Category: HIV Issues

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PrEP

— The small blue pill helping end HIV transmission

Pre-Exposure Prophylaxis (PrEP) is used to prevent HIV transmission

By James W Kelly

Access to a preventative drug has led to a fall in the number of gay and bisexual men diagnosed with HIV, a leading sexual health clinic has said.

Health Security Agency (HSA) figures for London show the number of first diagnoses had fallen in this group by 3% from 2021 to 2022.

Pre-Exposure Prophylaxis (PrEP) is a “powerful tool” in ending transmission, 56 Dean Street clinic said.

However there was a rise of 17% in new HIV diagnoses in the capital.

The treatment which has been free on the NHS in England since 2020, involves taking the PrEP pill containing the drugs tenofovir and emtricitabine before having sex.

Uptake of the drug has been greatest in gay and bisexual men, the clinic said.

Consultant Dr Alan McOwan said: “Everyone should know about PrEP and its potential for preventing HIV.”

Dr Alan McOwan

Dr McOwan said it’s “really simple” to access PrEP

He encouraged anyone considered at higher risk of HIV to enquire about it at their local sexual health clinic.

Across England however, among gay and bisexual men, the overall reduced HIV transmission is not reflected across all ethnic groups.

Tarun Shah, who was diagnosed with HIV four years ago while trying to access PrEP, said the results were encouraging but more work was needed to target more at-risk people in accessing the drug.

He told BBC News: “A few months after enquiring about the PrEP trial, I ended up getting quite ill and it came out that I was HIV positive.”

Tarun said his experience accessing PrEP before his HIV diagnosis was “frustrating”

At the time, PrEP was only available on the NHS to a limited number of people during its trial and Tarun said he was unable to get onto it and could not afford the drugs privately.

He said he found it “frustrating” to think about his situation but added: “I’ve now been quite healthy ever since and it’s great to see that PrEP is now widely available to everyone.”

‘Many not being talked to’

The data for England shows new diagnoses fell by 17% from 2021-22 for white gay and bisexual men, while rises were observed among men of Asian (17%) and mixed or other ethnicity (25%).

Tarun, who is South Asian, said: “There are a lot of groups who don’t feel like they are being talked to in these conversations.

“The more people we can include, the better and I think it will be great that everyone has access to PrEP.”

While effective HIV treatment eliminates the possibility of transmission, Tarun said his partner taking PrEP provide them with a “double zero kind of safety”.

Complete Article ↪HERE↩!

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A new morning-after pill to stop STDs could also make the problem worse

The CDC is considering recommending the antibiotic doxycycline to be used after sex to prevent syphilis, gonorrhea and chlamydia.

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Public health officials are deploying a powerful new weapon in the war against rising sexually transmitted infections: a common antibiotic that works as a morning-after pill.

It is the latest advancement as the sexual health field shifts to preventive medicine — not just condoms, abstinence and tests — as the best hope for quashing the pathogens that can spread during sex.

For the past decade, people have been able to have unprotected sex with a low risk of contracting HIV thanks to daily pills known as PrEP, or pre-exposure prophylaxis. But they were still susceptible to bacterial bugs, including the recent spike in syphilis, gonorrhea and chlamydia — until now.

Recent studies show the antibiotic doxycycline taken after sexual encounters works as a post-exposure prophylaxis to prevent those infections. But experts are also worried about unintended consequences. The Centers for Disease Control and Prevention plans to release guidelines later this summer for deploying the treatment, known as DoxyPEP, in hopes of addressing fears among medical professionals that preventive use would fuel antibiotic resistance — and the rise of drug-resistant superbugs.

“It’s the first major intervention we’ve had for STIs since the vaccine for human papillomavirus,” nearly two decades ago, said Jonathan Mermin, who leads STI prevention for the CDC. “But it is a new intervention, and because of that, there are potential benefits and potential risks.”

Doctors, public health officials and sexual health clinics have embraced preventive pills as a realistic way to curb STIs because they preserve pleasure while protecting partners. Some doctors have started prescribing it to a narrow segment of the gay community considered at elevated risk for STIs.

“Just like PrEP was a game changer, this empowers individuals to make choices about their sexual health,” said Jorge Roman, senior director of clinical services at the San Francisco AIDS Foundation, one of the first to widely distribute DoxyPEP. “It doesn’t always have to be about condoms.”

Doxycycline is already used as a front line antibiotic treatment for chlamydia and occasionally for syphilis and gonorrhea. But its use for prevention has drawn concerns that it would no longer be effective in patients who use it regularly and that it may facilitate the evolution of antibiotic resistant strains of the pathogens.

The drug’s proponents say these concerns are overblown because the criteria for eligibility are often narrow: Transgender women and men who have sex with men — and only if they have condomless sex and contracted an STI in the preceding year.

Those were the demographics recruited for a study of 500 patients in San Francisco and Seattle that found DoxyPEP effective. The study found a roughly 65 percent reduction in syphilis, gonorrhea and chlamydia cases in those who used the antibiotic between 2019 and 2022, mirroring similar results from European studies.

Another study of DoxyPEP use by cisgender women in Kenya between 2020 and 2022 did not find the treatment effective, a result that surprised and stumped researchers. Anatomical differences could play a role, but health officials say other studies suggest doxycycline becomes concentrated enough in vaginal fluid to confer protection against STIs.

Experts say it’s too early to conclude that DoxyPEP won’t work for women and more research is needed. Another possible explanation is women enrolled in the Kenyan study may not have consistently used doxycycline after sex. Researchers note early studies that found PrEP ineffective in protecting African women from HIV were eventually explained by poor adherence to the drug regimen rather than biological differences.

Researchers studying DoxyPEP are scrutinizing whether it could also render antibiotic treatments less effective. The U.S. study found a slight increase in antibacterial resistance, which the study’s authors said merits long-term attention. But they also said the finding should be tempered by the fact doctors would also be administering fewer antibiotics if people avoid catching and spreading STIs.

David Hyun, director of the Antibiotic Resistance Project at The Pew Charitable Trusts, said he was concerned by patients in the study using DoxyPEP as frequently as 20 times a month. More data is needed to understand the long-term effects — for individuals as well as broader communities, he said.

“If you keep exposing a patient to antibiotics like doxycycline, you are raising the risk of that patient being colonized or infected with a resistant strain sometime in the future,” Hyun said.

Some LGBTQ+ health providers suspect doctors may be using antibiotic resistance concerns to mask discomfort with condomless gay sex. They note that syphilis has yet to become resistant to penicillin since the antibiotic became the front-line treatment for the STI in the 1940s. And they point out doxycycline is widely used for other reasons, including long-term acne treatment and malaria prevention.

“We have used doxycycline for multiple other things,” Shira Heisler, medical director of the Detroit Public Health STD Clinic, said during a May conference of the National Coalition of STD Directors. “And I think specifically now being like, ‘We are not going to do it because of antimicrobial resistance’ when it’s specifically related to STIs is a good time to call out, ‘This is what stigma is. This is what bias is.’”

Proponents of DoxyPEP said it offers a long-needed solution to a spike in STIs. The CDC recorded more than 2.5 million cases of syphilis, gonorrhea and chlamydia in 2021, up from 1.8 million in 2011.

In 2021, 36 percent of syphilis and gonorrhea cases were in men who have sex with men, according to the CDC. The CDC says these disparities cannot be explained by differences in sexual behavior alone. When people have a smaller pool of potential sexual partners with higher rates of STIs, they are more likely to have sex with someone with an infection. Cases in cisgender women and heterosexual men have also been rising.

Experts say everyone would benefit from DoxyPEP being limited to those most at risk because that would break chains of transmission early and reduce the likelihood of infections spreading more broadly.

Some physicians say allowing people to have worry-free sex is a worthy goal on its own.

“My goal as a physician is to make sure my patients are able to have whatever type of sex they want and however much sex they want as safely as possible,” said Boghuma Kabisen Titanji, an infectious diseases specialist in Atlanta. “And if DoxyPEP would allow them to do it, then I have no problem offering it.”

Nick, a 35-year-old resident of Lafayette, Ind., said he recently started taking DoxyPEP for peace of mind, knowing he would be less likely to get an infection as he has frequent condomless sex.

HIV was no longer a concern because he has been taking PrEP for a decade, said Nick, who spoke on the condition that his last name not be used to candidly discuss his sex life. But he has endured uncomfortable bouts of syphilis and chlamydia.

“If you are taking HIV PrEP, why not take another extra kind of safeguard too?” he said. “It’s like a security blanket.”

