In other chapters we discussed the influence that AIDS has had on the sexual behaviors and attitudes of people in the United States. Because HIV can be passed to others through sexual activity, millions of Americans have changed their sexual lifestyles to include safer sex practices. But what of those who discover that they are HIV-positive or have devel­oped AIDS? Although we will discuss HIV and AIDS in depth in Chapter 15, here we will review how the knowledge about HIV and the virus itself affect sexual functioning.

Caught up in the tragedy of their situation, their fear of infecting others, and often their shame, some people cease all sexual activity. Others limit their sexual contact to hugging, kissing, and caressing. Although people with HIV often experience sexual dys­function (Catalan & Meadows, 2000), the existence of HIV in the bloodstream need not mean the end of one’s sexual life. HIV-positive people need to be careful and con­siderate with their partners, avoiding exchange of body fluids and accidental infection. However, there is ample opportunity for loving, sexual relations while maintaining safety.

Wearing a condom reduces (although it does not eliminate) the risk of sexually transmitting the virus during oral, vaginal, or anal sex (Schover & Jensen, 1988). Mutual massage, mutual masturbation, the use of vibrators or other sex toys, and kissing without the exchange of saliva are all safe practices if care is taken (for example, the ejaculate of an infected partner should not come into contact with skin if the skin has cuts or abrasions; Sandowski, 1989). Sexuality can be very important to those infected with HIV, for in the midst of the world’s fear and rejection, sexuality reaffirms that they are loved, cared for, and accepted by their partners.