Look, without getting into the nitty-gritty of the situation, I was once given some downright cooked direction from my local GP after a potential HIV exposure. I came to realise how misinformed they’d been in recent years – and while the outcome was a-okay, the fact that I was told PEP wasn’t necessary after I’d engaged in some undeniably high-risk behaviour still sticks out in my memory more than Jon Hamm‘s ham in a tight pair of slacks.
Circumstances like that are why it’s so important for us peen-partial gents to stay up to date with what’s what on the sexual health front – and in 2018, a big part of that is being aware of/knowing the roles of PrEP and PEP.
HOW OFTEN SHOULD I BE GETTING TESTED?
I recently had my own STI test over at a[TEST] on Oxford St and was able to get the DL from the incredibly friendly Karl Johnson who’s the Manager of Testing and PrEP Services for ACON.
Johnson informed me that “gay men should test twice a year, so every six months – for some men, however, we suggest testing every three months.”
That’s if you meet the following behaviours:
- You have more than ten partners every six months, which isn’t an outrageous number. That’s like one and a half a month, and some guys could do that in a weekend.
- If you have condomless sex with casual partners.
- Or if you have group sex – Sex On Premises Venue (SOPV) environments, parties, that kind of thing.
If this sounds like you, Johnson recommends you get tested four times a year.
People like Johnson are just there to give you all the information but the onus is on you to look after your own sexual health. Also, you need to keep in mind window periods. HIV, for instance, might not be detectable in blood tests for six to twelve weeks, depending on which HIV test your healthcare provider uses – so make sure you ask what’s what with these window periods during your next STI test.
WHAT SHOULD I EXPECT WHEN GETTING TESTED?
One of the huge advantages of going to a[TEST] or a similar service is that they’re geared up to get you clued-in on pretty much everything relevant to hopping on the good foot and doing the bad thing.
“Every person that walks through, we talk about PEP, we talk about PrEP, we talk about undetectable viral loads and how often to test,” he says.
These clinics test for HIV and the most common STIs that affect our communities. Apologies for the overshare, but it wasn’t until I had an anal swab taken (something that might not be done at a traditional GP when testing for STIs) that I found out I’d picked up anal chlamydia.
The more you know (/test), right? And just so you’re fully aware of what’ll go down at a facility like a[TEST], you’ll have a rapid HIV test (so you’ll know whether or not you’ve acquired HIV – but you’ll need to factor in the window period), a confirmatory HIV test blood sample taken to back up the results found in the rapid test, and a urine sample, throat swab and the aforementioned bum swab.
WHAT IS AN UNDETECTABLE VIRAL LOAD?
Given that sex itself was barely touched on in a Catholic high school environment like my own, let alone anything that strayed outside of the heterosexual norm, my knowledge of HIV transmission really wasn’t where it needed to be. While it’s embarrassing to admit, I was one of those fools who thought that HIV acquisition was inevitable if you fooled around in any capacity with someone who’s HIV+.
So, on the very off chance that you’re reading this and believe something even remotely similar to the above, then let me set the record straight. There has never been a documented case of an HIV+ person with an undetectable viral load transmitting HIV to a sexual partner.
An undetectable viral load is when someone living with HIV has been receiving treatment, and that treatment has caused their viral load (as in, the presence of HIV in their body) to drop to a point where it’s literally undetectable from a blood test.
“You can control it incredibly well,” says Johnson. “When you’re undetectable, there’s never been a case of someone transmitting the virus.”
And given the large scale, international studies conducted that prove this, I can reassure you that this isn’t some medical hunch. It’s fact.
This is also where treatment as prevention comes into the mix, which is covered below.
WHAT IS SEROSORTING?
“When people practice serosorting, they are choosing a sexual partner who shares the same HIV status,” says the Australian Federation Of AIDS Organisations.
An example of serosorting practice would see an HIV-positive person showing a preference for engaging sexually with another HIV-positive person, and the same would apply to an HIV-negative person engaging with an HIV-negative partner by choice.
Makes sense, right? But there are some pretty massive flaws with using negative serosorting as a prevention method – namely, not knowing for certain if your sexual partner is being 110% honest about their testing history or if they are truly aware of their status which can change since their last test. This often isn’t an issue when you’re looking at a monogamous relationship where couples could potentially go for tests together, or feel comfortable enough to physically share their results. But if you’re having, say, a random hookup, asking someone to produce the paperwork from their last assessment could be a bit of a boner kill – so some people just take their partner’s word for it. Johnson raised that negative serosorting is still reasonably commonplace in Sydney:
It’s a conversation I could have with a younger guy, y’know, early twenties – or it could be anyone – that might not have had that much sexual health education yet. They might be having condomless sex with partners, but they only do that with partners that they ask, ‘Are you negative?’ And if the person confirms that they’re negative, that’s their prevention strategy – I have to explain to them that’s a high risk prevention strategy.
