References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Erectile dysfunction (ED) is more common in men living with HIV than in the general population. Causes include psychological factors like anxiety and depression, the effects of HIV itself, some antiretroviral drugs, and other health conditions that are more common with HIV such as cardiovascular disease and diabetes.
The good news is that ED is treatable, and most treatments are compatible with HIV medication — though some need dose adjustments.
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Why ED Is More Common with HIV
| Factor | How It Contributes |
|---|---|
| Psychological | Depression, anxiety, stress, body image, relationship concerns |
| HIV-related | Chronic inflammation, low testosterone, fatigue |
| Medication | Some older PIs and NNRTIs are linked to sexual dysfunction |
| Cardiovascular | Higher rates of vascular disease affect blood flow |
| Substance use | Alcohol, smoking, recreational drugs |
| Ageing | The HIV population is getting older |
What to Do About It
Talk to your HIV team
Many men feel embarrassed, but your HIV clinic deals with this regularly. They can:
- Check testosterone levels
- Review your ART for potential contributors
- Screen for depression and anxiety
- Check cardiovascular risk factors
- Refer to a specialist if needed
Medication for ED
PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis, vardenafil) are the first-line treatment. They are safe with HIV medication but doses may need adjusting:
- With boosted PIs (ritonavir/cobicistat) — start with a much lower dose (e.g. sildenafil 25mg, no more than every 48 hours). These drugs dramatically raise PDE5 inhibitor levels
- With INSTIs (dolutegravir, bictegravir) — no dose adjustment usually needed
- With NNRTIs — generally no significant interaction
Lifestyle changes
- Stop smoking — the single biggest vascular improvement
- Exercise regularly
- Reduce alcohol
- Maintain a healthy weight
- Address stress and mental health
Recreational Drugs and ED
Using poppers (amyl nitrite) with PDE5 inhibitors is dangerous — it can cause a life-threatening drop in blood pressure. This combination should never be used, regardless of HIV status.
Chemsex drugs (GHB, meth, mephedrone) can also contribute to sexual dysfunction and interact with HIV medications.
Read more: Mental health and HIV | Blood pressure and HIV | What is HIV?
Frequently Asked Questions
Can I buy Viagra over the counter if I have HIV?
Sildenafil is available over the counter in the UK, but if you’re on a boosted PI, the standard dose is too high. Get advice from your HIV pharmacist before taking it.
Could my HIV medication be causing ED?
Some older drugs have been linked to sexual dysfunction. If you suspect your medication, talk to your HIV team — switching may help.
Is low testosterone common with HIV?
Yes, more so than in the general population. A simple blood test can check. Testosterone replacement is available if levels are low.
Related reading
- Common STI Symptoms in Women
- Is Testicular Pain a Sign of an STI?
- What Is a Female (Internal) Condom?
- Balanitis: Causes, Symptoms and Treatment
- Female Condoms for Anal Sex: What You Need to Know
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