As the country considers how widely to distribute DoxyPEP, public health officials and activists are worried it will be the latest medical advancement to roll out in an inequitable way, following similar racial gaps seen with PrEP and mpox vaccinations. Federal officials say PrEP users are disproportionately White even though most new HIV cases are in Black and Latino people. The CDC estimates that most mpox cases have been in Black and Latino men, but only a third of vaccine doses have gone to them.

LGBTQ+ health providers are already reporting disparities, with White patients more likely to ask about DoxyPEP and Black and Latino patients less likely to be familiar with it.

During a discussion about DoxyPEP at the STD conference, one state health official noted that those who can afford to travel to Puerto Vallarta, a popular vacation destination among some gay Americans, can buy doxycycline to stockpile for themselves and their friends because the antibiotic is available over the counter in Mexico. But experts say concerns about antibiotic resistance would make it difficult for over-the-counter sales to occur in the United States.

Mermin, the CDC official, said equity is a top concern as the agency crafts its guidance for the use of DoxyPEP. It would be essential to ensure the medication is available in clinics serving people at the highest risk for STIs, he said, and to raise awareness outside of medical settings, such as on dating apps.

In London, Joey Knock said he started buying DoxyPEP outside of official channels, a common practice among some gay Europeans, last winter after regular bouts of gonorrhea.

But he limits his use to higher-risk nights, such as when he has unprotected sex in dark rooms with strangers.

“I’m someone who was averaging an STI a month,” said Knock, 33. “I’ve done the risk analysis for me, but it also benefits other people if me taking DoxyPEP means I don’t get chlamydia, then I don’t pass chlamydia around.”

In San Francisco, the first major jurisdiction where public health officials recommended DoxyPEP, providers noticed patients taking a similar approach: Using it after higher-risk sexual encounters rather than every encounter.

“We need to do more analysis to see if that could be making DoxyPEP less effective or if perhaps people are making really good decisions about when to use it,” said Stephanie Cohen, who leads STI prevention for the San Francisco Department of Public Health.

The San Francisco AIDS Foundation, which says it has connected more than 1,800 people to DoxyPEP, does not limit the antibiotic to people who have recently contracted a sexually transmitted infection, but counsels patients on the unknown risks of antibiotic resistance.

Anu Hazra, co-medical director of the Howard Brown Health, an LGBTQ+ health provider in Chicago, said antimicrobial resistance is “probably the largest public health threat we have” but doxycycline for a small group of people pales in comparison to the rampant use of antibiotics in the meat industry and other sectors.

He and other experts say vaccines to prevent STIs could be another game changer that does not carry the same baggage as antibiotics. A recent study showing that a vaccine for meningitis can also reduce the likelihood of contracting gonorrhea offers promise on that front. But DoxyPEP offers an immediate solution to an ongoing problem and could be pared back if antibiotic resistance emerges, Hazra said.

“We are seeing rising rates of STIs across the board for nearly a decade now. What we are doing now is not working,” Hazra said. “We need to try something new.”

Complete Article ↪HERE↩!

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Sex After 60?

— You Need to Know About STD Prevention

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Coming this fall to your TV screen: “The Golden Bachelor.” That’s right, reality television fans, seniors are finally getting their shot at this (somewhat unscripted) love connection. The suspenseful rose ceremonies and extravagant date nights are likely. But will there be an overnight in the fantasy suite?

If this is, in fact, reality, then there should be. Physical intimacy important — sex even has health benefits. Yes, even for those in their twilight years. Shining a light on sex after 60 may be just what the doctor ordered. But seniors also need to know how to protect themselves from sexually transmitted diseases (STDs).

STD Rates Rise Along with Sex After 60

Sexual health may not be a topic older adults are keen on discussing — even with their care providers. “Unfortunately, this reluctance to talk about sex is putting newly single seniors at risk for sexually transmitted infections,” says Laurie Archbald-Pannone, MD, a geriatrician with UVA Health. As a geriatrician, she specializes in primary care for older adults.

One analysis showed that in adults over age 60, diagnosis rates for STDs (also known as sexually transmitted infections or STIs) increased 23% in 3 years.

That’s more than double the increase seen in the rest of the population, which saw a rise of just 11% in diagnoses of STDs. The main STDS are gonorrhea, chlamydia, and herpes simplex.

Why the STD Boom Among Boomers?

The rise is likely due to “a lack of awareness among this age group about STI prevalence and prevention,” says Archbald-Pannone.

“A common scenario is when someone older in life suddenly rejoins the dating scene after a decades-long monogamous relationship. This person may not have a history of STI education, so may not be aware of appropriate prevention or STI signs and symptoms,” she says.

With increased availability of medications for menopausal symptoms and erectile dysfunction, sex after 60 is more common. But older adults are also more susceptible to infections due to age-related changes in immune function. For women, postmenopausal vaginal dryness can increase the risk for tears in the vaginal wall, which can accelerate the spread of infection.

Let’s Talk About Sex After 60

Unfortunately, says Archbald-Pannone, many clinicians are missing an opportunity to educate this population about STD prevention, including the use of condoms and the importance of screening.

“In terms of sexual health, we as providers readily talk about STI prevention with younger patients,” she says. “Among older adults, however, studies show clinicians are not having the same conversations. Often it’s because the provider is uncomfortable bringing up the topic. At any age, it’s difficult to discuss sensitive topics. But, as providers, we can have a big impact by talking to our patients about sexual practices, sexual health and STI prevention.

“We have to make sure that, as clinicians, we’re well educated on these topics so we can be a resource for our patients,” adds Archbald-Pannone. “We also have to create a judgment-free, open environment so patients feel comfortable having those conversations.”

4 Tips for STD Prevention

For anyone entering a sexual relationship, Archbald-Pannone has the following advice:

Talk to Your Partner

Be aware of your partner’s sexual history and STD risk factors before being intimate.

Use Protection

Condoms or other barrier methods used during intercourse prevent infections.

Looking for Senior Healthcare?

UVA Health geriatricians are experts in senior care.

Get Screened & Encourage Partners to Do the Same

If you are sexually active — either with a new partner, with several partners, or if your partner has recently had sex with others — you should have an annual STD screening. There is no age cutoff for screening.

Know STD Symptoms

If you’re having sex after 60 or any age, educate yourself on the signs and symptoms of gonorrhea, chlamydia, and herpes simplex. Some of the most common include:

  • Bumps, sores, or lesions around the genitals
  • Discharge from the penis or vagina
  • Painful urination

Get Treated

If you experience any unusual symptoms after engaging in sexual intercourse, don’t delay treatment. The condition can get worse.

Be sure to discuss your diagnosis with your partner so that they can get treatment as well.

Talk to Your Doctor

Your sexual health is an important part of your overall well-being. So don’t hesitate to discuss your questions and concerns with a clinician. Make your doctor aware of changes in your sexual practices to ensure you’re making safe choices when having sex after 60 or any age.

Complete Article ↪HERE↩!

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Common Questions About Condoms

— Yes, there is a condom that will fit

Condoms are often part of safe sex and contraception discussions because, when used correctly, they’re effective for birth control and sexually transmitted infection (STI) prevention.

But there’s quite a bit of confusion out there about condoms. Do they truly protect against herpes? Are two condoms better than one? Are some penises really “too big” for every condom out there? Physician assistant and sexual health expert Evan Cottrill, PA-C, AAHIVS, HIVPCP, helps clear up common myths about condoms.

What are the types of condoms?

First, some basics. What are the different types of condoms? There are two main types:

  • External condoms are worn over the penis to collect ejaculation fluids.
  • Internal condoms are worn inside the body to act as a barrier and keep ejaculation fluids from entering someone’s body.

There are also dental dams, which act as a barrier during oral sex of any kind.

All types of condoms reduce the risk of transmitting STIs through bodily fluids. Condoms also prevent pregnancy by keeping semen from entering the vagina. There are many other methods of birth control to prevent pregnancy, but a condom can also protect you from STIs. This is also true if you’re having anal sex.

Below, Cottrill walks us through nine facts about condoms and debunks some popular myths along the way.

Are lambskin condoms different from latex condoms?

Condoms made from latex, polyurethane and other synthetic materials can protect you from STIs. But lamb cecum condoms, also called natural membrane or lambskin condoms, can allow viruses to pass through.

If you’re only concerned about preventing pregnancy, lambskin condoms are fine. But if you want protection from STIs, use a latex or polyurethane condom.

Are some people too big for condoms?

