In this section people with HIV discuss the personal and social implications of ageing, and discuss their strategies for coping with change.
Each section includes practical suggestions which may help meet the needs of people living longer with HIV. Looking beyond HIV to a fuller life and being able to see the person not just the disease is an important mantra for many individuals to achieve this personal goal. This may be especially so for people who were diagnosed in the 1980s—whom were often given a death sentence back then and may not have prepared themselves to be alive 20 years later.
A commonly held view about older people is that they are either asexual or exclusively heterosexual. However, research has shown that older people are sexual and that sexual expression is important for health and wellbeing and that some older people are gay, lesbian, bisexual, transgender and intersex or may be a sex worker.
For many people as they get older sex can lessen in importance compared with when they were younger. For others it is still an essential part of their life. You may not be defined by your sexuality or your HIV status, but whatever your path is, this part of your life is important. This chapter covers some ways for you to achieve your sexual desires.
Negotiating sex can always be a challenge; however we often gain experience and confidence as we age. No longer fumbling teenagers, we may have a better understanding of intimacy and sexuality. Whether looking for an intimate connection or just sex, life experience may assist us in meeting our needs.
What can you do?
There are websites that cater specifically to older gay men and their admirers, people over 50, volunteers and all sorts of social networking sites.
Use condoms with a water-based lubricant to avoid passing on HIV and protect you and your partners from some other STIs [Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). . There is a very low risk of passing on HIV through oral sex, but using a condom or dental dams will also protect you and your partners from some other STIs.
Accidents can happen. If you think you may have exposed another person to HIV, find out where they can get PEP treatment to prevent HIV infection taking hold.
PEP (post-exposure prophylaxis) must be started within 72 hours of exposure, but within a few hours is best.
For more information about PEP and where it is available, call your nearest major hospital, call your AIDS Council, or go to www.getpep.info 
HIV is still present, even if you have an undetectable viral load. The virus A small infective organism which is incapable of reproducing outside a host cell. remains in very small amounts, which are unable to be accurately measured by current blood tests.
It is possible to have a low or undetectable blood viral load, but higher levels of HIV in other body fluids such as semen, vaginal fluids and the fluid lining of the rectum and anus. This would increase the chance of passing on HIV to your partners.
While research suggests an undetectable blood viral load reduces the risk of passing on HIV, it has not yet been proven to completely eliminate the risk. Having an undetectable viral load result at your last test is not a substitute for safe sex.
Having another infection when you are HIV positive places further stress on your immune system as well as makes the other infection more serious.
If you have a sexually transmissible infection (STI) as well as HIV, then both the STI and HIV can be easier to pass on to your partners. Some STIs can also increase your viral load and decrease your CD4 count. Get regular sexual health check-ups (blood and urine tests as well as throat, vaginal and anal swabs). Many STIs do not have symptoms.
There is an increased risk of hepatitis B transmission through anal sex.
If you and your partner are both HIV positive and do not use condoms, there is a possible risk of being exposed to a different strain [HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person). of HIV. Being infected with a different strain (reinfection or superinfection) can limit your treatment options. Speak to your doctor or AIDS council or PLHIV Person (or people) Living with HIV. This term is now preferred over the older PLWHA. organisation for more information.