Often, people living with HIV have partners who are HIV negative (these are sometimes referred to by healthcare professionals as ‘serodiscordant’ or ‘serodifferent’ relationships). It can feel like relationships between people of different HIV status are sometimes thought of only in terms of sex and the risk of HIV transmission.

Sex is important to many intimate relationships – but few relationships are based on sex alone in the longer term. The sexual side of relationships may change significantly over time and its importance may vary for individuals in the relationship.

But one way or another, having HIV is likely to affect the way you and your partner feel about sex, and have implications for the type of sex you have. The presence of any illness in a relationship can affect sex. This is especially the case with HIV because it can be transmitted through sexual contact. It makes sense for you and your partner to talk about this. You may wish to discuss how it may affect your intimacy, desire and sexual performance. And it is important to talk about ways of preventing your partner getting HIV.

Having an undetectable HIV viral load, especially if you are on HIV treatment, makes you much less likely to pass on HIV. Doctors now advise that, in the right circumstances, taking HIV treatment is as effective in preventing HIV as properly used condoms. Read more about HIV treatment as prevention in the next section.

Another good way of preventing HIV transmission is to use condoms. Used properly and consistently, they also prevent the transmission of other sexually transmitted infections, and can prevent unplanned pregnancies.

Using condoms well is a solution for some couples, but others find it difficult to use condoms all the time or at all, or choose not to.

You might resolve some problems with using condoms by talking to your partner about it. You might also find it helpful to talk to someone at your clinic, such as a health adviser. There may be practical problems with using condoms that are easy to resolve. For example, some people find that standard male condoms break because they are too small, or slip off because they are too big, and trying different sizes of condoms might solve these problems. Using female condoms or different types of lubricants can vary and improve the experience of using condoms. Using female condoms can also give women more control over ensuring a condom is used.

If you are concerned that there may have been a risk of HIV exposure (perhaps a condom has broken or come off), post-exposure prophylaxis (PEP) is available. If your partner is HIV negative, your clinic may be able to provide a starter pack of post-exposure prophylaxis (PEP) for use if a condom breaks or comes off.

However, difficulties with using condoms are sometimes more connected to feelings about HIV, trust and intimacy, and talking through your feelings with your partner, or a professional such as a health adviser or counsellor might help in these situations.

If you are not practising safer sex, it’s important that you both understand and accept the possible risks and have considered the impact on both of you if your partner were to contract HIV.

Many people find it difficult to talk about sex, even with the person who is closest to them. If this is the case, you might want to discuss your concerns with someone at your HIV clinic, GP surgery or a support organisation. This can help you clarify your thoughts and what you’d like to say.

Sometimes, couples counselling can give you a chance to talk about difficult issues with your partner with the help of a trained counsellor. Your clinic or a local HIV organisation may be able to arrange this. In the UK, if you’re not sure where to start, you could contact the Terrence Higgins Trust helpline, THT Direct, on 0808 802 1221. You can also visit our online e-atlas for information on local, and national services and organisations all over the world.