Recently in PrEP & PEP Category
Dear Dr. Dick,
What's the deal with those big HIV box tests you can take and do yourself?
You must be referring to the HIV Home Test (also called "Self-Test"). These are kits that include everything you need to test yourself for HIV. Getting tested in a clinic is still the most accurate way to test for HIV, but the Home Test is a safe and convenient option when a clinic isn't available to you.
The Home Test Kit might be a good option for you if:
• You don't get tested at a clinic on a regular basis (it's recommended that guys who have sex with guys test every 3 months)
• You can't make it to a clinic in the near future to get tested
• You want to test between your regular clinic tests
HOME TEST KIT 101
HOW DOES THE TEST WORK?
First you swab your gums with a test stick, then put the swab in a little tube. The test looks for HIV antibodies in your saliva (spit). If your results show that antibodies were detected, this means you have likely been exposed to HIV.
When you open the test kit, take out the instruction sheet and read the instructions TWICE so you don't miss anything. Some guys like to have a friend sit with them for support. It's important not to eat or drink anything, or brush your teeth right before taking the test. Taking it when you're high isn't recommended either!
WHAT DO I DO WHILE I WAIT FOR THE RESULTS?
Your test results will take 20 minutes. While you wait you can clean, make dinner, chat with a friend, or even watch some porn.
If you get a positive result, it's important to get a follow-up HIV test at a clinic to confirm your results. If you do get diagnosed with HIV, connect with a medical provider right away so that you can start HIV medications. Anti-HIV meds are now recommended for all persons infected with HIV regardless of stage of infection.
WHAT IS THE WINDOW PERIOD OF THE TEST?
The Window Period is the time between when a person first gets infected with HIV, and when an HIV test can detect the infection. The Window Period is different for each kind of HIV test.
For the home test, the Window Period can be up to 3 months. So, if you got infected with HIV on March 1, the test may not show a positive result until June 1. That means that for those three months you may be transmitting HIV to your sex partners. The home test should NOT be used to determine your HIV status right before hooking up with someone because of the high false-negative rate during the window period.
For Clinic Tests: There are a couple of different HIV tests used with different window periods. In contrast to the home tests, clinic-based HIV tests can detect HIV infection as early as 10-25 days after infection, depending on the test.
WHAT ABOUT OTHER STDs?
The test does NOT look for other STDs, like chlamydia, gonorrhea, and syphilis. MSM (Men who have Sex with Men), are encouraged to test every 3 months for these STDs. For a list of testing providers, visit http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/testing.aspx#test
If you're negative for HIV, and think you might have come in contact with HIV through a condom break or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? You take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.
If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). For more info on PEP, check out my article Feelin' Peppy.
Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV. Guys who take PrEP should also do the following:
• Use condoms every time for anal and vaginal sex
• Talk to their partners about their HIV status and using protection
• Get tested regularly for STIs, and get treated if an STI pops up
• Get tested every 2-3 months for HIV
• Take their PrEP meds every day
• Use brand new needles and works every time they inject
TALK TO YOUR MEDICAL PROVIDER if you are interested in PrEP. For more info about PrEP, check out my article That Little Pill.
Thanks Hugh Jazz for your great question! Be well,
Dear Dr. Dick,
I'm HIV-negative, and I faithfully strap on a rubber every time I ride a hottie. I feel pretty good about my safety practices, but what do I do if the condom breaks? It's happened a couple of times in my sexual tenure, but I usually notice right away and pull out. I don't have to worry about pregnancy, but what about other stuff?
-On Top Of It in Seattle
Dear Seattle Top,
Condom breakage is a fact of life....in fact, I don't know too many guys who haven't experienced a break. It's great that you're educating yourself about risk. If a condom breaks, you might come in contact with fluids like semen or vaginal secretions, STI sores, and tiny breaks in the skin. What they all have in common is the potential to transmit sexually transmitted infections, including HIV.
If you're HIV-negative, and think you might have come in contact with HIV through a condom break or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? After a possible exposure to HIV, you take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.
If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). If it has been more than 72 hours since possible exposure, you can still seek HIV prevention counseling around reducing your sexual risks. Keep in mind, even if you've been exposed to HIV, it doesn't mean that you will necessarily get infected with the virus. Keep calm, continue your safe sex practices, get tested, and take care of yourself.
Taking PEP does not guarantee that you won't get HIV. More research is needed to find out how effective PEP is in preventing possible HIV infection. PEP should not be used as a regular prevention tool!
NOTE: PEP is often confused with PrEP (Pre-Exposure Prophylaxis). PrEP is designed for daily use for individuals who have a high risk of getting infected with HIV (like someone in a long-term monogamous relationship with a partner who is known to be HIV-positive, particularly if the partner is off HIV treatment), while PEP is designed for use in emergencies, AFTER a possible exposure to HIV. Taking PrEP means you take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill http://projectneon.org/learn/drdick/hiv/that-little-pill/
Things to keep in mind:
• PEP and PrEP can be costly. Check with your insurance if PEP and PrEP are covered. If not, ask if there are assistance programs to help cover the cost of the medication. http://www.nastad.org/docs/PrEP%20and%20PEP%20PAP%20fact%20sheet.pdf
REDUCE THE CHANCE OF CONDOM BREAKAGE:
• Lube, lube, lube! Water based lube is the safest option to use with condoms.
• If you're having marathon sex, change a condom if it starts to dry out or just doesn't feel right. Don't be afraid to stop and add lube throughout your escapades.
• Make sure you're wearing the right size and shape of condom for you. There are so many options. Extra-long, snugger fit, baggy head, insertive condoms...don't be afraid to experiment, and don't let anyone shame you about your condom preferences!
• Add some lube to the tip of the condom, and pinch the tip before rolling the condom on. Both of these will reduce the chance of breakage.
