Undetectable Viral Load

Your life didn’t stop when you were diagnosed with HIV – your sex life doesn’t have to stop either!

For some guys this may seem hard to believe because of HIV stigma, racism, or homophobia they have experienced. And while we may have reason to think that way, it’s important to know that we deserve to have the sex we want. This guide will help you navigate being a sexually active gay man living with HIV: how to talk about HIV, how HIV can affect your sex life, and the strategies you can use to take care of yourself and your partners.

Remember that your emotional and mental health are as important as your sexual health. Seeking the proper supports for your emotional and mental well-being can help set you on the path to having great sex. Most importantly, think through the sex you want, so you can look out for yourself if challenging situations come up.

Talking About HIV
Living with HIV is a lot different now. HIV treatment has allowed guys to live long, healthy lives. There’s more great news! When a guy living with HIV is on treatment and has an undetectable viral load, there is ZERO chance of HIV being transmitted through sex. However, some guys are still worried about transmitting HIV to their partners, and some guys have trouble getting or staying undetectable. Fortunately, with new treatment and prevention options available, guys can have sex with confidence that they will not pass HIV to their partners. Educating ourselves about the options available to us and our partners is an important step to making sex more fun. Talk to your doctor, or someone from an HIV/AIDS Service Organization or sexual health centre to help you figure out what works best for you.

Talking about your HIV-positive status can be particularly stressful when it comes to hooking up, since not everybody knows about the science of HIV transmission and sex or about what it means to be undetectable. There’s no one right way to disclose your HIV status, or anything else. Here are some tips on how to make this process easier:

• First, ask yourself: Do I want to tell them this information? Have we talked about what we’re going to do? Are we just making out, or are we going to fuck?
• It’s best to be as direct and clear as possible. If somebody reacts negatively, remember that not everyone will feel that way and that you deserve credit for your strength. Give time to the person to think about what you’ve said, and remember that people’s reactions can change over time.
• A lot of HIV-positive guys choose to put their HIV status on their online profile in advance as a way of filtering out people who might not be cool with it. There may still be a need for an in-person conversation to make sure you’re both on the same page.

What About Sex With Other Positive Guys?
Sometimes guys choose to have sex with other guys who are also HIV-positive. This is sometimes referred to as “sero-sorting.” See our section on sero-sorting for more info.

What If My HIV-Negative Partner Is Worried About Getting HIV?
If your partner is concerned about getting HIV, they should check out prevention options like condoms or PrEP. If there is a concern they may have been exposed, they can access PEP at their local emergency room within 72 hours after a possible exposure. The Sex You Want has information on all these prevention options. You can also speak with your doctor or local HIV/AIDS Service Organization for more info.

HIV Disclosure
Some guys wonder if they’ll get into legal trouble if they don’t share their HIV-positive status with their sex partners. In Canada, some people have been criminally charged for not disclosing their HIV status to sexual partners, so knowing what the criminal law says about HIV non-disclosure may help you make better decisions and potentially avoid legal problems. Recently, Ontario has announced that it will stop prosecuting people who pose no chance of transmitting the virus if they have had an undetectable viral load for 6 months.

If you are unsure about your need to disclose or interested in what legal experts are saying about this issue, check out the HIV/AIDS Legal Clinic of Ontario (HALCO) website. If someone is giving you a hard time about disclosure, you should get in touch with HALCO right away.

Handling Rejection
Every guy has heard “no” when they asked another guy for sex, a date, or a relationship. And each of us has probably said “no” to someone. Sometimes guys say “no” when they find out you’re HIV-positive. It may help to think of these things while learning to handle “no”:

• Your worth as a person didn’t change when you got HIV.
• It’s not about you. It’s about him – what he thinks and feels about HIV.
• Lots of HIV-negative guys have sex with, date, and love HIV-positive guys.
• You did what you felt you had to do by telling him you’re HIV-positive. It may not have been easy to do. You respected yourself and respected him – no one can take that away from you.

Your Sex Drive
Sometimes you may feel less interested in sex. That’s not necessarily a problem. Your sex drive can be affected by your physical, mental, or emotional health. It happens to everyone, not just people with HIV. Some things that may affect your sex drive include:

• Being stressed, tired, or sick.
• Smoking, drinking, or using drugs.
• Depression.
• Self-esteem issues.
• Prescription medications.
• Getting older.

If you are not interested in sex for a long time and that bothers you, talk to your doctor. There are a few things you can do to get your sex drive back.

Hard-On, Not Hard-Up
If you’re having issues getting or staying hard there are ways to help. Medications – like Cialis and Viagra – can help you get a hard-on, but they require a doctor’s prescription. They can be quite expensive and many insurance companies do not cover them.

Some things to consider when taking erection drugs:

• High doses of erection drugs can damage your cock. Some HIV medications can boost the dose of erection drugs you take, meaning you’ll get a higher dose than you took. Be especially careful if you are taking ritonavir (Norvir).
• Avoid poppers. Poppers cause a very sharp drop in your blood pressure. Erection medication lowers your blood pressure, too. Combining the two can be dangerous, especially if you have heart or blood pressure problems.
• If you’re having trouble staying hard while wearing condoms, erection drugs may help.
• If you still get a hard-on in the morning, erection drugs are probably not the answer. Taking care of your emotional and mental health may be the answer. Talk to your doctor, or a counsellor you feel comfortable talking about your sex life.

