Tag Archives: HIV

MODERN GAY HEALTH: WHAT IS PREP?

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To PrEP or not to PrEP: Is Truvada really a sexual health game changer?

There’s a lot of discussion at the moment about the use of PrEP as a safe sex tactic for gay men. Writer David Mang explains what PrEP is and looks at whether or not it’s the right tactic for you.

While the horrors of the AIDS crisis of the 1980s are mercifully consigned to history, HIV remains a major health risk for all sexually active people, particularly gay and bisexual men. In 2014, around 2,800 LGBT men were diagnosed HIV positive in the UK – many of whom could potentially have avoided infection had they been using a PrEP drug such as Truvada.

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, and is a method of preventing HIV infection which has recently been made available for sale in some territories, including the USA. It involves taking an antiretroviral drug on a daily basis. At present, the leading drug on the market is Truvada, which has been shown to reduce the risk of HIV infection for people who are identified as ‘high risk’ by as much as 92%.

The easiest way to think about is is to remember that PrEP is the method, whereas Truvada is simply a brand name. When the patent on Truvada expires in a couple of years time, the market may well be flooded by equally effective alternatives, lowering the cost of the drug.

How does it work?

First of all, it’s vital to remember that PrEP is not a vaccine. When you take PrEP on a daily basis, it enters your bloodstream and can stop HIV from taking hold and spreading. However, of you fail to take PrEP consistently, it’s effectiveness weakens, and there may not be enough medication in your bloodstream to protect you.

Should I be using PrEP?

The reduction rate in HIV transmission from using PrEP is hugely significant. With the medication broadly considered to be safe and relatively low on harmful side effects, the evidence in favour of taking them is compelling – particularly if you frequently engage in high-risk sexual activities such as barebacking, anonymous sex or group sex, or if you’re an intravenous drug user. It could also be a major breakthrough for mixed HIV status couples. According to a study by HIV I-Base, around half of gay men in London would take oral PrEP drugs to reduce their risks of contracting HIV.

On the other hand, PrEP is not a silver bullet for sexual health. First, it is only effective if taken consistently, so don’t think of it as a gay version of the ‘morning after pill’. If you decide PrEP is for you, it’s critically important that you take the drug every day. It also provides no protection against other STIs such as chlamydia, gonorrhoea, anal warts and syphilis.

What are the potential side effects?

Some people who have taken Truvada have complained of mild side effects including loss of appetite, insomnia and an upset stomach. However, in most cases these issues have resolved after regularly taking the drug for a month or so. Beyond that, it appears to be a fairly comfortable and easy drug to take.

How do I get hold of PrEP?

A relative newcomer to the sexual health market, PrEP is not currently available on the NHS in the UK, and can only be accessed by participants in selected medical trials. However, in other countries such as the USA it has been brought to market, albeit at a high price point. Sexual health campaigners are calling for Truvada to be made available on the NHS, and it is hoped that before too long PrEP will become another powerful weapon in our sexual health arsenal.

For more information on PrEP click here 

Image by Bruce Weber for VMAN.

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RULE NO.5: YOU CAN CONTRACT HIV FROM SOMEONE YOU LOVE

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One of the best things about having a boyfriend is choosing not use condoms. I’ve heard from friends of mine that they choose not to use condoms with their boyfriends after a certain period of time dating. They rationalise that they’ve been together for long enough that they can trust their partner but this is a grave mistake. A large portion of newly diagnosed HIV cases are the result of a person contracting the virus from a partner who did not know that they were HIV positive. You cannot assume that your partner is negative simply based on the period of time that you’ve been dating. He may not be aware of his own status.

When and if you decide to stop using condoms in your relationship it’s important to follow the Four T’s: Talk, Test, Test, Trust. This is the safest approach to ensuring you look after your health and the health of your partner.

I have copied the following information from the ACON website (an Australian health organisation established to promote sexual health for the gay community) as they explain the Four T’s best.

Some HIV negative men in ongoing relationships with other HIV negative men choose to have anal sex with each other without using condoms. At best this decision can help make the sex they have special, at worst it can increase the risk of either or both partners contracting HIV.

Choosing not to use condoms with a regular partner is a major decision. It’s not only a decision about the type of sex you have together, it’s a decision about how much responsibility for your sexual wellbeing you’re prepared to hand over to your partner. By choosing to have sex without condoms within your relationship you are saying to each other ‘I trust you with my health and safety’.

THE FOUR T’S

Step One – Talk

To safely stop using condoms within your relationship you need to be able to talk openly and honestly with each other about why you want to do it, what the potential benefits and risks might be, the ground rules for sex inside and outside the relationship and how you’ll deal with any problems that may arise.

If you come to an understanding with each other on all of these issues and still want to ditch the condoms you should then move on to Step #2.

Step Two – Test

Step 2 is for both of you to have an HIV test. You can do this together or separately. If you’re going to have anal sex without a condom you should both be totally sure you are HIV negative and aren’t going to put each other at risk.

If the tests for both of you come back negative, you should still continue to use condoms for 3 months before moving on to Step #3.

Step Three – Test

Step #3 is to get a second HIV test. If neither of you have had unsafe sex throughout the three-month period then the second test will confirm that both of you are HIV negative.

If this is the case and you still want to stop using condoms with each other you can then move on to Step #4.

Step Four – Trust

Step #4 is to negotiate a clear agreement for sex with each other and other people outside the relationship (if that’s what you’ve decided) as well as guidelines for dealing with any problems that might arise.  Once these have been made clear you can then trust that you and your partner will stick by them.

If the two of you decide to stop using condoms for anal sex with each other remember it depends upon open and honest communication.  The discussions you have about condoms and sex can help you understand each other better and build a stronger relationship

www.acon.org.au

Photo Credit: “Viva Las Vegas” by Matthias Vriens McGrath

How have you negotiated safe-sex with your partner?

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