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I have a problem that started a year ago approximately. First of all, I was diagnosed as HIV-positive 3 months ago. Like many people I got infected because I started having unprotected sex, this was because I started having problems using condoms. Every time I was with a hookup everything went well, we had some foreplay and my dick is erected but then, when I put the condom on, I lose the erection completely and it’s something that gets me really frustrated at that time (I’m a top). I started not using condoms sometimes but now, in my case, I need to use them mandatorily, but the problem still persists and I really don’t know how to handle the situation. I don’t know if it’s something psychological or something else. Hopefully, you can give me some advice.
I’d like to take the opportunity to thank you for your articles. They helped me A LOT when I was depressed about my diagnosis and made me feel much better.
Your message is kind. Your question illustrates a common problem in the condom doctrine. Various people fighting AIDS — including the bombastic Michael Weinstein, president of the AIDS Healthcare Foundation — have smeared HIV prevention methods that don’t involve condoms (and he has supported his arguments with unfounded, anti-scientific rhetoric).
Being HIV-positive doesn’t require you to now use condoms. I’m HIV-positive and I haven’t touched a condom in years.
In his arguments, Weinstein mostly takes aim at PrEP, a daily pill for HIV-negative people that prevents HIV. Like other anti-science scaremongers, Weinstein has touted a disaster scenario that PrEP (currently the drug Truvada) will eventually fail, resulting in a scenario like the early years of AIDS. He claims that organizations like the Centers for Disease Control are actively pushing PrEP as a replacement for condoms as part of some kind of anti-condom conspiracy.
Although these claims are false (the CDC clearly states on its website that PrEP should be used in conjunction with condoms to be most effective), PrEP doesn’t mean much for us, people living with HIV. Luckily, PrEP is not the only HIV preventative. Being HIV-positive and undetectable — achieved by taking anti-HIV meds as prescribed — makes you undetectable and unable to transmit HIV. This is called TasP, or treatment-as-prevention. I take one pill a day and never touch condoms because I am unable to give anyone my HIV.
But HIV isn’t the only sexually transmitted infection out there, and TasP, of course, only prevents the spread of HIV. PrEP and TasP don’t protect anyone from gonorrhea, chlamydia, syphilis, or other common STIs. With these nasties — most of which are still treatable with antibiotics, though who knows for how much longer — you have to weigh risk versus reward. I choose to forego condoms because I don’t enjoy how they feel. Therefore I am at higher risk of catching gonorrhea and syphilis, and I often do, and I get frequent STI testing to catch these infections quickly. I know many HIV-positive men who do the same.
Condoms don’t feel great. Many men can’t stay hard when using them. And sexually active men who have sex with men aren’t going to use an HIV prevention method that doesn’t feel great — regardless of the risks. Prevention methods work best when they are actually used, and it’s hard to make gay men use something that sucks. So a harm-reduction approach would be to scrap condoms and make do with PrEP, TasP, PEP, and frequent STI screening (monthly or more).
So let’s talk reality. You’re not going to want to continue using condoms if you can’t stay hard. Your meds can prevent HIV, but what do you do about other STIs? Nothing — except getting tested frequently. If you’re having lots of condomless sex, I recommend getting a full STI screening once a month, or even more frequently. In your STI screenings, you should try to get tested for everything, including Hep C. Tell your doctor to be thorough.
Very frequent testing is what barebackers (guys who don’t use condoms) do to minimize the spread of STIs like gonorrhea and syphilis in our midst. If you catch something, get treated for it, and don’t fuck anyone for at least a week. It’s true that this isn’t a preventive healthcare method — it’s a responsive one, so it’s automatically more taxing on the body and less healthy in the strictest sense, especially in the long term. Frequent antibiotics used to treat STIs are hard on the immune system (as well as your gut and colon health). But these are risks many of us choose to live with for now. A realistic public health approach must advocate for practices people will actually adhere to — and available data shows that men who can’t get hard with condoms will not use them. So, this is the next best thing.
An HIV diagnosis is hard, but I hope someone has told you by now that you’re going to be fine. Your sex life will continue, and it may even get better — mine did.