A lot has changed since 1983. Bangs are out, beards are in, and condoms are no longer the end-all when it comes to HIV prevention. Today, the modern gay and bisexual man has a variety of options to prevent HIV, none of which should come with fear or hesitation when it comes to his sex life. Unfortunately, the pitiful sex education provided to gay youth fails to mention a practical approach to gay sex. To make up for it, here is a quick and easy guide to selecting the safe-sex method that works for you.
Condoms - There haven’t been enough studies on the efficacy of condoms in anal sex, but in a nutshell, condoms are the easiest and cheapest way to prevent HIV. However, if condoms were all it took to prevent HIV, new infections wouldn’t be on the rise among young gay and bisexual men. The majority of gay men reported that they failed to wear condoms 100 percent of the time. Overall, attempted consistent condom use has been found to be 70 percent effective in preventing HIV infection. In other words, condoms work, but only if you use them. If you are someone who doesn’t always manage to slip on a rubber, condoms aren’t the fail-safe method you might have thought.
Pre-Exposure Prophylaxis (PrEP) - Although pre-exposure prophylaxis, or PrEP, for HIV prevention might not be as easy to use as condoms, that very well may be why it works better for you. PrEP requires you to take real action to ensure your sexual safety. The use of PrEP requires a prescription from your doctor for Truvada, the only drug so far approved for PrEP, and regular checkups to ensure your health and compliance. When taken daily, the drug is 99 percent effective in preventing the user from contracting HIV from a partner. Even if a user misses one or two doses per week, PrEP’s efficacy remains high. The key difference between PrEP and condoms is how it is administered. The PrEP drug is taken with your morning breakfast or right before you go to sleep. Although it directly impacts your sexual health, taking PrEP is separate from the sexual experience. Let’s face it; “forgetting” to wear a condom is not the same thing as forgetting to take a pill.
Condoms + PrEP - Even if you take PrEP religiously, it does not protect against other sexually transmitted. If you are unfamiliar with your sexual partner and wish to further protect yourself, the use of condoms and PrEP is your best bet.
Treatment as Prevention - Think of treatment as prevention, or TasP, as PrEP for HIV-positive people, but with the added benefit of keeping you alive and healthy. Of course, if you are living with HIV, there are numerous reasons for you to stay compliant with your medication, but its use as TasP is probably the most applicable to your everyday dating life. When you achieve an undetectable viral load through treatment, which is often just a pill a day, you reduce your risk or transmitting the virus by 96 percent. But don’t let that 4 percent risk trip you up. To date, there has never been a confirmed case of someone with an undetectable viral load transmitting HIV.
Condoms + TasP - As with PrEP, combining condoms with TasP protects against other STIs as well as HIV. It may also place you or your sexual partner at ease if either of you are not yet comfortable with the science of TasP. The use of condoms in addition to TasP is 100 percent effective and leaves you worry-free.
Post-Exposure Prophylaxis - Post-exposure prophylaxis, or PEP, is not a first-line effort to prevent HIV, but a secondary option if you believe you have been exposed to HIV and TasP, PrEP, or condoms weren’t involved. You can elect to take PEP up to 72 hours after exposure, although it is ideal to start within 24 hours. The treatment regimen usually involves two or three drugs over a 30-day period and will be monitored by your doctor. PEP reportedly reduces the chance of HIV infection by 83 percent but can often come with some unpleasant side effects such as vomiting, nausea and fatigue. Still, PEP is an excellent option if you believe you have been exposed to HIV and you run a risk of seroconversion (becoming HIV-positive).
Sero-sorting - Sero-sorting is the act of choosing your sexual partners based on their HIV status, and it is an outdated, antiquated, and ineffective way to prevent HIV. One in eight people living with HIV are unaware of that fact, and they account for one out of five new infections. A study presented at the 2012 Conference of Retroviruses and Opportunistic Infections found that restricting sex to partners who you think are HIV-negative does not work as a prevention strategy. The problem is that many people are unaware they are HIV-positive, and they assert that they are HIV-negative.