For many men who have sex with men (MSM), their greatest fear is contracting HIV but many of these men actually know very little about it. This blog post is a crash course in every thing you need to know about HIV and hopefully a way to ease fears about catching it.
First of all, HIV is very rare in men who only sleep with women population but remains a real risk for MSM. It’s estimated that about 7% of all men who have sex with men have HIV and this figure is probably closer to 10-15% in the capital cities (where man-on-man sex is typically more readily available). AIDS (the condition where HIV has progressed to the point where your immune system is very weak) is exceptionally rare these days. There aren’t figures on how often someone develops AIDS in Australia because it is such a rare event. For the vast majority of people living with HIV its a chronic condition that has minimal effect on their health and the greatest inconvenience is needing to take a medication every day.
In Australia about 90% of people with HIV know that they have it and most of those people (84%) will be taking medication to treat HIV. The goal for people with HIV on treatment is to have an undetectable viral load and 92% of people on treatment in Australia have an undetectable viral load. This is important because even without using a condom there has never been a case of someone who has HIV and an undetectable viral load passing the virus on to somebody else. That means it’s effectively impossible to catch HIV from someone with an undetectable viral load. Often MSM are reluctant to engage in a sexual relationship with someone with HIV but ironically they are more likely to get HIV from someone who isn’t getting tested regularly and not using protection (condoms or PrEP).
What is PrEP? Glad you asked there is a link to an explanation here.
What is treatment? Treatment is known today as anti-retroviral therapy or ART. These days it is usually a combination of three medications that are either taken separately or with two or three medications combined into one pill or capsule. In the old days it was common to have to take lots of different medications multiple times per day but these days most people with HIV just take one pill, once per day that is a combination of three different medications. The biggest risk to someone with HIV on treatment is when their virus develops resistance to the medication but this is happening less and less often because the new drugs are very hard for the virus to resist.
So, if you meet someone and you’d like to enter into a sexual relationship with them what is the best way to ensure you don’t get HIV? First of all be on PrEP, with perfect use it is about 97% effective and with typical use it’s 90% effective. Secondly, you can feel very safe if your sexual partner either has HIV and has an undetectable viral load for the last 6 months or if your sexual partner is on PrEP. The reason why someone on PrEP is a better option for man on man sex is because in order to get the medication they must be getting checked regularly and so its very unlikely that they might have HIV and not know about it. Third, wear a condom, it protects against other STIs that aren’t HIV and by adding this method the chances of you getting HIV are becoming so low that it may as well be impossible.
What do you do if, for whatever reason, you have sex with someone and don’t use a condom, aren’t on PrEP and they either have HIV and a detectable viral load or you have no idea whether they could have HIV or not. That’s where PEP comes in.
PEP stands for post exposure prophylaxis. I’ll write a blog post about PEP in the future but PEP is recommended in all of the situations below.
- Where you’re the bottom and there is no condom used (regardless of whether he came inside of you or not)
- Where you’re the top and there is no condom used (regardless of whether you are circumcised or not)
It’s not necessary to use PEP for oral sex without a condom. PEP should be started as soon as possible after a potential exposure and it must be started within 72 hours. If the person you were potentially exposed through can be contacted to find out more about their status then they should be but it shouldn’t delay starting PEP. If they are contacted and they let you know they are on PrEP then PEP can be stopped. If they have the virus but an undetectable viral load then PEP can be stopped. If they don’t know their status or refuse to disclose it then PEP should continue for a full course. A full course of PEP is 28 days of a once per day medication.
Hope that helped. Please reply or message me with any further questions and I’ll be very glad to answer them.