If someone has ever told you, Condoms don’t fit me, don’t buy it — this is a myth.

“Anatomic size varies, of course,” says Cottrill. “But there is a condom that can fit every person.”

Most penises don’t require a special condom size. But if needed, there are larger — and smaller — condom sizes available. If you can’t find the right fit at your local grocery store, try searching for them online.

Do condoms protect against herpes?

“Yes, when you use condoms consistently and correctly, they do protect against herpes,” says Cottrill.

The myth that condoms don’t protect against herpes probably came from people who weren’t using them correctly or weren’t using them enough. Herpes is a lifelong condition that spreads through close contact with someone who’s had the infection — even when they’re not having an outbreak and show no signs or symptoms of infection. Herpes can also spread through oral sex and by sharing sex toys, which means it’s important to use a dental dam or condom when participating in these activities.

“You need to use condoms for all types of sex, including oral sex, to prevent the spread of herpes,” states Cottrill.

Do condoms protect against HIV?

“Condoms most definitely reduce the risk of transmitting HIV,” says Cottrill.

However, when it comes to protecting against the spread of viral STIs, such as HIV, hepatitis C and herpes simplex virus (HSV), the condom material matters. For the best protection, avoid lambskin condoms and use latex or polyurethane instead.

Do condoms protect against HPV?

Yes, condoms protect against human papillomavirus (HPV) infection.

“Condoms are effective against any STI, whether bacterial or viral,” notes Cottrill. He again emphasizes that latex and polyurethane condoms — not lambskin — are your best protection.

Is it bad to keep a condom in your wallet?

“This is a very popular question,” says Cottrill. “I do not recommend keeping condoms in your wallet because heat lowers the quality of the material over time. Plus, the packaging can get torn or opened.”

It’s also not a good idea to keep condoms in your car, which can get very hot in the sun. It’s best to store condoms in a cool place where the package won’t get crushed, folded or punctured.

Should you use two condoms?

It might seem logical that two condoms would be better than one — twice the protection or something like that, right? But it’s actually the opposite.

“Do not use two condoms at the same time,” says Cottrill.

Friction during sex can weaken the condoms as they slide against each other, leading to breakage. You also don’t want to wear external condoms while your partner wears an internal condom for the same reasons. Using one condom at a time is most effective.

Can you use any lube with condoms?

Choosing the right lubricant depends partly on the type of condom you’re using. If you’re using latex, stick with silicone or water-based lubricants. Don’t use oil-based substances such as petroleum jelly (Vaseline®), lotion, massage oil or coconut oil, as these can weaken the latex and lead to tears.

But you can use oil-based lubricants with condoms made of polyurethane or other synthetic materials, as these won’t break down so easily.

Do condom expiration dates matter?

Yes, condoms expire, and it’s important to look at those dates.

“It’s best not to use a condom that’s past the date printed on the package or over five years old,” cautions Cottrill.

The condom material breaks down over time, so an older condom is more likely to tear during sex.

Tips for choosing and using condoms

When choosing a condom, consider:

  • Size: Regular-sized external condoms work just fine for most people. But you can find other sizes available, if necessary, typically right on the shelf at your local drugstore or online.
  • Material: Lambskin condoms work for avoiding pregnancy but aren’t great for STI protection. Latex and polyurethane condoms are best if you want to prevent the spread of STIs.
  • Allergies: Some people are allergic to latex. If that’s you or your partner, use condoms made of polyurethane or another synthetic material.

No matter what type of condom you’re choosing, use a new condom every time and follow the directions on the package to minimize the risk of slippage, leakage or breakage. If your condom does tear or break while you’re having sex, stop immediately and replace it with a new condom. If you’re concerned about possible pregnancy or STIs, make an appointment with a healthcare provider.

If you’ve tossed the box and need a refresher on how to properly use external condoms, the Centers for Disease Control and Prevention (CDC) has a handy guide for using external condoms.

Complete Article ↪HERE↩!

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Gay social and sexual norms are shifting in the PrEP era

By Krishen Samuel

While cost remains the biggest barrier to accessing PrEP for gay and bisexual men in Canada, they also felt pressure to take PrEP and have sex without condoms, with younger men tending to feel less anxious about HIV transmission. This reflects shifting social and sexual norms in the era of PrEP and U=U, according to recent qualitative research.

While pre-exposure prophylaxis for HIV (PrEP) has been approved in Canada since 2016, implementation has been impeded by cost challenges. Certain provincial health insurance plans, including British Columbia’s, fully cover PrEP for gay and bisexual men who meet the guidelines. However, this is not the case in other provinces, such as Ontario, where PrEP is fully covered until the age of 25, over the age of 65, and for those receiving disability grants and social assistance. Across Canada, eligible Indigenous people, members of the armed forces and military veterans can access PrEP.

The study

Dr Mark Gaspar from the University of Toronto aimed to better understand PrEP-decision making among HIV-negative gay, bisexual and queer men. Drawing on the PrEP Cascade, which considers readiness for PrEP, seeking PrEP out and discussing it with a healthcare provider, he and colleagues conducted 45 in-depth one-on-one interviews between March and October 2020 (all but one were over Zoom) with men in Ontario and British Columbia.

Forty percent of the men were aged 30-39, while just under a third were between 20-29. Most men identified as cisgender (91%), and gay (87%), while 38% were White, 16% East Asian and 13% Black. Thirty-seven of the 45 men were taking or had taken PrEP. Thirty-eight percent lived in the greater Toronto area, while 33% resided in Vancouver.

The costs of accessing PrEP

The cost of PrEP presented the biggest access barrier, particularly in Ontario.  Some participants said they felt PrEP was “only for rich people” as access to PrEP often depended on having a job with private health insurance and being able to paying the co-pay associated with PrEP. For men participating in the ‘gig economy’ or for those changing jobs and insurance plans, consistent access to PrEP presented a challenge.

While many participants acknowledged that if they wanted to access PrEP, they could do so, they were aware of the effort involved in getting PrEP consistently, including transportation costs and taking time off work to go to medical appointments. Thus, in addition to viewing themselves as at risk for HIV, they also needed to feel that PrEP’s value outweighed all associated costs. For some men, despite seeing themselves as being at a high risk for HIV and needing to access PrEP, cost presented too prohibitive a barrier. For those who could afford PrEP, other barriers were seen as less significant.

Health concerns related to PrEP

Men who were hesitant about taking PrEP tended to voice the strongest concerns about side effects, contracting other STIs and the effectiveness of PrEP. In general, participants agreed that PrEP was highly effective at preventing HIV. Some participants expressed concerns regarding the fact that PrEP contains anti-HIV drugs, and its effects on their kidneys, bones and liver, although none of the interviewees had themselves experienced such problems:

“I don’t have a concern with [immediate, short-term] side-effects. I just haven’t seen what it does to the body. We have to see what it does to the body after five to ten years, or three years, you know?”

One user shared that he would often pause his PrEP due to concern over side effects. However, most men viewed side effects as temporary, or easily reversible if PrEP was stopped.

Another concern related to contracting STIs other than HIV; the necessity of PrEP was questioned if one could simply use condoms to prevent all STIs: 

“Yes, [I am concerned with] side effects and also what’s the . . . if I still need to wear a condom—so a condom is supposed to prevent HIV and other STIs. If you take PrEP it’s going to protect you against HIV but not everything else. So then taking PrEP and using a condom I think is overdoing it. So just use a condom and get it over with. That’s my simple-minded thinking. And I don’t like condoms. So that’s why I would end up with the unsafe sex situation [on PrEP].”

PrEP’s impact on sex

Participants shared varied experiences regarding the effects PrEP had had on their sex lives. Several had more sex and used condoms less. In some relationships, PrEP opened the door to exploring non-monogamy. However, there were some men who stated that their sex life had remained unchanged and questioned whether they needed PrEP. According to one participant: “Like I’m wasting it. Like I’m taking it but I’m still not that [sexually] active, you know?” However, one participant stated that he was glad that he kept taking PrEP, despite not thinking that he needed it at one point. This challenges the notion of risk as fixed and instead indicates that it fluctuates over time, with PrEP being more necessary at some points than at others. Additionally, some men start PrEP not because they see themselves as being at high risk, but rather to try it out and see how it fits in with their sex lives.

“Previously a man could be accused of being promiscuous for taking PrEP, now he was viewed as responsible for doing so.”

