it. It is well known that the brain can turn off thinking about the unpleasant, and if this includes daily meds, this could lead to some real medical problems including developing resistance to some antiretrovirals. Getting used to a regular routine of pill-taking needs a few mental prompts, maybe a pill box or a daily alarm.

Of course, the more experienced positive person can also benefit from counselling. Sexual negotiation is never easy with HIV. Much as we like to think most sex partners in this era will understand what Undetectable Equals Untransmittable (U=U) means, there will always be some who come back with: “It’s not worth the risk.” Learning to live with HIV as just a manageable part of life is certainly easier these days but having a good counsellor as a sounding board is never a bad idea.

Talking with other HIV-positive people is also one of the most valuable things you can do for your mental health and general wellbeing. Sharing some of your journey and developing friendships with other positive peers can make a big difference to your outlook on life, particularly if you are feeling lonely and isolated. The best tips on how to negotiate an HIV-positive sex life are generally exchanged between peers.

Find organisations in your area that offer HIV peer support and peer navigation.

 

Darren Russell (left) with his son, Guy at Brighton Beach for an ocean swim, recently

Darren Russell (left) with his son, Guy at Brighton Beach for an ocean swim, recently

Sexual health

Keeping on top of your general sexual health, including checks for sexually transmitted infections (STIs) which can increase the risk of HIV transmission, is another essential reason to regularly visit your doctor. Sexually active gay and bisexual men need to test regularly for HIV (unless they already have it), syphilis, hepatitis B, chlamydia, and gonorrhoea. Talk to your doctor about risk factors but getting vaccinations for hepatitis A and B and the Human Papillomavirus (HPV) is standard cover for the sexually active. MPox might also be considered, depending on its prevalence.

If you have an HIV negative partner, find a doctor who understands and can reassure them about the safety of U=U or prescribe PrEP as extra protection.

Finding a doctor that you feel sympatico with can be a bit of trial and error and, given the shortage of GPs across the country, your doctor of choice may not always be available when you need them. But every sexually active person with HIV needs to talk with their doctor about sexual matters and be confident that they will be treated with respect and understanding. You shouldn’t feel that any issue is too sensitive to raise. Schedule a longer appointment to ensure you have enough time. And don’t forget to top up your regular scripts while you’re there.

Don’t rule out hospital clinics. HIV-positive people from rural or outer suburban areas or those with a CALD background requiring culturally appropriate care and support services may prefer to go to the dedicated centres of excellence in hospitals (in either infectious disease or immunology) or to the large sexual health clinics connected to these hospitals. Some large rural city centres now provide these services too.

New to Australia? Find information on HIV testing, treatment and care.

Remember, if there’s anyone you should be talking to about your sex life—apart from your sex partners—it’s your doctor. That way you’ll keep everything down there healthy.

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