Safer Sex in the Age of PrEP

I started taking PrEP. As a person in queer and trans communities I’ve had sex with bisexual, gay, and straight identifying men who have sex with other men. These people comprise a higher risk group when it comes to HIV transmission. Lately my tendency is sex with partners I’m not regularly involved with. People I’m intimate with have sex lives I know little about, as might their other partners, and so on. I engage in the occasional blood play scene, and teach play piercing. Even though I’m not regularly (or frequently) sexually active, PrEP seems a fair precaution to take. HIV is one of the STIs* I’d like to place further from reach.

If a condom broke, didn’t get used, or I was put at risk in another manner, I can take an injection or pill to clear up Chlamydia, Gonorrhea, and Syphilis. I’ve already had my Hepatitis B vaccinations, and I test positive for HSV 1 which I contracted 20 years ago when someone went down on me. In the past I’ve tested positive for HPV (which they don’t test AMAB people for), and a significant portion of the population is positive with this virus already. Until the HPV vaccine is affordably available to people over 20-something years old, HIV is the unaccounted for STI that I can do something about in a prophylactic manner. As for pregnancy, it just so happens that the assigned male at birth (AMAB) partners I have who are semi-regular (therefore more likely to engage in unprotected sex with) have all had vasectomies. I’m also on Testosterone which makes it harder (though not impossible) to conceive.

I screen for sexually transmitted infections (STIs) every three months and whenever else might seem appropriate. Probably the number one thing I do to avoid STI transmission though, is have “the talk” with each person I hook up with before we engage in risky behavior. I run through my history with STIs, share my most recent test results, bring up any risky behaviors or new partners I’ve engaged with since my last test, and answer whatever questions they have for me. Then I ask for that same information from my playmate. I’m astounded that approximately 95% of the time I’m the one to bring this conversation up, and a lot of people say they’ve never had this conversation before. Happily, most of the people I chat with get tested relatively regularly and can speak to their histories and experiences. If after the conversation we don’t feel like engaging in risky contact, there’s always mutual masturbation, and other safe forms of intimacy which don’t risk exposure, but feel sexy and great!

Being the sex nerd I am, I wondered to what extent PrEP actually protects me, and in doing research I found out I’m not in the same situation as AMAB people who take it. This is a complicated bit of research to chase reliable information down about. The recommendation to wait 7 days after starting PrEP applies to receptive anal intercourse only. If you’re interested in vaginal intercourse the recommendation increases from a week to 20-30 days. Similarly, while PrEP boasts being around 90% effective for receptive anal intercourse exposure, there is only about a 70% rate of effectiveness for intravenous drug users, and nothing I can find which specifically addresses exposure from receptive vaginal intercourse. It seems generally to be agreed upon that receptive vaginal intercourse is a more risky activity than receptive anal intercourse.

A lot of people believe (and it’s advertised as such) that PrEP is 99% effective. That number was found specifically amongst gay men in a controlled study, yet those findings have not been replicated en mass in the real world. When PrEP is used correctly, in conjunction with condoms, and limiting one’s number of sex partners, it seems as though its effectiveness is closer to 90%. Among gay men who do not regularly use condoms and who do not limit their sex partners the rate of effectiveness is closer to 86%. I find it frustrating that I cannot get a clear account of PrEP’s effectiveness for people who regularly engage in receptive vaginal sex.

There is at least one rare strain of HIV which is resistant to PrEP and has infected at least two people in the past couple years who were on PrEP. One other person reported contracting a non-resistant strain of HIV after having unprotected sex with multiple partners while on PrEP, even though he tested with appropriate levels of the drug in his system. He was reported to have had unprotected sex with a high number of people, and to have contracted Chlamydia and/or Gonorrhea a couple of times during the period in question. So, what does this add up to?

In short, it’s very important to test for HIV before you take PrEP. If you are already infected, the regular and continued use of PrEP can develop a drug resistant strain of HIV within your own body, which might then potentially infect partners. This is also why it’s important for people taking PrEP to be tested every 3 months, and to take their medication regularly and without fail. Aside from continued use of condoms in conjunction with proper PrEP use, the recommendation to limit one’s sexual partners seems a reasonable precaution as well. There is little information about exactly what factors should be considered when looking at the case of the person who contracted a normal strain of HIV while on PrEP. Was it the number of partners he had, or the number of potential virus types his body may have been contending with that led PrEP to fail? Was is the sheer amount of sexual activity he was engaging in, leading to more micro-tearing of his anal tissue and increased access to the bloodstream? Could it be that other STI infections he contracted lowered his resistance to HIV? Or it might it be something else entirely? So far that data is not available.