Linked to this, many PrEP users shared how they stopped, paused and restarted PrEP at different points. Men spoke about using event-based dosing or planning sex around PrEP dosing, but stated that it was difficult to find accurate information on using PrEP episodically:

“I guess even if someone asks me, oh do you want to have sex and I say yes, if I’m not on PrEP at that time I’ll usually kind of set a date with them a week from now or more than a week so I have time to ramp up the PrEP again.”

PrEP contributed to how men planned both their immediate and future sex lives. One participant stated that he hoped to be in a long-term monogamous relationship once he turned 25, as PrEP would no longer be covered by provincial insurance in Ontario at that age:

“I want to finally settle down, and be with someone exclusively and not have to worry about hooking up and stuff.”

Changing social and sexual norms

Men stated that norms around sex had changed because of PrEP, especially regarding condom use and notions of ‘safe sex’.

“There are some people that just don’t want to use condoms and if you want to have sex with them, that’s kind of where you’re gonna be.”

For some participants, this had a distinct racial element to it, with PrEP being seen as something associated with White gay men. This association meant that some Black gay men would not take it unless other men they knew were taking it, or they could risk being seen to cater to the whims of White men.

“If my Black friends aren’t taking it then I’m obviously not going to take it.”

Glossary

stigma

Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged.

Undetectable = Untransmittable (U=U)

U=U stands for Undetectable = Untransmittable. It means that when a person living with HIV is on regular treatment that lowers the amount of virus in their body to undetectable levels, there is zero risk of passing on HIV to their partners. The low level of virus is described as an undetectable viral load. 

safer sex

Sex in which the risk of HIV and STI transmission is reduced or is minimal. Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. However, some people do continue to use the term as a synonym for condom use.

qualitative

Qualitative research is used to explore and understand people’s beliefs, experiences, attitudes or behaviours. It asks questions about how and why. Qualitative research might ask questions about why people find it hard to use HIV prevention methods. It wouldn’t ask how many people use them or collect data in the form of numbers. Qualitative research methods include interviews, focus groups and participant observation.

event based

In relation to pre-exposure prophylaxis (PrEP), this dosing schedule involves taking PrEP just before and after having sex. It is an alternative to daily dosing that is only recommended for people having anal sex, not vaginal sex. A double dose of PrEP should be taken 2-24 hours before anticipated sex, and then, if sex happens, additional pills 24 hours and 48 hours after the double dose. In the event of sex on several days in a row, one pill should be taken each day until 48 hours after the last sexual intercourse.
Participants also described an evolution of perceptions related to PrEP. Whereas previously a man could be accused of being promiscuous for taking it (“Truvada whores”), he was now viewed as responsible for doing so.

“I would get guys saying, ‘no thanks, I’m not interested’ and I’d be like oh ok, and they’d be like, ‘well you’re on PrEP and I don’t want to hook up because you’re obviously on a whore rampage.’ That’s been said to me a few times. Now it’s like, I talk to guys who aren’t on PrEP and I’m like, ‘what the fuck, you’re not on PrEP, are you crazy?’”

However, some men resisted the pressure to take PrEP. For them, it was either not seen as necessary to ensure sexual safety, or it was viewed as a way for pharmaceutical companies to make a profit from the sex lives of gay men.

While some men on PrEP had become more confident in having sex with men with an undetectable viral load, and there was an acknowledgement that it could make disclosure easier, there were some who still expressed stigma towards those living with HIV in the era of PrEP.

“I’m on PrEP, yeah I feel comfortable hooking up with undetectable people.”

“Nowadays, guys who are [HIV-] positive don’t even feel like they need to tell you that they’re positive. [. . .] I’m just like, I don’t want to do it [have sex with HIV-positive men]. It’s my body I can do whatever the hell I want. It doesn’t mean I don’t understand all the facts.”

Generational differences

There were distinct generational differences in PrEP perceptions. Men who were sexually active in the 80s and 90s viewed it very differently to younger men, who tended to feel less anxious regarding HIV transmission.

“I always assumed that not using a condom equated to AIDS.”

“I’m [in my 40s]. So when I was like 20, like there wasn’t, you know, HIV was still like a death sentence kind of a thing. So, these kinds of things [like PrEP] are exciting, but I guess I yeah . . . I’m not sure, I don’t know what my hesitation is in terms of wanting to take it fully or know more about it.”

“I’ve not had a lot of anxiety around [HIV] transmission, I think part of that was because of that . . . I think more recent medical advancements in the treatment of HIV.”

There was also a sense that all the progress made regarding behavioural interventions would be lost on the younger generation with the advent of PrEP.

“So now to say, yo, take this pill and don’t even think about it. I was like, ugh, fuck, all of those years of behaviour change work sort of scuttled out in one moment.”

“My identity as a queer person, a queer man, was so interlinked with the looming threat of HIV that whether I was conscious of it or not, my early reticence and scepticism around these other options [like PrEP] was almost comparable to that example of an old person going, ‘oh well, I grew up it was really hard and these [younger] motherfuckers have it too easy.’ Well we all should have it a little bit easier, right? And so yeah, I was like, we should all be free of this [fear of HIV].”

Conclusion

“In addition to pragmatic barriers and biomedical concerns, PrEP has significant social implications with its uptake altering sexual practices and sexuality in diverse and complex ways,” the authors conclude. “The more healthcare providers and health promotion experts are able to understand these shifts in sexuality, the better equipped they will be at producing education, soliciting questions, and refining their messages to clients to ensure that gay, bisexual and queer men are making informed choices about PrEP that effectively reduce their risks.”

Complete Article ↪HERE↩!

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Should You Be on PrEP?

This medication can significantly lower your risk of HIV

As recently as the 1990s, it was unthinkable that medication could someday prevent the spread of HIV. But in 2012, the U.S. Food and Drug Administration (FDA) approved the first medication known as pre-exposure prophylaxis, or PrEP, which can prevent HIV from taking hold in your body.

Now, PrEP has become an important tool in combatting the spread of HIV. Internal medicine specialist James Hekman, MD, explains what PrEP is, how it works and whether it’s right for you.

What is PrEP?

Human immunodeficiency virus, or HIV, is a sexually transmitted disease that attacks your immune system, which can make it difficult for your body to fight off illness. The most common way people get HIV is through vaginal, oral or anal sex, but you can also get it by sharing needles to take drugs.

But taking PrEP can prevent you from contracting HIV by blocking the virus from taking hold within your body.

The name says it all: “Pre-exposure” means “before you get exposed,” and “prophylaxis” is a common medical word that refers to actions you take to prevent a disease from developing or spreading. PrEP, then, is medication you take to keep you safe from HIV — before you’ve ever been exposed to it.

Should you take PrEP?

“PrEP is for people who don’t have HIV but are at an increased risk of contracting it through sex or injection drug use,” Dr. Hekman explains.

Your doctor may recommend you go on PrEP if you:

  • Have a sexual partner with HIV.
  • Have sex without using condoms.
  • Have been diagnosed with a sexually transmitted disease in the last six months.
  • Inject drugs with someone who has HIV.
  • Inject drugs by sharing needles or syringes.
  • Have been exposed to HIV in the past and continue to engage in high-risk behavior.

How to take PrEP

PrEP isn’t a particular brand; rather, it’s a category. Right now, there are three types of PrEP:

  • Truvada® is a daily pill that combines two drugs called tenofovir disoproxil and emtricitabine. It’s for anyone who’s at risk of contracting HIV through sex or injection drug use, and it’s also available in generic form.
  • Descovy® is a daily pill that combines two drugs called tenofovir alafenamide and emtricitabine. It’s for sexually active cisgender men and transgender women who are at risk for HIV; it’s not for people who have vaginal sex. The generic form is not currently available in the U.S.
  • Apretude® is the brand name of medication called cabotegravir, which is an injection you receive every two months from your doctor. The FDA approved it for use in December 2021, and no generic form is currently available.

How long does it take for PrEP to work?

You should be on PrEP for one to three weeks in order for it to start working. But to maximize your protection from HIV, you have to be sure to take every dose. Simply put, Dr. Hekman says, “PrEP is incredibly effective, but only if you take it as prescribed.”

HIV.gov reports that when taken correctly, the pill forms of PrEP reduce the risk of getting HIV from sex by about 99%, and it reduces the risk of getting HIV from drug use by at least 74%. But the medication isn’t nearly as effective if it isn’t taken consistently, so be sure to set those daily reminders.

Side effects of taking PrEP

PrEP is considered safe, but you may experience some side effects at first. They should go away on their own, but talk to your doctor if you continue experiencing them:

  • Nausea.
  • Diarrhea.
  • Headache.
  • Fatigue.
  • Stomach pain.