It’s for this very reason that having condomless sex with someone living with HIV who has a UVL is actually safer than just being a douchelord and asking, ‘You clean, brah?’.
Most HIV transmissions would come from someone who thinks they’re negative and at some point has contracted HIV. Because they don’t know they’re positive, they’re not on treatment – and because they’re not on treatment, they’re infectious.
Negative serosorting is a flawed strategy, inherently.
WHAT IS PEP?
“PEP is Post-Exposure Prophylaxis, which is used to treat a patient who has potentially been exposed to HIV via sexual or other bodily fluid contact,” says Dr Tanner, Head Doctor at the online STI testing service Stigma Health. “It is taken after the fact to reduce the acquisition of HIV if exposure has occurred.”
To put it in aggressively simple terms, it’s kind of like the morning after pill for HIV transmission. It prevents the virus from replicating and then the original cells infected with HIV naturally die off shortly after – meaning that the HIV would struggle to make itself at home in your bod.
If you believe you might have been exposed to HIV, then you need to take it within 72-hours from the potential exposure. It won’t be effective otherwise.
HOW DO I GET PEP?
“Accessing PEP in each state is different as the access is run by the state governments,” says Dr Tanner. “To see how you would access PEP in your state and location, visit GetPEP and use the interactive guide.”
Most states/territories have a PEP Hotline (if available, the number will be listed when you use the interactive tool on GetPEP) for you to call and chat through the circumstances of your exposure – but if you’re really worried, just head to your nearest emergency room or sexual health clinic and they’ll help you out.
WHAT IS PREP?
“PrEP is Pre-Exposure Prophylaxis, which is used for treating a patient who is deemed at risk of HIV exposure due to sexual practices,” says Dr Tanner. “They will take the PrEP medication daily, like the contraception pill for women, except PrEP is used to prevent contraction of HIV if exposed to it.”
PrEP is taken once daily and has been proven to be effective in reducing the risk of HIV acquisition.
HOW DO I GET PREP?
The two most common ways to access PrEP in Australia are by joining a trial, or via personal importation.
1. PrEP TRIALS
There are a bunch of medical trials happening around Australia RN. For instance, there’s QPrEPd in Queensland, EPIC-NSW in New South Wales, and VicPrEP for Victoria. This is probably the most common way PrEP is being accessed by most people nationally – given that it’s a trial, the cost of the medication is covered, and people have a lot of time for free things.
To get on these trials, you need to fall into a high or medium risk group for HIV acquisition. Check out the breakdown of EPIC-NSW’s eligibility criteria here at Ending HIV.
For the purpose of the study, they’re really trying to reach high risk and medium risk – so it works in that sense. In terms of everyone who could possibly benefit from being on PrEP, more people could be on PrEP. That’s a distinct conversation from what’s the eligibility for the study. When you start getting down to low risk, like there’s an occasional slip-up or something, you’ve got stuff like PEP. You have the opportunity to personally import as well.
2. PERSONAL IMPORTATION
Personal importation involves gaining a prescription to PrEP from an Australian doctor, purchasing a generic brand of the medication, and having it internationally imported to you.
In terms of getting a script, you can go to any doctor if they’re willing to write a PrEP script. They don’t have to be a HIV specialist, they don’t need to be what’s called an S100 provider – which is someone who traditionally is the only doctor who could write Truvada scripts for HIV+ people. Any doctor can write a script for personal importation.
Ideally, however, you’ll go to a high caseload gay GP because they’ve worked with men who have sex with men before and tend to have a higher understanding of your needs.
Once you have your script, you’ll need to find an importer. PrEP activists in Australia have set up a website called PrEPaccessNOW which lists potential providers, costs and all the information you’ll need to personally import.
There you have it, gents. If you have any more questions surrounding HIV, STIs, PrEP, PEP, or anything within the borders of Boner Town, then please do yourself a favour and chat to a sexual health professional or suss some of the great resources provided by ACON. Ain’t nobody got time for any unexpected sex-related situations to crop up from lack of education, right?
And if you’re keen to make sure you have health cover for the unexpected, then check out Medibank’s Healthy Start Extras HERE.