Background Across Sub-Saharan Africa, HIV is still predominantly spread via heterosexual intercourse. Understanding sexuality in this region and its relationship with HIV is, therefore, a vital aspect of understanding the disease. Anthropology has offered many perspectives trying to better understand the social and cultures aspects of HIV as a sexually transmitted infection. This contribution aims to explore the complexity of the symbol of “live sex” (sex without a condom) as an endorsement of risky sexual behaviour.

Methods This is a personal ethnographic account of the discourse surrounding HIV and sexual practise amongst young educated Ugandans.

Results HIV has become embedded into the discourse surrounding sexual practise of young educated professionals in Uganda. Traditions of polygamy in East Africa battle with strong Christian morals. HIV has become inextricably linked to this discussion. It is not only seen as a sexually transmitted infection, but as an integral part of decisions regarding sexual practise. I found two common perspectives. Firstly, participating in “live sex” is used as a deep symbol of trust between partners when embarking on a new monogamous relationship. Secondly, “live sex” is a symbol of romance, of natural pleasure, and a reflection of one’s true masculinity. A consistent opinion was; “if you are going to catch it, at least catch it in a moment of ecstasy”.

Conclusion For young educated Ugandans, HIV is not just a risk associated with unprotected sexual intercourse, but it has developed additional symbolic meaning to sexual relationships. Despite high levels of understanding regarding HIV and its mode of transmission, educated individuals still engage in risky behaviour. Does this undermine our focus on education in terms of combating spread? This contribution suggests we need to understand more about HIV as a symbol in a complex social and cultural context, and not just as a medically-defined disease.