If you have kidney disease or a history of hepatitis B, be sure to tell your doctor. It may impact whether you’re able to go on PrEP.

Does PrEP prevent STDs?

Condoms are just as important as they’ve always been. “PrEP does not prevent the spread of STDs,” Dr. Hekman says. You can (and should) pair PrEP with condom use for the best chances of reducing your risk.

Will PrEP interfere with hormone therapy?

If you’re on gender-affirming hormone therapy, you may be worried about whether and how PrEP will interfere.

Trans women have been reported to have lower levels of PrEP in their bloodstream than other people, Dr. Hekman says, but there’s not yet enough research to say why. And because the transgender population is at high risk for HIV, it’s important to work with a doctor who can ensure that you can remain on hormone therapy and guard yourself against HIV.

“We know that when trans women are under medical care, doctors can monitor their levels of both HIV control and hormones,” Dr. Hekman explains. “We can adjust doses to make sure that they achieve appropriate levels of gender-affirming hormone therapy while also remaining protected from HIV.”

Can you take PrEP after HIV exposure?

PrEP is a pre-exposure medication, which means that in order for it to do its job, you need to be taking it before you’re exposed to HIV. That means PrEP is not the right medication to take if you’ve been exposed to HIV and want to reduce your chance of infection.

If you’ve been exposed to HIV and aren’t already on PrEP, see a doctor — whether your primary care physician or at an emergency room or urgent care facility — within 72 hours. They can prescribe post-exposure prophylaxis (PEP), medication to prevent HIV after exposure. Unlike PrEP, PEP is used in emergency exposure situations.

Talking to your doctor about PrEP

PrEP is only available by prescription, so if you’re interested in starting it, make an appointment to speak with your doctor. “They’ll give you an HIV test and talk you through any concerns you have about going on PrEP,” Dr. Hekman says.

Looking for a healthcare provider who is trained in health issues specific to the LGBTQIA+ community? Many nationwide health services and state clinics are open and affirming, and there are other ways to find an LGBTQIA+ doctor’s office near you.

If you’re concerned about how to pay for PrEP, be sure to ask your doctor about that, too. Most insurance companies and state Medicare plans cover PrEP, and other options are available for those who qualify.

Complete Article ↪HERE↩!

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A Quarter Century With HIV and Thriving Sexually

By Alex Garner

One of my greatest fears after testing HIV-positive was that I would never have sex again. Fear had been a constant presence in my sex life even when I was HIV-negative, and now that I was positive that fear transformed into something else. Then it unexpectedly dissipated. Living with HIV allowed me to explore and deepen my sexuality in a way I had never anticipated. For many of us, the 40-year pandemic has affected all facets of our sex lives, but we can continue to prioritize the pursuit of pleasure and intimacy.

After 25 years of living with HIV, I felt it was time to reflect on the impact it’s had on my sex life. HIV was always incidental to my life. I was scared of getting HIV even before I first had sex. For me, like many gay and bi men (and trans women) of my generation, HIV was not a matter of if. It was simply a matter of when.

Soon after my diagnosis, I experienced a surprising sense of liberation when I realized I never had to worry about getting HIV again. Of course, having HIV came with a set of fears, but they were tangible, not some ominous specter haunting all facets of my sex life. I was 23 and my sexuality was still evolving, so a new sense of liberation allowed me to embrace it in a way I never thought possible when I was consumed with fear of HIV.

The absence of fear finally allowed me to concentrate on pleasure and understanding my relationship with sex. I could experiment and explore in all sorts of ways. I had the opportunity to meet other guys living with HIV who were on a similar journey.

We fostered a sense of community from our shared experiences. We were gay and bi men living with HIV who dared to cultivate a satisfying sexuality amid that pandemic. This led to the creation of social groups, sex parties, and bareback hookup sites, all catering to those living with HIV. And that was all before the advent of U=U (the knowledge that those who are on treatment and undetectable are unable to transmit HIV). Our mutual positive diagnoses countered any concerns of transmission. 

My new sexual frontier was teeming with opportunities, but it also meant navigating stigma and fear within our community. There are persistent and insidious beliefs that people living with HIV are “stupid,” “reckless,” or “whores.” (Studies show none of that is true.) The advent of gay dating apps made it easier to find other poz guys, but it also meant dealing with explicit HIV-phobia in men’s profiles with requests like, “Clean, UB2.” Having to regularly confront stigma can have a profound impact on one’s mental health and sex life.

There is also the structural stigma that still needs to be dealt with, such as HIV criminalization. In the U.S., over 30 states still criminalize HIV in some way. It’s difficult to overstate the detrimental impact of such policies. For many, fear of arrest and prosecution infects all parts of their sex lives.

Gay men living with HIV have had to cultivate a sexuality while encountering stigma, rejection, and criminalization. We’ve also had to navigate feelings of guilt and shame around our status. Yet through it all, we persist. We pursue a fulfilling sex life and explore meaningful connections between HIV-positive men, and in doing so, create a sense of community.

Gay men must be reminded that being HIV-positive does not mean giving up one’s sexuality. We can value, invest in, and cultivate a pleasurable and satisfying sexuality. Our sex has meaning and value, and it’s one of the reasons we’ve been able to endure four decades of a global pandemic.

Complete Article ↪HERE↩!

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An essential safe sex guide for lesbian, bisexual and queer women

Everything you need to know about vulva-to-vulva sex.

By Paisley Gilmour

If you’re a lesbian, bisexual, pansexual or queer woman, or someone who has a vagina and sleeps with vagina-having people, it’s likely you haven’t had the sexual health education you need. School sex ed is so heteronormative that many of us never heard so much of a mention of vulva-to-vulva sex. It’s no wonder many queer folk don’t realise STIs can be transmitted through fingering, oral sex and sharing sex toys.

This gap in our knowledge is nothing to be ashamed of. Safe sex for LGBTQ+ women, non-binary, trans and intersex people is just rarely (if ever) efficiently covered in school.

So here’s your essential safe sex guide, courtesy of Linnéa Haviland from sexual health service SH:24.

Stigma exists and it might affect you

A recent study found LGBTQ+ women face barriers when accessing sexual health care, the main reason being ignorance and prejudice among health care staff. I have certainly been questioned a few times about why I’m going for a smear test, simply because I’ve said I have a girlfriend. With information about safe sex being extremely penis-centred, it can be really hard to know the facts and stand your ground in the face of individual and institutionalised queerphobia.

Know how STIs are actually spread…

Contrary to popular belief, there doesn’t have to be a penis involved for STIs to spread. STIs can be passed on through genital skin-on-skin contact, through bodily fluids on hands and fingers, oral sex and sharing sex toys. STIs “like the specific environment of the genitals, so can spread from one vulva to another when they are in close contact or if fluids come in contact via sex toys or fingers,” says SH:24 sexual health nurse Charlotte.

Chlamydia, syphilis, gonorrhoea, HPV, genital warts and genital herpes can all be spread this way. These STIs can also spread via oral sex. Throat swabs for STIs aren’t routinely offered to women, but if you are worried you can request one. STIs won’t survive outside their cosy environments for long though, so you can’t get them from sharing towel, toilet seats, or by using a sex toy someone else used a week ago.

…and know how to protect yourself

You’ve probably heard of a dental dam for oral sex, but if you’re anything like me before I started working for a sexual health service, you’ve probably never actually seen one. Originally used for dentistry, they are quite expensive and hard to get hold of, so unless your local sexual health clinic has them I would recommend a DIY version: the cut up condom!

Unroll the condom, cut the tip off, then cut it lengthwise to unroll it into a rectangle. Use the lubricated side against the vulva, or if flavoured, the flavoured side against your mouth (note: flavours can irritate the vulva!) When sharing sex toys, use a condom on the sex toy, and change this every time you switch user.

For fingering and fisting, you can use latex gloves for extra protection (add some lube though – they’re dry!) If you’re rubbing genitals or scissoring, you can try to keep a dental dam in between, but it can be really hard to keep it in place… the best way to stay protected is to test regularly for STIs (we recommend yearly or when changing partners – whichever comes first!)

Go for your smear test

There is a prevalent heteronormative notion that you don’t need to get a smear test unless you’ve had/are having S.E.X (meaning penetrative sex with a penis.) This isn’t true! HPV, the virus which can cause cervical cancer, can be transmitted via oral sex, sharing sex toys and genital contact. HPV is very common, and most people will have it at some point in their life, but clear it without symptoms. Because it’s so common it’s important to always go for your smear test!

