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24 November, 2009

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HIV and men - safe sex

In Australia, the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. Describing a couple as ‘serodiscordant’ means that one partner is HIV positive and the other is not. This can raise a number of issues, such as how to have sex safely. If you are HIV positive, you should talk with your doctor or local HIV/AIDS organisation for further information and advice.

HIV transmission
HIV is transmitted by body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), female genital fluids (both vaginal and cervical fluid) and breast milk.

The way the virus gains entry to another person may be directly across the mucosa (the lining of the vagina or bowel) or into the bloodstream. HIV can also pass from mother to baby during pregnancy or birth, or via breast milk.

Transmission can from men to women and from women to men. As well as between same sex partners.

The best way to stop HIV transmission is to always use a condom when having sex.

Safe sex
Safe sex is sex where semen, vaginal secretions or blood are not exchanged between sexual partners. It is important to prevent the transfer of these body fluids whether the man or his partner is HIV positive. Be guided by your doctor or health worker, but safe sex suggestions include:

Kissing, cuddling, masturbation, mutual masturbation, massage, and ejaculating or urinating on unbroken skin.
Always wear a condom and use a water based lubricant when having vaginal or anal sex.
The woman may prefer to wear a female condom that is inserted into the vagina.
Don’t rely on the withdrawal method. The pre-ejaculate (pre-cum) of an HIV positive man may transmit the virus.
Oral sex with either a man or woman is considered a ‘low risk’ activity for transmission of HIV. The risk increases when people have cuts or sores in their mouth or on their lips, or have recently brushed or flossed their teeth. For extra safety, people may choose to use a condom during oral sex performed on the man, or a dental dam or similar protection (such as clear plastic cling wrap – but not the ‘microwave safe’ variety which has tiny holes in it) during oral sex performed on the woman.
Avoid penetration of the vagina or anus with finger or fist if there are abrasions on the hand or arm – to be sure, wear a latex glove and use lots of water based lubricant.
Don’t share penetrative sex toys such as dildos. It’s best to have a separate collection for each partner. You should also cover them with a new condom each time they are used, or wash them thoroughly in warm soapy water between partners.

Some tips to consider
Negotiating safe sex is not always easy. Here are a few tips that may help.

Have condoms handy if you think there is a possibility that you will be having sex.
Don’t assume that your partner will take responsibility for having condoms. Make sure you have condoms with you.
Don’t assume that your partner will feel confident about using condoms. Everyone should learn how to use them correctly.
Make it your business to find out about condoms. Investigate colours and flavours.
Find out where you can get condoms without embarrassment.
Try to negotiate safe sex before you get into the ‘heat of the moment’. This is usually not the best time for debate and discussion.

What to do if you are exposed to body fluids
If you are exposed to body fluids, you should wash the skin or area thoroughly with soap and water. Don’t use a douche in the rectum as this can irritate the area and increase the risk of HIV transmission. See your doctor for further information and advice.

Post exposure prophylaxis (PEP) is a month-long course of medications for people who have been exposed to the HIV virus. To be most effective, they should be commenced within 72 hours of exposure. It is best to take them as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex.

If you think you have been exposed to HIV or think you need advice, call 1800 889 887. This is a 24-hour telephone service.

Clothes, bedding or other material can be washed in water and detergent or dry-cleaned.

Don’t share toothbrushes or razors
Everyday household contact doesn’t transmit the HIV virus, but the intimacy of a sexual relationship means that lovers tend to share personal items, which can be a risk. A serodiscordant couple should avoid sharing toothbrushes, razors or any other personal item (including injecting equipment) that could have come in contact with blood.

Long-term relationships for serodiscordant couples
Practicing safe sex in long-term relationships can be a challenge. The term ‘safe sex’ seems to conjure up thoughts of condoms and not much else. It is normal for people who are in a serodiscordant relationship to become frustrated and angry about limitations on their sexual expression. You might even think that it’s not really worth it. Being honest with your partner about your feelings and talking will help to get you through. In any relationship, communication is the key.

For the positive person in the relationship, issues can be totally different to those of the negative person. Fears around transmitting HIV to your sexual partner are real. Sometimes these fears may need to be addressed by a professional counsellor. It is helpful to remember these fears are occurring because the partner cares.

The negative person may have fears associated with getting HIV, or of family or friends finding out about their partner and what their reaction might be.

Talking to other people living with HIV about these issues may be helpful. People Living with HIV/AIDS Victoria, Straight Arrows and Positive Women are community support organisations that have peer support workers.

Where to get help

Education & Resource Centre, The Alfred Hospital Tel. (03) 9276 6993
Your specialist HIV doctor
Victorian HIV/AIDS Service, The Alfred Hospital Outpatient Clinic Tel. (03) 9276 6081
Positive Women Victoria, Fairfield House, The Alfred Hospital Tel. (03) 9276 6918
Straight Arrows, Fairfield House, The Alfred Hospital Tel. (03) 9276 3792
People Living with HIV/AIDS Vic. Tel. (03) 9865 6772
Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
Family Planning Victoria Tel. (03) 9257 0100
Well Women’s Clinic, Royal Women’s Hospital Tel. (03) 9344 2288 or 9344 2183
Blood Borne Viruses/Sexually Transmissible Infections Program, Department of Human Services Victoria Tel. (03) 9096 0000

Things to remember

The HIV virus is transmitted by body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), vaginal and cervical fluids, and breast milk.
It is important to prevent the transfer of the HIV virus in these body fluids whether the man or his partner is HIV positive.

You might also be interested in:
HIV and AIDS.
HIV and gay men - safe sex.
HIV and women - safe sex.
HIV testing.
HIV treatment.
Safe sex.
Sexually transmissible infections - avoid the risk.
Sexually transmissible infections - overview.
Sexually transmissible infections - signs and symptoms.

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