Mark Fisher, Manager of Body Positive explains.
I’ve been doing some outreach on the hook-up Apps lately and there have been a lot of questions about PrEP, Undetectable and condom use. There has been a lot of media around these but it’s usually in isolation and not how they work together. Technically it’s known as combination prevention, where people choose the tool that works for them and by the combination effect we eliminate transmission of HIV.
If you are currently using condoms and they work for you- that’s great keep going. The good thing with condoms is that you can see them so you know they are being used and as a physical barrier they may prevent some other STI’s. If condoms don’t work for you or you have occasions where you might forget or slip up then PrEP may be your thing….. you need to take a pill every day and you won’t get HIV. You might pick up some STI’s so the three monthly STI check-up is important to get those easily treated.
It’s important to test regularly for STI’s including HIV – remember there is a syphilis epidemic. If you have contracted HIV it’s vital that you get tested to know this and immediately get connected into care. Starting treatment on the day of diagnosis has been shown to improve your long term health outcomes… and once you maintain an undetectable virus you cannot pass on HIV through sex.
Take your time. Be informed. Take control of your sexual health.
Having these tools available gives people choice – abstinence and monogamy work as well but we won’t discuss those here.
PrEP is good when you need constant protection. You have to take the pill every day and it takes 7 days to get to full rectal protection. If you are sexually active with people of unknown status this is a great tool. If you aren’t that sexually active it might be best to stick with condoms rather than deal with the pill burden and the (limited) side effects. Or you might decide to do a season of PrEP when you need it. Like that Pride Tour of the US when you plan to be busy sampling the local talent – that extra layer of protection will come in handy. You can always stop when you get home (just take it for 28 days after your last play session).
With open relationships it’s a trust thing. You need to talk about your agreements and what is permitted in and outside the relationship. If things happen you need to be aware so that you can use the correct tools. A simple one is “Condoms with Casuals” or maybe you both go on PrEP.
The way you behave with a casual hookup will be different from your regular partner. Is he really on PrEP or does he just want to do it raw? How do you know – do you even know his real name?
Some poz guys are saying that they are on PrEP as it equates to being undetectable (no risk of transmission due to the meds) and its carries less stigma. Some people still freak out if someone says they are poz even if there is no risk of transmission. This needs to change so that people can be open about their status and people understand what it means and how it works. In reality you have less risk of getting HIV from someone that is engaged in care (Poz undetectable or on PrEP) and regularly taking medication than someone that says they are negative but hasn’t tested for two years and only uses condoms occasionally.
Which brings us to consensual sex. Consent is for everyone. It means feeling safe and comfortable with what’s going on. It’s not a one-time thing and you have the right to change your mind. If someone wants to use condoms… discuss it and respect that decision. Understand how the different tools work. If you are negative and your regular partner is poz and undetectable … it’s okay to use condoms or PrEP – they give an extra layer of protection but you don’t need them to stop HIV transmission just to give you peace of mind. Take your time. Be informed. Take control of your sexual health.