Coming Clean On Butt Play
For many guys it is important to have a clean ass when we have sex. HIV might make that a challenge since HIV and HIV medications give some guys diarrhea. Here are some tips on how to deal with diarrhea:

• If you have diarrhea that comes on suddenly, it may be a sign of an infection. See your doctor if that happens.
• If your diarrhea is the result of your treatment, you may want to talk to your doctor about different treatment options.
• Try medications like Imodium to control your diarrhea.
• Be sure you’re getting enough fibre in your diet. Eat fruits, vegetables, and whole grains and avoid eating too many processed foods. You can also buy psyllium fibre to add to your fibre intake.

Sex and Partying
Some guys use party drugs when they have sex – or have sex when they use party drugs. These drugs can affect our health, especially if you take them often or in large doses. Party drugs can also affect your HIV medications. Here are some things to be aware of:

• Both ecstasy (MDMA) and crystal meth (Tina) can react dangerously to ritonavir (Norvir) and cobicistat (Tybost).
• Drinking alcohol can increase the level of HIV medication abacavir (Ziagen/Triumeq) in your body.

If you want to learn more about which HIV medications you’re on and their interactions with party drugs, speak with your doctor or pharmacist. Talking about drug use with your doctor can be a difficult topic, but having an open and honest conversation will help you get the care and information you need. If you are experiencing challenges with your substance use, you can talk to your doctor or connect with your local HIV/AIDS service organization to find resources you need. You can also check out PartyAndPlay.info for information on safer partying.

Sexual Health
You can take better care of your sexual health when you have the knowledge to make informed choices. This includes taking your HIV meds as prescribed, getting regular viral load, CD4, and STI tests, and communicating with sex partners about HIV, STIs, U=U, treatment as prevention, PrEP, or condoms. Taking care of yourself puts you in a better place to take care of your partners.

Your Viral Load
Taking your HIV medication (as prescribed) will help reduce your viral load to low or undetectable levels. Check out the other pages in our undetectable section for more info.

The key to staying undetectable is adhering to your medication. Check out The Sex You Want for our SMS reminder service to help keep on track with your meds.

HIV Treatment
HIV treatment has come a long way. There are a variety of available drug options, including once-daily pills which contain a combination of drugs. These new drug combinations are more effective, safer, and have less side effects than ever before. Talk to your doctor about the side-effects you experience, as there may be other treatment options available to you. Check out our section on HIV Treatment!

HIV and Sex
If you’re undetectable, you can’t transmit HIV through sex. If you aren’t undetectable, it may be useful to understand the chances of transmitting HIV to your partners. Depending on the type of sex you’re having, the chances of passing on HIV will be different. Check out our section on HIV and Sex!

STIs
In recent years, sexually transmitted infections (STIs) like chlamydia, gonorrhea, and syphilis are on the rise among gay men. While research has shown that STIs do not increase the risk of HIV transmission for guys who are undetectable, having an undiagnosed and untreated STI can still impact you and your sex partners health. Check out our section on other STIs to learn more.

If you’re choosing to have condomless sex, testing regularly will help to diagnose and treat STIs quickly to reduce the chances of passing them on. The more you have sex and the more sex partners you have, the more you need to test. If you are having sex and aren’t using condoms regularly, you should get tested every 3 months. If you use condoms every time, you probably don’t need to test so often. You may want to ask your doctor to test for STIs when you go for your viral load and CD count. Talk to your doctor or sexual health clinic about what is best for you. You can also get vaccinated to prevent hepatitis A and B and HPV. These vaccines are free for gay guys, so talk to your doctor or go to your local HIV/AIDS service organization or sexual health clinic for more info.

HPV and Anal Cancer
HPV means Human Papilloma Virus. It’s one of the most common STIs in Canada with over 150 strains. Fortunately, only a few strains cause health problems. It is spread through skin-to-skin contact and in some cases, can cause warts on your ass hole, inside your ass, or on your cock. These warts are uncomfortable, but do not pose any significant harm. Some strains of HPV however can lead to anal, penile, and oral cancers. For HIV-positive guys, the risk of anal cancer is higher.

There is no test available for guys to determine if you have HPV, but you should consult your doctor if you start to notice symptoms in your ass, such as unexplained bleeding, pain, or discomfort. Currently there are vaccines that protect against the 9 strains of HPV that cause warts and cancer. Even if you have HPV already, getting vaccinated is still a good idea to prevent additional strains. In Ontario these vaccines are free for guys if you are under 26 – talk to your doctor or go to your local HIV/AIDS Service Organization or sexual health clinic for more info.

Hepatitis C
Hep C (also called HCV) is a virus that affects the liver. It is spread through blood and is transmitted through sex (especially rough sex, fisting, group sex, sharing open tubs of lube, and sharing sex toys) and sharing needles. Unlike Hep A and B, there is no vaccine, but there are tests available. HIV positive guys are more likely to contract Hep C so talk to your doctor about developing a testing routine if this is a concern for you. If you test positive, effective treatments are available, and many of them are covered.

MPOX and HIV

Like many infections, the impact of MPOX (monkeypox) can be worse for people with weakened immune systems. For people living with HIV who aren’t on treatment or have low T-cell counts, including people who don’t know they have HIV, it is possible for more complications to come up if they contract MPOX. There’s no evidence that someone living with HIV who is undetectable has any greater risk of complications from MPOX than someone without HIV. Learn more about MPOX here.