GAY & BISEXUAL MEN - HIV Prevention including PrEP, PEP & U=U
HIV Prevention including PrEP, PEP & U=U
If you have anal sex, the best way to prevent getting or passing on HIV is to use condoms and lube. Going for regular check ups is also important since STIs can increase both a HIV negative person's risk of becoming infected with HIV and an HIV positive person's risk of transmitting HIV to someone else.
Giving oral sex is very low risk for HIV, however having cuts or sores in your mouth, having an STI in your throat, or having had recent dental work done increases the risk from oral sex.
Knowing your HIV status has never been more important. If you are HIV positive you can get treatment to help keep you fit and healthy. When on effective treatment the amount of HIV virus in your body may get below a certain amount, and then HIV can become undetectable. Your HIV doctor is the only person who can confirm that you are undetectable.
If the amount of HIV in your blood has been undetectable for more than six months and you continue to take your HIV treatment as prescribed by your HIV doctor, and you do not have any sexually transmitted infections (for example gonorrhoea, chlamydia or syphilis) you cannot pass HIV on through sex. This is called untransmittable. U=U (short for undetectable = untransmittable) has been a game changer for people living with HIV since it can lead to better self esteem as well as helping to reduce stigma and discrimination. It's important to remember that U=U ONLY prevents HIV being passed on through sex - it doesn't prevent HIV being passed on through other routes such as sharing injecting equipment. U=U does not prevent passing on hepatitis B, hepatitis C or other STIs. Using condoms and lube is the best protection against STIs. Never sharing injecting equipment is the best protection against hepatitis C. A safe and effective vaccine for protection from hepatitis B is available.
To find out more about U=U go the THT website.
Knowing you are HIV negative can be a great incentive to practice safe sex. You may also be eligible for pre-exposure prophylaxis (PrEP) medication to reduce your risk of getting the virus.
PrEP is available free from sexual health clinics in Scotland. It is a combination of two medicines (tenofovir disoproxil and emtricitabine) taken as one pill. Depending on the type of sex and how often it takes place, pills need to be taken every day or only around sex.
It will only be prescribed to men who meet the eligibility criteria which can be found at https://prep.scot/.
In 2015, two studies (PROUD in the UK and IPERGAY in France) reported 86% reduction in acquiring HIV in gay men and trans women using PrEP. It is not expected that people will take PrEP for many years at a time, or forever. Most people will be prescribed PrEP to cover the time that they are at greatest risk of HIV infection. This means people can discuss stopping PrEP when they are no longer at increased risk of HIV infection.
Less than 10% of people report mild nausea, mild bowel disturbance, bloating and headache when starting PrEP. These side effects usually stop within the first month. Occasionally PrEP can cause more serious side effects that reduce kidney function.
Men who are prescribed PrEP need to attend a sexual health clinic regularly for monitoring of their renal function and HIV status.
PrEP will not protect against any STIs other than HIV. As condoms are still the best way to prevent HIV and other STIs we recommend that you use condoms too.
If you would like more information on PrEP you can download the Scottish version of the i-Base PrEP leaflet.
For HIV negative people not on PrEP, post exposure prophylaxis (PEP) for HIV is available. It is a month of antiretroviral therapy taken after exposure to a person known to have or thought to be at high risk of HIV. PEP should be started as soon as possible and definitely within 72 hours. To check if you've been at risk of contracting HIV through sex and what action you may be able to take use the on line assessment tool available at https://www.tht.org.uk/PEP-tool
PEP is available from most sexual health clinics and emergency departments and including Sexual Health D&G and the Emergency Departments at Dumfries Royal Infirmary and the Galloway Community Hospital.