Know about HIV

HIV is is slightly different from other STIs, because it has to get into your bloodstream. “There is a high quantity of white blood cells both in the rectum and on the cervix, so if the virus gets there, it is very close to where it needs to be. Tearing adds another way for the virus to come in contact with your blood stream during sex,” says Charlotte. HIV can only survive outside the body for a few seconds, so transmission via non-penetrative sex or sharing sex toys is thought to be extremely low.

However the actually transmission rates of HIV during sex between two vagina-having people is unknown, since this has not been recorded or studied on any larger scale. There has been one documented case of HIV transmission between two women – but more cases might be masked by assumptions that the virus was contracted in a different way (such as heterosexual/penis-vagina sex or needle sharing). There is a lot of stigma attached to HIV, so it’s important to remember that if you have HIV and are on the right medication, you can keep the viral load undetectable, which means you can’t pass it on!

Learn the risk factors

When making a decision about whether to have protected or unprotected sex with someone, it’s a good idea to be informed about the risk factors involved in different types of sex. British Association for Sexual Health and HIV (BAASH) guidelines says non-penetrative contact carries the lowest risk, but no sexual contact is without risk.

For penetrative sex (like fingering, using sex toys and fisting) the risk of transmission is related to the degree of trauma – i.e if there is friction or aberration (tiny cuts). Risk is also related to if you or your partner(s) are likely to have an STI – so be in the know and test, test, test! There is an assumption in the medical field that vulva-to-vulva sex carries hardly any risk of STI transmission, but different reports suggest this generalisation may not be correct.

Complete Article ↪HERE↩!

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Gay men: Finally, sex without fear

PrEP is effective as a protection against HIV – though condoms can still be used to prevent STDs. Why can’t we celebrate the idea that men can have sex without fear of death?

By

Have you heard of the anti-AIDS drug PrEP? Most straight people are unaware of it. In 2015, the World Health Organization said “the efficacy of oral PrEP has been shown in four randomized control trials and is high when the drug is used as directed.”

PrEP (Pre-exposure Prophylaxis) is a drug that allows you to have as much sex as you want, without a condom, and remain HIV-negative. If you use it, you probably won’t catch HIV. POZ magazine says that it has “100 per cent efficacy for those who stick to the treatment.”

Doctors recommend everyone use condoms, because although PrEP is very effective as a protection against HIV, it does not guard against the transmission of other sexually transmitted diseases.

Recently, Patrick William Kelly — a gay academic from Northwestern University who is writing a “global history of AIDS” — sounded the alarm about PrEP. For many straight people, Kelly’s discussion of PrEP may be the first they have heard of this revolutionary drug.

Kelly’s concern is that the popularity of PrEP will cause gay men to stop using condoms. He worries:

“An entire generation of gay men has no memory or interest in the devastation [AIDS] wrought. AIDS catalyzed a culture of sexual health that has begun to disintegrate before our eyes. What is there to be done to bring it back?…The nonchalant dismissal of the condom today flies in the face of the very culture of sexual health that gay men and lesbians constructed in the 1980s.”

Doctors still recommend that everyone use condoms because although PrEP is effective as protection against HIV, it does not guard against the transmission of other sexually transmitted diseases.

There is one sentiment that is missing from Kelly’s article. Why doesn’t he celebrate the fact that gay men — and everyone else — can now have sex without fear of death? PrEP makes sex safer for everyone. It is just one new tool in the “safe sex arsenal.” Why not be happy about the fact that PrEP will undoubtedly save many lives?

Not a lethal illness anymore

Some might ask — isn’t AIDS still a lethal illness? Not so much.

“The gold standard in HIV treatment” (highly active antiretroviral therapy or HAART) was first introduced at the 1996 Vancouver International AIDS Society (IAS) Conference. According to Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS, “this was a pivotal moment, when HIV infection became a chronic manageable condition.”

In 2014, The Globe and Mail reported that worldwide deaths from AIDS were massively decreasing:

“In 2013, 1.5 million people died from AIDS-related causes worldwide, compared with 2.4 million in 2005, a 35 per cent decrease.”

This state of affairs seems particularly significant when one considers hysterical early predictions concerning the effects of the disease. In 1987, Oprah Winfrey stated confidently that “research studies now project that one in five — listen to me, hard to believe — one in five heterosexuals could be dead from AIDS at the end of the next three years.”

This never happened.

It’s absolutely true that AIDS affects different demographics,

In this 1989 photo, protesters lie on the street in front of the New York Stock Exchange in a demonstration against the high cost of the AIDS treatment drug AZT. The protest was organized by ACT UP, a gay rights activist group.

ethnicities and geographies differently, and that gay men are not the only population to be affected by it worldwide. But the improvement in the lives of HIV-positive people everywhere is only in part due to the tireless efforts of doctors, researchers and health-care workers.

It is also due to the tireless efforts of gay men everywhere — many of whom became safe-sex activists during the last 35 years, distributing pamphlets, marching and just generally spreading the news.

So why would a gay professor characterize PrEP as a bad thing? Why is he worried that gay men — en masse — will suddenly start practising unsafe sex?

Kelly is the victim of another kind of infection — the notion that gay men are criminals whose desires must be controlled.

This criminalization of homosexuals goes back as far as the notion of sodomy.

Viewing homosexuality as criminal

In the England of Henry VIII, the punishment for sodomy was death; India today is still struggling to legalize same-sex encounters.

In 1972, gay liberation theorist Guy Hocquenghem flatly stated in his book Homosexual Desire: “Homosexuality is first of all a criminal category.”

Hocquenghem went on to suggest that even though the late 19th century brought a tendency to view homosexuality through the more “tolerant” lens of illness, the human need to view homosexuality as criminal is persistent.

“Certainly as we shall see later, psychiatry tends to replace legal repression with the internalization of guilt. But the passage of sexual repression from the penal to the psychiatric stage has never actually brought about the disappearance of the penal aspect.”

Both the sexuality of gay men and the sexuality of women are a threat to the primacy of patriarchal male heterosexual desire. Heterosexist culture believes this threat must be controlled. The LaBouchere Amendment in England (1885) was used to incarcerate Oscar Wilde for his homosexuality as a crime of “gross indecency.”

But Labouchere was an amendment to legislation designed to control female prostitution — a law that angered many 19th-century trailblazing feminists.

When AIDS appeared in the early 1980s, some heterosexuals saw it as primarily a gay disease (AIDS was first called GRID — gay-related immune deficiency). They worried that gay men might infect straight people, especially children.

In his influential book of essays, Is The Rectum A Grave?, Leo Bersani suggests that when small-town Americans wanted to ban HIV-positive hemophiliac children in schools, what they actually feared was the spectre of “killer gay men” acting too much like women:

Women and gay men spread their legs with an unquenchable appetite for destruction. This is an image with extraordinary power; and if the good citizens of Arcadia, Florida could chase from their midst a very law-abiding family it is, I would suggest, because in looking at three hemophiliac children they may have seen — that is unconsciously represented — the infinitely more seductive and intolerable image of a grown man, legs high in the air, unable to refuse the suicidal ecstasy of being a woman.

AIDS was not the first thing to make straight people think gay men

A doctor holds Truvada pills, shown to help prevent HIV infection.

had to be controlled. It simply fit like a glove on a fear of homosexuality that was already culturally endemic.

Our society seems addicted to the notion that homosexuality is something uncontrollable and potentially lethal. So when AIDS came along, as the long-time AIDS worker Simon Watney wrote, it was “effectively being used as a pretext throughout the West to justify calls for increased legislation and regulation of those who are considered to be socially unacceptable.”

The concern over gay male imagined libidinal insanity is a throwback to an old trope. Gay men don’t need to be controlled; at least not any more than anyone else. And if you think otherwise? Well, it’s based on prejudice. Not fact.

Complete Article ↪HERE↩!

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Gay or bi men who disclose sexual history may get better healthcare

By Anne Harding

Young men who have sex with men (MSM) who disclose their sexual orientation or behavior to a health care provider are more likely to receive appropriate healthcare, new data suggest.

Dr. Elissa Meites of the Centers for Disease Control and Prevention (CDC) and her colleagues studied 817 MSM, ages 18 to 26, who had seen a healthcare provider in the past year.

Men who had disclosed were more than twice as likely as those who had not to have received the full panel of recommended screenings and vaccines, the researchers found.