Theories on safety: Getting tested for STIs regularly is important for one’s sexual health. Period. I like to think about regular testing as a form of self care which is also community care. This is an ethic I have in mind when I find I’ve tested positive for an STI. If I consider talking about STIs as self and community care, it helps me gather up courage to contact anyone I might have exposed or been exposed by, in order to let them know they should get tested and/or seek treatment. Talking frankly to past and present partners about sexual behavior and STIs is a responsibility of mine as a sexually active individual, and as a loving individual.

I know many people struggle with the courage or language to talk about sex frankly. In situations where one feels guilt or shame, it can be doubly hard to make that happen. It takes practice to speak openly about sexual health in general, and when fear or shame enters the equation silence can easily win out. Unfortunately silence perpetuates the spread of disease. If you enjoy someone enough — even for an hour — to risk STI infection with them, consider linking that enjoyment to the resilience demanded in order to call them a month or two down the line if an STI shows up positive on your test.

Speaking of STIs should not be linked with finger pointing or shaming. Just like we don’t stigmatize a friend, coworker, or loved one who may have given us a cold. Speaking honestly about STIs could merely be seen as an act of care-taking and routine sexual responsibility. If every person treated for an STI waited the recommended amount of time to become sexually active after, and shared their status with past and present partners, the dividing and multiplying paths leading others to risk would diminish considerably.

Access to regular STI testing is an important factor in keeping individuals STI free, and so keeping the number of infections significantly lower in communities. Easy and affordable access to STI treatment is an important factor in keeping spread of illness down as well. Unfortunately these two very simple and obvious access points to sexual health are absolutely impacted by wealth in the United States. People who can afford healthcare, who get tested regularly, and who are better educated about their risk factors, are more likely to both avoid STIs and get treated in a timely manner if they do not. This helps the spread of STIs minimize in their communities.

If access to testing, access to treatment, and comprehensive sexuality education are what help a society lower certain types of illness, why is it that those things are so hard to come by equally for all people in this country? It seems our sexually repressive social mores are, in fact, an undeniable contributor to the survival and prevalence of sexual disease. It is no coincidence that better sexuality education, better healthcare, and better access to wellness resources are available to those who are wealthier. It follows that these things are not simply about education and access, they are 100% about class.

What can we all do? Probably the easiest thing that anyone and everyone can do in order to make informed decisions about what risks we’re taking with our own bodies and the bodies of our loved ones, is to get comfortable talking about our sexual histories with everyone we come into sexual contact with. Talking about sex is free and all it requires is that you have courage, that you share facts, and that you ask questions. It’s important to consider whether or not you trust the person you’re speaking with, and that you take sexuality education into our own hands by learning about risk factors for various STIs and methods of lowering those risks.

There are lots of sexual and sensual activities anyone can enjoy if you decide you don’t want to risk your health with a particular partner. From less risky heavy petting, to making sure you use appropriate barrier methods (condoms, gloves, dental dams, etc), to sensual and BDSM activities which don’t require fluid exchange, to mutual masturbation, and safe use of toys.

The math: Consider that some people (AMAB people especially) can be asymptomatic for STIs they carry, or might test false negative more frequently. Consider that it can take up to three months (or more) for enough bacteria to be built up in a person’s system to test positive for certain STIs. Consider that many patients are not given “multiple location tests” for Chlamydia, and so while they may test negative from a urine sample they may still be infected anally or orally with that bacteria. Consider that patients are often not coached on how to appropriately take a “dirty” urine sample, instructed not to drink anything, or pee for at least two hours prior to testing — all which can provide a more accurate sample for certain urine tests.

I don’t consider my testing completely “up to date” if I’ve had risky sex leading up to 3 months before my last test. Of course I sigh a breath of relief and emotionally consider myself negative when that’s what my stats say, but in the back of my head I know there’s a possibility that the person I slept with a month prior to testing could well have infected me with something which hasn’t shown up yet. I consider three months to be an appropriate amount of time between testings, and it’s an interval which many sexually active and non-monogamous people generally agree upon. In addition to that, I make sure I get tested after leaving a long term or monogamous relationship, as I’m more likely to have had unprotected sex with that person, and end-of-relationship times are culturally notorious for overlap of undisclosed sexual activities. If I feel symptomatic of anything, especially if I’ve recently had sex with someone new, I don’t wait until my three months are up, I get tested. Some people also wait to have sex with a new partner until they’ve both been freshly updated with recent tests. I enjoy going to a clinic with a partner, it feels supportive and freeing.

