Dear Dr G,I read with interest the articles highlighting the various adversities of sexual and reproductive health.I think it is time for me to be open about my status as an individual living with HIV.I am a 33-year-old man who contracted HIV in my late 20s through ignorance and carelessness.Although guilt and shame initially drove me to despair, I am living proof there is a fulfilling life after being infected with HIV.My world crumbled when I learned I had tested positive during routine blood donation screening, as HIV was always three letters associated with imminent death.Now living with the virus with the right treatment, I feel compelled to spread the word that HIV no longer has the haunting past it once did.Although I am living healthily on an antiretroviral regimen, I still cannot help doubting how treatment, or living with HIV, might affect me sexually.As I start a new life with my wife, I would like to put you on the spot for clarification on the sexual and reproductive impact of living with HIV.First, how does HIV affect men’s reproductive health?Can the virus or its treatment cause sexual dysfunction in any way?How can I prevent HIV transmission to my loved ones, including the next generation?Lastly, my biggest fear is stigma. How do we stop stigma from consuming us?Yours truly,HIV-Howard Living with HIV can affect sexual and reproductive health in physical, emotional and social ways. Since HIV was identified in the 1980s, medical advances have transformed it from a life-threatening illness into a manageable chronic condition. Today, antiretroviral therapy (ART) allows many people living with HIV to live long, healthy lives. However, HIV and its treatment can still influence fertility, sexual wellbeing, mental health and long-term physical health. HIV can affect sexual and reproductive health in several ways. In the early stages of infection, the virus weakens immune function and may contribute to fatigue, weight loss, hormonal imbalance and increased vulnerability to other sexually transmitted infections. In men, HIV may be associated with reduced sperm quality, lower testosterone levels and erectile dysfunction, particularly if infection is untreated or treatment is interrupted. Women living with HIV may experience menstrual irregularities, pelvic infections and pregnancy-related complications if proper care is not available. The emotional and social impact of HIV is also significant. Many people living with HIV experience anxiety, depression, fear of rejection and stigma that affects relationships and sexuality. Concerns about transmitting the virus to partners or future children can affect intimacy and family planning decisions. In some societies, stigma and discrimination still create barriers to healthcare and emotional support, even though medical understanding of HIV has improved greatly. One of the greatest breakthroughs in HIV care has been antiretroviral therapy. ART works by reducing the amount of virus in the body to extremely low levels. When taken consistently, treatment can make the virus “undetectable”, meaning it cannot be sexually transmitted to others. This is the basis of “Undetectable = Untransmittable” (U=U) and has expanded the reproductive choices of people living with HIV. In the short term, ART can cause side effects such as nausea, headache, fatigue, diarrhoea, and sleep disturbance, particularly when treatment is first started. Some people may also notice changes in mood or appetite. These symptoms often improve as the body adjusts. The long-term effects of ART are more complex. While modern medications are far safer than earlier HIV drugs, long-term treatment may still be associated with weight gain, higher cholesterol, liver or kidney problems and reduced bone density in some patients. Long-term HIV infection and chronic inflammation may also increase the risk of cardiovascular disease and diabetes as people age. Despite these challenges, ART has dramatically improved reproductive outcomes. With proper treatment and medical follow-up, women living with HIV can become pregnant and give birth with a very low risk of mother-to-child transmission. Couples affected by HIV can also pursue parenthood with medical guidance, including timed conception and assisted reproductive technologies where appropriate. Living with HIV today is very different from what it was decades ago. Many individuals can maintain healthy relationships, active sex lives and successful pregnancies. However, HIV still carries physical, emotional and social challenges that require ongoing healthcare, education and support. Reducing stigma remains essential. “Stigma is more harmful than the disease itself” is a widely used mental health advocacy quote. In the 21st century, with the right treatment and disease awareness, living with HIV can be much like living with other chronic conditions. Dr G is often put on the spot about how to minimise stigma. His view is: “Only disease awareness and open communication can sway the shame and stigma against the disease itself!”
