In the sexual health landscape for gay men, there’s been some relatively recent developments that have been major game-changers.

Undetectable = Untransmittable

Often referred to in the short-hand as U=U, what this means is that if someone has HIV but their medication has reduced their viral load to ‘undetectable’ levels, then they can’t transmit the virus to anyone else.

A number of major studies have now confirmed that - ”A person living with HIV who has undetectable viral load does not transmit HIV to their partners.”

Whatever your status, this is a real game-changer.

According to Matthew Hodson, of UK health charity AIDS Map - ”Most people will become undetectable if they take their HIV treatment daily, as directed. However it can take some time for people to get the levels of virus down to undetectable. Someone won’t be undetectable when they first begin HIV treatment. It’s also vital that an individual has maintained an undetectable viral load, which requires more than one undetectable result over a period of time for confidence.”

PrEP

PrEP stands for pre-exposure prophylaxis. PrEP is a tool that HIV-negative guys can use to avoid acquiring HIV. Essentially, it’s taking medication that acts as a preventative to HIV infection. Truvada is one of the drugs commonly used as PrEP medication, there are other generically-branded medications that deliver the same results.

According to activist Greg Owen from #IWantPrEPNow - ”PrEP works for everyone, regardless of sexual or gender identity. Anyone who belongs to a group with high rates of HIV should think about using PrEP. Similarly, anyone who has sex with people who are from groups or countries with high rates of HIV might think about PrEP too. We know that HIV rates are highest among men who have sex with men, trans women, and Black African communities.”

Jason Domino of Porn4PrEP has been taking PrEP daily since 2015. “I started PrEP following an incident where I thought I may have contracted HIV…” explains Domino. “It was difficult to obtain PrEP to begin with. Initially I was buying PrEP independently online. At that time, some close friends contracted HIV. I had information that could have prevented them contracting HIV, but I chose to keep how I was getting PrEP private out of fear that my own access would be taken away if more people knew. I’ve had to try and deal with that guilt. Since then, I’ve dedicated most of my time to PrEP advocacy and helping as many people as I can find ways to get it.”

When PrEP first became available, it was approved for use on the basis that it should be taken daily to ensure protection. However, the research now indicates that on-demand dosing is just as effective for anal sex.

On-Demand Dosing

In relation to PrEP, On-Demand or Event-Based Dosing means that instead of taking PrEP medication on a daily basis, you only need to take the PrEP medication before and after you have sex.

For example, if you’re going away on vacation and planning on having some fun, then you might want to take PrEP before and after the vacation, but then plan to come off the medication when you’re back in your usual routine or when your chances of acquiring HIV are lower.

According to Matthew Hodson from AIDS Map, the directions for on-demand PrEP dosing are:

• 2 pills taken between 2–24 hours before you have sex.
• 1 pill taken 24 hours after the first dose.
• 1 pill taken 48 hours after the first dose.
• If you continue to have sex after that first day, continue to take 1 pill per day until 48 hours after the last sexual event.

The research has shown that if you take PrEP before and after sex in this way, then this gives your body the same level of protection against HIV as if you had been continuously taking PrEP every day.

If you haven’t been able to follow the recommended dosage for the on-demand protocol, then you should seek medical advice and access PEP medication - PEP is post-exposure prophylaxis.

According to Matthew Hodson from AIDS Map - ”As we get more data from additional studies, and use of PrEP outside of studies, it’s becoming increasingly clear that people who take PrEP daily are extremely unlikely to acquire HIV. There have only been a couple of cases where this appears to have happened out of hundreds of thousands of people who are using PrEP. We don’t yet have quite the same level of data to have the same confidence for on-demand dosing as we have for daily dosing, because fewer people have used PrEP this way, but the evidence so far suggests that it is effective.”

The research regarding On-Demand Dosing is from a major study in France, the results of which were presented at the International AIDS Conference in July 2018.

Barriers to PrEP

Speak with your local sexual health professional or check the information available online to see whether On-Demand Dosing of PrEP is right for you.

If you’re finding it difficult to obtain PrEP medication, or the cost of PrEP medication is prohibitive, moving to On-Demand Dosing might help you to be able to enjoy the health benefits of PrEP as well as enjoying an uninhibited sex life.

According to Greg Owen of #IWantPrEPNow - ”There are lots of reasons why people might delay taking PrEP or think they don’t need PrEP. But the biggest barrier to PrEP is always awareness of it, and then access to correct information and supportive friends, lovers, fuck-buddies, and clinic staff.”

“People always worry about side effects, mainly at the beginning or just before they start taking PrEP…” explains Greg Owen. “Some people might get an upset tummy or headaches or a little tiredness, but there are no ‘serious’ side effects from taking PrEP -  either in the short-term and the long-term.”

“It takes a while for some people to see their body as a specialist machine, one that needs a specialist fuel…” adds Jason Domino. “Learning not to be ashamed of pills that you take has an impact on drug adherence. Adherence is also something that can be harder to tackle if taking PrEP is conflated with slut-shaming.”

“Something that would really help remove a barrier is free access to PrEP for all who need it…” suggests Greg Owen. “We need our governments to do that - and it really needs to be a global initiative.”

Get tested regularly

Regular testing at your local sexual health service is important to ensure that you know your status regarding HIV, and that you’re keeping on top of any other STIs that you may be exposed to from time to time.

Matthew Hodson from AIDS Map advises that - ”If you’re sexually active you should get tested at least once a year, but if you have new sexual partners you should get tested more often than that. If you’re involved in group or party scenes, it’s very easy to acquire and transmit STIs. If you have condomless sex with multiple partners on a regular basis, you might consider monthly screens. The more frequently you get tested, the faster you’ll be treated if you’ve picked up an STI. Frequent testing and early treatment can help to reduce the number of STIs circulating in our communities.”

Testing is quick, easy, painless, and ensures that you’re fully equipped to keep yourself fit and healthy while enjoying an active sex life the way you want it.