There’s a lot of conflicting — and downright confusing — information about HIV these days, and yet the ways to prevent it are deceptively simple, and increasingly so. Then there’s the scary, staggering fact: 50,000 new HIV infections every year in the U.S. alone.
What’s a boy to do?
Today, there are new weapons in our arsenal to halt new transmissions, whether you are negative, positive, or don’t even know (quick tip: find out). So let’s get back to some basics — while exploring new strategies that have a real chance of eradicating HIV. You’re welcome to tape this list to your bathroom mirror, guys.
Or to your bedroom ceiling.
But the most important step of all might simply be the most human: Take care of yourself and your sex partners, no matter how many or few of them you may have.
First, the vocabulary lesson
Let’s not forget that countless gay men are coming out every day, and for them, the HIV landscape is completely new territory. And even for those vets of gay life, there’s plenty of new developments to track. So let’s start by defining terms.
Pre-Exposure Prophylaxis (PrEP) is the most recent and most debated development. It is a pill (Truvada) that has been used for years as a HIV medication, but is also proven to prevent HIV infection when taken regularly by HIV negative people.
Post-Exposure Prophylaxis has been around for years (health care workers taking HIV medications after getting a needle stick by an HIV patient, for instance), but has been terribly under-used by gay men under other circumstances, like when the condom breaks, have been on a bareback binge, or they otherwise are exposed to HIV. Most gay men simply don’t know about the option (it must begin with 72 hours of exposure), and many emergency rooms are not well informed about PEP.
This means that a person with HIV is on successful treatment and the virus is not detectable through a “viral load” test (these tests have become extremely sensitive to locating active virus). Being undetectable is not the same as HIV negative. It means their viral activity is so low it cannot be measured by the most modern means, and is unlikely to be transmitted during sex.
So now that we’re on the same page of this HIV prevention guide, here are five ways to prevent getting or transmitting HIV.
1. Use a condom every time
Talk about old school, right? Except the tricky part of this advice is “every time.” Using condoms inconsistently is a risky endeavor. Though HIV is actually difficult to transmit, sooner or later the odds might catch up with you. So if condoms are your mode of protection, stay vigilant. And keep plenty stocked in the nightstand, along with latex friendly water-based lube.
2. Know who you’re fucking
This might be the hardest advice for the sexually adventurous single man. Sex with strangers definitely has its allure to some of us. But until you know him well — and we’re talking more than his first name and favorite underwear brand — the best policy is to assume he’s poz and act accordingly. Condoms, PrEP, or putting off unprotected anal sex can all make you breathe a little easier.
Speaking of strangers, remember that crystal meth abuse isn’t just bad for your health. It’s also a major contributor to HIV infection. If your hookup is using recreational drugs, chances are his commitment to a healthy lifestyle — or his adherence to HIV medications — is much lower than normal.
3. Face the facts: PrEP works
The verdict is in, men. Truvada as Pre-exposure prophylaxis (PrEP) is an effective way to prevent becoming infected, with efficacy ranging from 70 percent to 100 percent in various studies when the drug regimen is adhered to carefully, although one recent study found perfect efficacy when taken only four times per week. Yes, there are sometimes side effects and it should only be taken under a doctor’s guidance (which offers further benefits to HIV negative men who might not otherwise be getting regular medical care). The debate over whether or not it works is over, but the choice is yours.
New versions of PrEP are also on the way, including other medications which might suit your body better, and an injectable version given every three months is under development.
It’s hardly worth mentioning that a large organization, AIDS Healthcare Foundation (AHF), continues its confounding battle call questioning PrEP. AHF stands virtually alone in this opinion, dismissing the support for PrEP from most every AIDS agency, the CDC, and even the World Health Organization. You may have seen the organization’s new anti-PrEP ad campaign in which it references worst study outcomes, which were largely due to poor adherence by early study participants who weren’t even sure the drug would work. But AHF does have a point: medications only work when you take them, and adherence to regimen’s is often a problem both for poz guys on meds and neg guys on Truvada.
4. If you dig him, get tested together
So the two of you have been getting naked on a regular basis and are wondering what the next step might be. Here is the answer: get tested together. As in, right now. Hear the results of your tests together (if he is unwilling or says he just got tested, you’ve got a problem, sweetheart, no matter how adorable he is). And then respect your new relationship by supporting each other no matter the outcome. He won’t get tested with you if he fears you will abandon him based on the results.
Budding love (or lust) is a wonderful thing, but hear this loud and clear: the biggest threat to seroconversion is from a primary partner (a boyfriend or regular fuck buddy). There’s plenty of reasons. People think they’re negative when they are not, or they are positive and terrified of rejection, living in denial, or just plain lying. For all the talk about gay marriage (and its inference that gays are dying to become monogamous PTA members), nothing protects us better than getting the facts about your partner and staying honest about the parameters of your sex lives.
5. Stay on your meds
Another new reality is that those who are undetectable for at least six months (which suggests they are taking their medications regularly) are unlikely to transmit the virus to their negative partners. This development is nothing short of miraculous, and will hopefully help stem the bigoted notion that guys with HIV are dangerous vectors of disease. You can take this fact at face value, or use condoms as an added measure of protection.
Our sexuality as gay men is a gift and, well, a total blast. We have the potential for more and better sex than anyone on earth. But it’s also our responsibility to help wipe out this virus so the future gay generations can be spared the devastation of older generations of gay men.
The good news is that whether you are on PrEP or taking HIV meds, these amazing new tools, when used strategically in combination, have the potential to significantly lower new infections among gay men and eventually eliminate it altogether. When infections decline, it creates a kind of virtuous cycle where fewer infections mean even fewer infections.
But like any new medical breakthrough, it still depends on human beings being well informed and making good decisions about their health. Have at it, boys.