know your options more than condoms lube april2014

It’s no longer just about condoms and lube! Thanks to medical advances, we, as gay and bisexual men or Men who have Sex with Men (MSM), now have more options than ever to help keep ourselves safe from HIV infection. To clear things up, here’s a simple guide to available HIV prevention strategies and their pros and cons.

CONDOMS & WATER BASED LUBE
What’s it all about? The consistent and correct use of condoms with water-based lubrication is the most commonly known method to avoid HIV infection.

How well does it work? Studies have found that even with repeated sexual contact, 98% to 100% of people who used latex condoms correctly (with water-based lube) and consistently did not become infected with HIV. To get the maximum protection, the key words to remember are “consistent” and “correct”, otherwise effectiveness is reduced. Condoms can also help prevent other sexually transmitted infections (STIs).

What’s the price? They can be free or can cost between R7 and R30 for condoms and R30 to R140 for water-based lube. Even if you pay, it’s still your cheapest option to avoid HIV infection.

Where do I get it? You can get free condoms and lube from organisations like OUT, or government clinics. You can also buy a wide variety from supermarkets and chemists.

PEP (POST-EXPOSURE PROPHYLAXIS)
What’s it all about? PEP (Post Exposure Prophylaxis) is a 4 week course of HIV medicine that is taken AFTER you may have come into contact with HIV (such as having anal sex without condoms and lube with someone who may be HIV positive).

How well does it work? PEP should be taken no later than 72 hours after your sexual encounter. Studies suggest that PEP is about 80% effective in preventing HIV infection if taken within this 72 hour window. Not taking PEP exactly as prescribed can dramatically reduce its effectiveness. PEP can have side-effects. PEP does not prevent other sexually transmitted infections (STIs).

What’s the price? You can source free PEP (including a required HIV test) at clinics that cater to gay and bisexual men and MSM such as OUT as well as at government emergency clinics or hospitals. Otherwise, you can ask your GP to give you a prescription. It will cost between R250 and R300 for a once-off month’s course. This excludes consultations and HIV tests. Your medical aid, if you have it, should pay for the PEP.

Where do I get it? Contact OUT or a government clinic or hospital for free PEP or your doctor or GP for a prescription.

PrEP (PRE-EXPOSURE PROPHYLAXIS)
What’s it all about? PrEP is ongoing HIV medication that is taken daily by someone who is not HIV positive to avoid becoming infected. This is especially useful for men who have sex without condoms with many partners or with an HIV positive partner.

How well does it work? Studies have shown that PrEP can reduce the risk of HIV infection by up to 92% among men who use it consistently and correctly. Not taking PrEP exactly as prescribed dramatically reduces its effectiveness. It can also have side-effects and no-one really knows the long term effects of its use. PrEP does not prevent other sexually transmitted infections (STIs).

What’s the price? In addition to the PrEP, there will be additional costs because you may have to do HIV, Hepatitis B and kidney tests. The use of PrEP must be monitored regularly by your doctor to watch for side effects. Your monthly bill for the medicine will be around R500 per month. This excludes the cost of blood and urine tests and consultations. At this point, medical aids do NOT pay for PrEP.

Where do I get it? PrEP is not yet available at government clinics. Organisations like OUT will assist you in sourcing PrEP but you will have to foot the bill. You can also speak to your GP about getting PrEP, although not all doctors may be knowledgeable about its use.

VOLUNTARY MEDICAL CIRCUMCISION:
What’s it all about? Removing the foreskin of the penis (circumcision) can reduce the chances of a man who has vaginal sex with women becoming infected with HIV.

How well does it work? Based on recent studies, voluntary medical circumcision may reduce the risk of a man contracting HIV by 60% to 70% during vaginal sex. There is no evidence that it is effective when it comes to anal sex without a condom. However, if you are a man who has sex with women, in addition to being a top with men, circumcision is definitely worth considering.

What’s the price? Circumcision is offered as a free service by some government hospitals and clinics. It can also be paid for at private hospitals or clinics and would cost around R1,000, once-off.

Where do I get it? Government hospitals and clinics or private hospitals or clinics.

ARV TREATMENT
What’s it all about? If you’re in a relationship with an HIV positive partner, he should ideally start early antiretroviral (ARV) treatment to decrease the amount of HIV in his blood (his viral load). This should reduce the chances of him infecting you when having anal sex without a condom.

How well does it work? A recent two year study of a group of HIV positive gay men with undetectable viral loads (thanks to ARV treatment) found that none transmitted the virus to their negative partners. The effectiveness of limiting transmission through this method is estimated to be close to 100% - if the ARV treatment is effective and the HIV positive partner’s viral load is undetectable. Remember that taking ARVs exactly as prescribed is vital for them to be effective and that the positive partner's viral load must be monitored regularly.

What’s the price? ARV treatment is being offered as a free service by government hospitals and clinics. It can also be paid for at private hospitals or clinics and will cost around R550 per month for first line treatment (this may increase if the initial medication is not effective). This excludes the costs of consultations and any tests required. You may also need complimentary or additional medication against opportunistic infections, TB or to deal with possible side effects. ARV treatment does not prevent other sexually transmitted infections (STIs).

Where do I get it? Organisations like OUT, government hospitals and clinics or private doctors and GPs.

OTHER OPTIONS: There are other, as yet unproven, strategies you can consider that may reduce your chances of HIV infection. These include:

• Taking the “top” role during anal sex if you are negative (being a bottom has higher risk).
• Reducing your number of sexual partners.
• If you are the top, pulling out before coming.
• Watching your alcohol or drug intake; they can lead to risky choices.
• Knowing your partners’ sexual histories and if they are HIV positive or not.
• Testing every three months for HIV.
• Testing and getting treated for sexually transmitted infections (STIs) - they may make you much more susceptible to HIV infection.

Sources: Dr Kevin Rebe (Anova Health); OUT Clinic Pretoria; www.aidstar-one.com; www.cdc.gov; TAC.

For free HIV testing, condoms, lube and PEP as well as advice, counselling and information on PrEP, ARV treatment and sexual health services for men who have sex with men contact OUT in Pretoria on 012 430 3272.