Sex happens in Technicolor when a person is on crystal meth. Or so people say. Mark S. King knows the answer for sure. After an uneven five years of recovery from addiction, which only recently scored him a full year of uninterrupted sobriety, King says he finally knows now that all the wild fun he had when he was high was just a mirage: "I had this chemical, fake view that (a) this is what real sex is like and (b) it was enjoyable. It's a lie that it's enjoyable. And the lie is being told by this disease of addiction that I have."
King, a boyish and muscular 49-year-old blond who lives in Atlanta and blogs about HIV for TheBody.com, is now taking baby steps out of what he describes as a "sexual Peter Pan thing for most of my adult life, thinking that sex was apples being picked from a tree and that it was an inexhaustible resource." A relationship with another HIV-positive man in Fort Lauderdale that imploded a few years back because of King's drug use has shown promising signs of new life, though, and King is planning to move back to Florida to give it another shot -- ever mindful, he says, that clean and sober sex is a strange yet potentially many-splendored thing.
"Sex is really important for a whole lot of reasons: establishing emotional intimacy with partners, experiencing physical pleasure, relieving negative feelings such as distress or loneliness, and also affirming your identity," says Robert Kertzner, a Columbia University psychiatrist with a large number of HIV-positive clients in his private psychotherapy practice. "And all the reasons for sex being important for someone's well-being remain true for people who are HIV-positive -- and probably are even more compelling for them."
But sex is often a thorny issue for HIVers, to say the least. The reality of life with the virus rears its ugly head in the very place where most people want to let it all hang out and forget their troubles. Many, instead of experiencing orgasmic bliss, end up dealing with a laundry list of anxieties: worries about disclosure, transmitting the virus, or potential superinfection; concerns about body image caused by lipodystrophy or aging (King woefully cites his "flat butt" issues); feelings of shame over getting the virus in the first place; and for people like King, ripple effects from current or past drug use.
To that list add performance anxiety or just plain disinterest in sex. Although studies vary in their findings, it is clear that at least half of all HIVers suffer some kind of sexual dysfunction, including low sex drive, problems with getting an erection or with vaginal engorgement and lubrication, or difficulty achieving orgasm. Researchers believe the psychological strain of living with HIV is largely to blame. But, particularly for men, many antiretroviral medications can also cause sexual problems. Other medical culprits, such as low testosterone, diabetes, or cardiovascular disease, can throw their wrenches into the works as well.
Sometimes, though, it's the place where we expect to get help that can be a problem or at least contribute to existing ones. Julianne Serovich, a professor of human development and family science at Ohio State University who studies the psychology of HIV-positive women, says medical professionals in particular tend to overlook HIVers' sexual needs. "I think we are more concerned about how [HIV-positive] people are having sex -- what they're doing -- not necessarily whether they're enjoying it, whether it's healthy for them," she says. "We all have the right to have a healthy sexual existence."
Fortunately, though, there are caregivers who specialize in helping people turn their not-so-steamy sex lives around. "HIV affects people's sex drives for lots of reasons," says David McDowell, a psychiatrist in private practice in Manhattan. "But there are good remedies. It's amazing. You give somebody the right amount of testosterone, they all of a sudden perk up." That's all the more reason to talk to your doctor or a mental health specialist about possible solutions for your problems.
As for people recovering from addiction, like King, McDowell says there's a good deal of hope -- as long as recovering addicts can do the work to recalibrate their expectations of sex. "Sex then becomes a much more sensual, romantic, fun, balanced experience rather than this hyperkinetic overdrive," he explains. "It's going from an incredible, driving disco beat to a nice symphony. But it's in some ways much more enjoyable because it's about connection, not just in a very animalistic driving, predatory way."