Dear Dr. Dick,
My absolutely amazing and gorgeous partner of three months is poz, and I' m not. We use condoms for anal sex, but I still kind of worry about getting HIV. Dr. Dick, I want to be with this man, and this man only! So, I'm wondering, is double bagging a way to make sex even safer than just using one condom?
Dear Double Mint,
Double-bagging seems like it would work to keep fluids in check---much like the double bag you might receive with a saucy order of take-out. However, double-bagging during sex just isn't necessary and can actually make the ride less safe. Here's why:
Wearing two condoms on your dick, or wearing one condom while your partner uses an Insertive "Female" Condom, will cause a lot of friction that can cause the condoms to break. The friction will also cause the lube on both condoms to dry up more quickly, even if you keep adding more. This can lead to condom breakage, which can expose you to infection.
When you use a condom EVERY TIME you have sex, and use it CORRECTLY, you can greatly reduce your chances of HIV, STIs, and pregnancy (for those who have female-bodied partners of course). Condoms fail most of the time due to human error. Check out my Condom Basics for safety tips.
It sounds like staying negative is important to you and your health. If you want to lower your chance of getting infected with HIV, here are some things you can do in addition to using your favorite rubbers:
• Test every 2-3 months for HIV and STIs like chlamydia, gonorrhea, syphilis, and herpes. If you test positive for an STI, connect with a medical provider right away for treatment.
• Talk with your partner often about your plan to keep each other safe.
• Use water-based lube with condoms to prevent tearing your delicate flower.
• Use condoms for anal, vaginal, and oral sex, and use a dam for rimming.
• Talk to your partner about his taking HIV medications. U.S. National HIV treatment guidelines now recommend that everyone with HIV take antiretroviral therapy (medicines that fight HIV). Those medications will help your partner stay healthy. They can also help protect you from getting HIV from him. Large studies have proven that HIV medications are over 90% effective in preventing heterosexual HIV transmission. We don't know exactly how effective HIV meds are in protecting men who have sex with men, and they might be less effective in preventing HIV transmission through anal sex compared to vaginal sex. Still, the meds probably help a lot and it would be best if your partner was on meds and had an undetectable viral load (a blood test showing he has no HIV in his blood).
• Think about getting on PrEP (Pre-Exposure Prophylaxis). Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill.
• PEP (Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV (like if a condom breaks or you get a needle stick) go to the emergency room at Harborview within 24 hours of the exposure. PEP works best when started immediately, and will not be prescribed after 72 hours.
• If you're using crystal, and worried about remembering to use a condom, try an insertive condom. You can put one in up to 8 hours before sex!
• If you and your partner use together, keep your points and injection equipment separate. Don't share or reuse.
Remember: go with the single bag. Have fun, and be safe!
Dear Dr. Dick,
I try to use condoms when I can, but I definitely slip 'n slide. I don't want to catch the bug - ya know, HIV. I've heard there's a little pill that can prevent it. Tell me mo' 'bout it... pretty please?!
"Pretty 'n Pink"
It sounds like & quacks like - PrEP (Pre-exposure Prophylaxis).
Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV.
The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. Studies show that PrEP can reduce your chances of catching HIV, however, taking PrEP does not guarantee that you won't get HIV.
The iPrEx study, which tested PrEP use in gay and bisexual men, found that participants were 44% less likely to get HIV than men who didn't take the pill. Furthermore, the guys who took PrEP everyday as prescribed (instead of missing or forgetting doses), reduced their risk of HIV infection by 90%. This year, the CDC released the results of the Bangkok Tenofovir Study--which tested PrEP in men and women who inject drugs. The study showed that participants who took PrEP every day had a 74% lower chance of getting HIV. However, some PrEP studies have found no benefit, probably because people didn't consistently take their medication.
It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV. Some guys think that if they take PrEP, it's a ticket to ride bareback without the risk of HIV. PrEP should be one part of your safer sex and safer use practices.
Here are basic guidelines. GUYS WHO TAKE PrEP SHOULD:
- Use condoms every time for anal and vaginal sex.
- Talk to their partners about their HIV status and using protection.
- Get tested regularly for STIs, and get treated if an STI pops up.
- Get tested every 2-3 months for HIV.
- Take their PrEP meds every day.
*If you take PrEP and use crystal, you should still use brand new needles and works every time. Don't share or reuse!
Talk to your doctor if you are interested in PrEP.
Before you can start PrEP, you'll need to test negative for HIV. Once you're on PrEP, your doctor will check-in with you regularly to talk about any side effects, your sexual safety practices, and make sure you are taking the medication as prescribed. You'll also get a blood test every 2-3 months to check for HIV and make sure the medication isn't damaging your kidneys or other organs. A common side effect of PrEP is upset stomach.
You shouldn't take someone else's PrEP drugs either. Only take it when it's prescribed for you by a doctor!
THINK IT OVER:
- If you take PrEP, you have to take it every day for it to prevent HIV infection. You can't just take it the day before you plan to hook up with a hottie. Plain and simple, PrEP only works when you take it everyday. This can be hard for some guys, with all the other things going on throughout the day. Setting a phone alarm is one way to remember the medication.
- If you don't have insurance, PrEP can be super expensive. However, there are medication assistance programs like start.truvada.com.
Check out the PrEP Factsheet by Public Health Seattle King County here: PrEP Q&A: Using HIV Drugs to Prevent HIV Infection <http://www.kingcounty.gov/healthservices/health/communicable/hiv/publications/~/media/health/publichealth/documents/hiv/PrEPfacts.ashx>
Here's an editorial from OUT Magazine: Why Are We Not Talking About PrEP? <http://www.out.com/news-opinion/2013/07/24/michael-lucas-comes-out-hiv-negative-sexually-active-man-prep>