The CDC and the Advisory Committee on Immunization Practices recommend that MSM be screened for HIV, syphilis, gonorrhea and chlamydia at least once a year, and immunized against hepatitis A and B and human papillomavirus (HPV), Meites and her colleagues note the journal Sexually Transmitted Diseases.

Overall, 67 percent of the study participants had received all four recommended STI screenings, but that was true for only 51 percent of the MSM who had never disclosed.

Nine percent overall had received all vaccinations, compared to six percent of those who hadn’t disclosed.

The pattern was similar when researchers looked to see how many participants received all seven recommended services. The rate was just seven percent for the overall study population, but it was even lower – at less than four percent – for the MSM who hadn’t disclosed.

About two-thirds of study participants (64.2 percent) said they had disclosed their sexual behavior or orientation to a healthcare provider, while roughly nine in 10 (91.7 percent) said they would do so if it was important to their health.

“This shows us that the patients are doing all the right things. They are going to the doctor regularly and they are willing to speak about their sexual behaviors,” Meites told Reuters Health in a telephone interview. “It looks like health care providers may be missing some opportunities to provide the best health care to these young men.”

Doctors can encourage disclosure among MSM by asking about sexual history, and “fostering a clinical environment where people can be comfortable revealing their sexual behavior,” Meites said. And doctors should be aware of the panel of health care services that are recommended for MSM, she added.

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The End of Safe Gay Sex?

By Patrick William Kelly

June is Pride Month, a ripe time to reflect on one of the most startling facts about our sexual culture today: Condom use is all but disappearing among large numbers of gay men.

Many rightly attribute the condom’s decline to the rise of PrEP — an acronym for pre-exposure prophylaxis, a two-drug cocktail that inoculates a person from contracting H.I.V. But another crucial component is the fading memory of the AIDS crisis that once defined what it meant to be gay.

After tracking the sexual practices of 17,000 gay and bisexual Australian men from 2014 to 2017, a team of researchers this month unveiled the most convincing evidence to date. While the number of H.I.V.-negative men who are on PrEP increased to 24 percent from 2 percent, the rate of condom use decreased to 31 percent from 46 percent. More troubling, condom use among non-gay men is also down significantly</a

Although public health advocates have been sounding the alarm on condom use for the last decade, their calls have gone largely unheeded. Part of that is because of a shift in how we talk about risky sex: The Centers for Disease Control and Prevention has replaced “unprotected” with “condomless” sex.

The dangerous implication is that PrEP alone may ward off all sexually transmitted infections. Indeed, studies have shown a strong correlation between PrEP use and the contraction of S.T.I.s. PrEP enthusiasts counter that PrEP mandates testing for S.T.I.s every three months, a practice that promotes rather than discourages a culture of sexual health.

But a 2016 study by the University of California, Los Angeles illustrated that PrEP users were 25.3 times more likely to acquire gonorrhea and a shocking 44.6 times more likely to develop a syphilis infection (other studies have found no significant uptick in S.T.I. rates, however).

More than the specific public-health risks of declining condom use among gay men is the shocking speed with which a sort of historical amnesia has set in.

The very idea of “safe sex” emerged from the gay community in the early 1980s, in response to the AIDS crisis. Drag queens once ended performances with catchy one-liners like, “If you’re going to tap it, wrap it.”

AIDS indelibly shaped what it meant to be gay in the 1980s and 1990s. When I came out at the tender age of 14 in 1998, I recall my mother’s reaction. As tears welled up in her eyes, she buried her face in her hands and said, “I just don’t want you to get H.I.V.” No stranger to controversial allusions, the AIDS activist and author Larry Kramer famously called it a homosexual “holocaust.” Condom use, therefore, was never a negotiating chip.

Until it was. PrEP, which the Food and Drug Administration approved in 2012, replaces the condom’s comforting shield. Liberated from the stigma of AIDS, gay men, many people think, are now free to revert to their carnivorous sexual selves. In this rendering, the condom is kryptonite, a relic that saps the virile homosexual of his primordial sexual power.

AIDS is no longer a crisis, at least in the United States, and that is a phenomenal public-health success story. But it also means that an entire generation of gay men has no memory or interest in the devastation it wrought. AIDS catalyzed a culture of sexual health that has begun to disintegrate before our eyes. What is there to be done to bring it back?

One answer is to recall the gay culture of the 1970s that gave rise to the AIDS crisis in the first place. The myth of a world of sex without harm is not new. The 1970s were a time of unprecedented sexual freedom for gay men, during which diseases were traded rampantly, fueled by a libertine culture that saw penicillin as the panacea for all ills.

The nonchalant dismissal of the condom today flies in the face of the very culture of sexual health that gay men and lesbians constructed in the 1980s. If a hyper-resistant strand of another life-threatening S.T.I. develops, we will rue the day that we forgot the searing legacies of our past. We might also recognize that PrEP has not proved nearly as effective a prevention strategy for women as it has for men, and that some strains of H.I.V. have developed resistance to the drug.

While we debate the utility of latex, what are we to think about the millions of sex workers, injecting-drug users and marginalized populations (in particular, black men who have sex with men) without adequate access to costly and coveted drugs like PrEP? If they develop AIDS, they also struggle to acquire the triple drug therapies that have since 1996 turned AIDS into a manageable if chronic condition. Millions have died from lack of access while pharmaceutical companies rake in billions every year.

We might also pivot away from the individualistic and privileged approach of our dominant L.G.B.T. organizations — what one scholar called the “price of gay marriage.” We might, then, regain a radical sense of queer community that we lost in the wake of AIDS.

Complete Article ↪HERE↩!

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Can You Get An STI From Anal Sex?

That itch in your butt? It may not just be a harmless rash.

By Isadora Baum

[W]hen you think of sexually transmitted infections, symptoms like vaginal itching and pelvic pain probably come to mind. But the same STIs that threaten your health down below can infect other body areas. They’re typically transmitted through oral sex or anal sex, but some can be picked up after direct skin contact.

The scary thing about getting an STI in another part of your body is that you’re less likely to recognize signs, so you don’t seek the right treatment—and the infection potentially gets worse. Here are four body areas that can play host to an STI, plus the symptoms to look for.

On your face

You already know that genital herpes can spread to your lips if you have oral sex with someone who has this STI. What you may not know is that the same type of herpes that shows up below the belt can infect other parts of your face, such as around your mouth, Amesh Adalja, MD, an infectious disease physician and senior scholar at Johns Hopkins Center for Health Security, tells Health. Herpes can also appear on your tongue or nose.

How do you know if a sore on your face is herpes? Early signs are the same as genital herpes: tingling and itching, and then as the sore develops, it blisters and scabs over. If you’re unsure, check in with a dermatologist. You can treat herpes with over-the-counter cold sore remedies; your doctor can also prescribe antiviral meds that cut the duration of an outbreak.

In your butt

Yep, we have to go there. Chlamydia, gonorrhea, and syphilis can be transmitted to the rectum if you have anal sex with an infected partner, Karen Brodman, MD, a gynecologist in New York City, tells Health. Your risk of one of these backdoor STIs increases if you develop small tears or nicks in the thin skin of the anus, through which the bacteria can get into your system.

STIs transmitted through skin contact, such as genital herpes or HPV, can develop in or outside the anus and rectum, says Dr. Brodman. Herpes may also show up as sores on the skin of the buttocks. And of course, HIV is spread via anal sex, as are blood-borne viruses such as hepatitis B and C.

Signs of an STI in your behind include rectal burning, unusual discharge, bleeding, pain, or a fissure, says Dr. Brodman. You might also notice blisters or achiness in the groin, she adds. If any of these develop, let your doctor know. And don’t be embarrassed—she’s seen it all before.

In your eyes

STIs that trigger eye infections include herpes, gonorrhea, chlamydia, and syphilis, says Dr. Adalja. The signs of many of these conditions mimic pink eye: think pain, swelling, redness, and discharge.

An eye herpes infection, however, can present differently. If the herpes virus is in your eye, it may result in an outbreak of one or more lesions on the eyelids or even the cornea, triggering pain and sensitivity that could jeopardize your vision by causing scarring. If you have any symptoms, see your ophthalmologist promptly, says Dr. Adalja.

In your throat

STI infections in the soft, moist tissues of the back of the mouth and throat are more prevalent than you might think. Chlamydia and gonorrhea (including the drug-resistant strain known as “super gonorrhea”) can set up shop here if a person contracts either of these infections during oral sex. Scarily, you may not even know it; sometimes the only symptom is a sore throat, according to the Centers for Disease Control.

