Since testing positive two years ago, I’ve lost all desire for sex. I avoid putting myself in sexual situations, and the few times I’ve met someone, I’ve become anxious and gone through the paces for their sake.Will I ever have a normal sex life?  
—Sexless Sam

Dear Sam,
Sexual anxiety and dysfunction are common among both rookie and veteran HIVers. Left unchecked, the condition can last several years. But you can prevail if you discover what causes your anxiety before trying to please a partner.

If diagnosed recently, you may have unresolved feelings of self-blame for being infected through a potentially controllable behavior. What’s more, you could feel“diseased” or like damaged goods, and your resistance to sex could be a guard against rejection. Counseling and support from other HIVers can clarify these feelings and help you realize you are sexy—and deserve a fulfilling sex life.

Fear of infecting your partner can cause anxiety, too. Calm yourself with an honest discussion about the risk you’re both willing to take, and share responsibility—safe sex is the duty of both partners. Couples therapy can help with both same- and mixed-status issues.

Your low sex drive may be physiological. HIV meds can cause anxiety and deplete libido. HIVer men have less testosterone—and therefore less desire. Hormone treatments and exercise can enhance endorphins and desire. Erectile dysfunction meds can be a quick fix but won’t resolve underlying feelings.

And beware: Impotence meds can interact with protease inhibitors and can cause heart trouble or prolonged erections.

Sex is important and life-affirming. If you face your fears and find a centered place, you’ll be able to give and get more emotionally and physically.

Perry N. Halkitis, PhD, is a professor at New York University and Director of the Center for Health, Identity, Behavior & Prevention Studies.

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