HPV is another infection that invades the throat—and it’s thought to be behind the recent rise in cases of head and neck cancers, especially among men. While there are more than 100 types of HPV, the type that causes many cases of cervical cancer, HPV 16, is also responsible for most head and neck cancers. Though HPV of the throat is becoming more common, a 2017 study emphasizes that the overall lifetime odds of cancer is low. Still, if you think you might be at risk, talk to your doctor.

Complete Article ↪HERE↩!

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Queen Mother of the South: My Life as a Transgender Parent

By Evonne Kaho

[T]he Southern part of the U.S. has to be one of the more conservative regions in the nation. Rooted in traditional, religious, and conventional values, it is often referred to as the “Bible Belt.” Southern traditionalists marvel at their old-fashioned ways and high moral standards. These standards are applied to every aspect of Southern culture, regardless of race, color, ethnicity, religion, or gender.

Evonne Kaho

This is most evident in the Southern family. As experienced by many in the South, I was taught that the family should consist of a father, a mother, and children. As in my family, these roles are defined and dominated by principles engrained in “Southern tradition.”

Although I embraced this experience, deep down I knew that my life would take a turn that would clash with the very things I had been taught to respect and uphold. In 2000, I became a transgender woman. My transformation was a long-awaited accomplishment that symbolized my freedom, but not an end to my struggle as a member of the transgender community. I so desperately wanted to be a parent, but I shivered at thought of becoming one in Mississippi. As a transgender woman, I hoped, but I thought that I had no chance of having my own child. After all, as a child, I was taught that only traditional families that consisted of heterosexual couples should have children.

In 2002, I met the mate of my dreams, and we were married. In 2003, we were blessed with a beautiful baby girl. Watching the women in my family, I knew how to be a mother, but society was not ready for it. Even my parents criticized me and told me that my household was an abomination to God and was not the right environment in which to raise a child. With less and less support, I became stronger and more determined to be the parent that my child needed. I was taught that support, love, understanding, patience, and empathy were needed to successfully raise a child, and I possessed them all. My transgender identity did not prevent me from loving my daughter, nor did it take away from the positive contributions that I made in her life.

My daughter is 15 now and more beautiful than ever. She is one of my more, if not my most, important accomplishments. She is loving, caring, empathetic, and most of all open-minded. I taught her not to judge or to be critical of those who differ from her. My mate and I both reinforced choice. We would often explain to her that her choice to be whatever she wanted should not be dictated by who we were.

When I contracted HIV, the hardest thing was not accepting that I had it, but deciding how I would explain it to my daughter. I didn’t want the ignorance and stereotypes of society to determine her view of me or those like me.

I remember the morning that I told her. I asked myself, “Am I really prepared her this?” Sure, she knew about HIV/AIDS. My mate and I had both talked to her about it. However, other people had the disease, not one of her parents. It was one of the hardest things that I had ever done. She looked at me and said, “Mama, they have medicine for that, and you will be OK; I will help you.” I had not failed. That was one of my defining moments as a successful parent. The loving, caring, and empathetic spirit that I had worked so hard to impart to my daughter had revealed its beautiful head.

That day, as well as my experiences since, has equipped me with the skills I need to care for others like me. The number of transgender families has increased since 2003. As the CEO of Love Me Unlimited for Life, a non-profit transgender organization in the state of Mississippi, I have the resources to help transgender families and those living with HIV/AIDS. My organization serves as a support system for individuals who lead alternative lifestyles.

Becoming transgender after forming a family can be hard. We provide support for the whole family. In addition, we provide a repertoire of resources for families whose parents are living with HIV/AIDS. It’s very hard to explain to your child what HIV/AIDS is and what it means to live a long healthy life with it. It’s neither a death sentence nor a punishment for being homosexual or transgender; it’s a life change like having any other chronic disease.

Over the years, I have become a mother to many in the LGBTQ community. I have utilized the same parenting skills that I began using with my own child in 2003. Regardless of their ages, they appreciate the love and support that they receive. I am thankful that I have been able to serve as a beacon of hope for so many.

After all, I am known as “Queen Mother of the South.”

Complete Article ↪HERE↩!

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Here’s what happens when you get an STI test — and if it comes back positive

By Erin Van Der Meer

[I]f you’ve never had an STI test, you’re probably imagining it’s a horrendously awkward experience where a mean, judgmental doctor pokes around your nether regions.

But like getting a needle or going to your first workout in a while, it’s one of those things that seems much worse in your mind than it is in reality.

For starters, often you don’t even have to pull down your pants.

“If someone comes in for a routine test for sexually transmissible infections (STIs) and they don’t have any symptoms, they usually don’t need a genital examination,” Dr Vincent Cornelisse, a spokesperson for the Royal Australian College of General Practitioners, told Coach.

“The tests that are ordered will depend on that person’s risk of STIs – some people only need a urine test, some need a self-collected anal or vaginal swab, and some people need a blood test.

“We aim to make this process as hassle-free as possible, in order to encourage people to have ongoing regular testing for STIs.”

Cornelisse says the embarrassment and stigma that some of us still feel about getting an STI test is unnecessary.

“STIs have been around for as long as people have been having sex, so getting an STI is nothing to be ashamed about, it’s a normal part of being human.

“Getting an STI test is an important part of maintaining good health for anyone who is sexually active.”

If you’re yet to have an STI test or it’s been a long time, here’s what you need to know.

How often do you need an STI test?

On average it’s good to get an STI test once a year, but some people should go more often.

“Some people are more affectionate than others, so some need to test every three months – obviously, if someone has symptoms that suggest that they may have an STI, then a physical examination is an important part of their assessment.”

As a general rule, people under 30, men who have sex with men, and people who frequently have new sexual partners should go more often.

To get an STI test ask your GP, or find a sexual health clinic in your area – the Family Planning Alliance Australia website can help you locate one.

What happens at the test?

As Cornelisse mentioned, the doctor will ask you some questions to determine which tests you need, whether it’s a urine test, blood test or genital inspection.

You’ll be asked questions about your sexual orientation, the number of sexual partners you’ve had, your sexual practices (like whether you’ve had unprotected sex), whether you have any symptoms, whether you have injected drugs, and whether you have any tattoos or body piercings.

Your results will be sent away and returned in about one week.

What if you test positive?

There’s no reason to panic if your results show you have an STI – if anything, you should feel relieved, Cornelisse says.

“If you hadn’t had the test, you wouldn’t have realised you had an STI and you wouldn’t have had the opportunity to treat it.

“Most STIs are easily treatable, and the other ones can be managed very well with modern medicine. So don’t feel shame, feel proud – you’re adulting!”

You’ll need to tell your recent sexual partners. While it might be a little awkward, they’ll ultimately appreciate you showing that you care about them.

“People often stress about this, but in my experience people appreciate it if their sexual partner has bothered to tell them about an STI – it shows them that you respect them,” Cornelisse says.

“Also, if this is a sexual partner who you’re likely to have sex with again, not telling them means that you’re likely to get the same STI again.”

The risks of leaving an STI untreated

You can probably think of 400 things you’d rather do than go for an STI test, but the earlier a sexually transmitted infection is caught, the better.

A recent spate of “super-gonorrhea” – a strain of the disease resistant to normal antibiotics –can result in fertility problems, but people who contract it show no symptoms, meaning getting tested is the only way to know you have it, and treat it.

“Untreated STIs can cause many serious problems,” Cornelisse warns.

“For women, untreated chlamydia can cause pelvic scarring, resulting in infertility and chronic pelvic pain.

“Syphilis is making a comeback, and if left untreated can cause many different problems, including damage to the brain, eyes and heart.

“If HIV is left untreated it will result in damage to the immune system — resulting in life-threatening infections and cancers — which is called AIDS.”

There is a long-term treatment for AIDS, but this depends on it being caught early.

“People living with HIV now can live a healthy life and live about as long as people without HIV, but the chance of living a healthy life with HIV depends on having the HIV diagnosed early and starting treatment early.

“Which it’s why it’s so important to be tested regularly, particularly as many STIs often don’t cause symptoms, so you won’t know you have one.”

Looking at the big picture, if you have an undiagnosed and untreated STI, you could give it to your sexual partners, who pass it onto theirs, which is how you got it.

“Getting a regular STI test is not only important for your own health, it also makes you a responsible sexual partner,” Cornelisse says.

“I encourage people to discuss STI testing with their sexual partners. If your sexual partners are also getting tested regularly, it reduces your risk of getting an STI.”

Complete Article HERE!