I hope this blog has given you some new things to think about when it comes to sexual health and safety. I hope it encourages you to talk with sexy people about all of these things. I hope if you haven’t gotten tested recently you’ll find a place nearby and update your stats, or have an in-depth and accurate conversation with your Doctor about your actual sexual behavior and potential risks for STI transmission. In most areas you can find free STI clinics, some of which offer anonymous resources as well. Consider asking exactly what they are testing you for, as some sites offer testing for only a limited number of STIs rather than the full gamut. As I already know my ongoing HSV, HPV, and Hep C stats, I prefer to update my Chlamydia, Gonorrhea, HIV, and Syphilis tests each time, making sure I’m offered a throat and anal swab in addition to my urine (or cervical) sample for accurate Chlamydia results.

May we all become better at talking about sex openly and without judgement or shame, and accessing the help we need for ourselves, our loved ones, and our communities.

*STI stands for “Sexually Transmitted Infections”, which is a more up to date term than “STD” these days. The word “infection” carries with it less stigma than “disease”. Similarly, when speaking of one’s STI test results it’s more appropriate to say “negative” than “clean”. Cleanliness has nothing to do with STI status and contributes to the feeling of stigma and alienation when one finds out they are positive for an STI, which further incentivizes people not to speak freely and accurately about their sexual histories and status. 

Play On My Friends,
~ Creature

This writing takes time, research, and consideration. It is my art.
Please visit my Patreon, offer one time Support or email me for other options. Thanks.

S is for Sexy Times Ahead… so STI Testing!

Photo by masaki ikeda

Don’t look the other way…  (Photo by masaki ikeda)

A beautiful Autumn is mustering up its might just about now, morning chill hangs persistently in the air, and bed is increasingly the thing no one wants to get out of…  Take a moment now, before falling into what sexy times lie ahead, to get yourself to a clinic for STI/STD (Sexually Transmitted Infection/Disease) testing, so you can play around with a clear and informed conscious.

Here is a great online resource that will help you find a place near you: National HIV and STD Testing Resources.  It’s really helpful for people who are on the road, like myself, or for anyone who doesn’t know exactly what their city or area offers for medical and testing support.  You can always look to Planned Parenthood or Family Planning, and many cities have free STI testing clinic hours at certain hospitals.  You may find health centers specifically serving young adults and students at discount rates or for free (usually through age 26, plus or minus), and sometimes there are medical centers or clinics that aim to provide safe and comprehensive care specifically for LGBTQI communities; they’re likely to be well informed about Kink and Poly health concerns as well.

Why get tested regularly?  Because you, your body, your heath, and your partners matter.  If you are informed about what is going on with your body you can take care of yourself and those you love better.  No one wants to test positive for a STI, but a large percentage of sexually active adults, at one point or another, will.  Whether it be something that you can take a pill to clear up or something you’ll need to live with for the rest of your life, knowing the facts about your body and treating your partners with honesty and respect before engaging in potentially risky behavior is one way you can gain the confidence to be a great lover.

Testing positive is not a sexual death sentence:  It does mean you have to practice talking clearly and openly about what you have tested positive for with play partners who might be put at risk.  In my experience, both being told by a partner that they were (or had recently been) STI positive, and having to tell a partner that I am positive for an STI, I have had great conversations.  No one has ever recoiled in horror or become abusive, and neither have I.  I can say that it is sometimes hard to have the confidence and presence of mind to stop in the midst of a great make-out that looks like it’s going somewhere and say “so before we go any further, I’d like to have a chat about STIs and sexual history with you…”.  I’ve found it feels really great when you do.  If a moment where you’re actively being physical with a playmate isn’t a good place to interrupt and start that conversation for you, then make sure you find time before your date to talk it out.  It’s great to hear “I really like you and if we’re going somewhere more physical with one another, I’d like to make sure we talk about our sexual histories and STI statuses, can we chat about that sometime soon?”.  Respecting the people around you is the best way to get closer to them.  That said, everyone has a right to turn you down for sex or play for any reason including your STI status, and it is not your right to take that choice away from them.  Ignorance is not a good reason to put someone at risk of anything, and it’s a horrible way to start what might have been a great friendship or partnership.

So, celebrate your body today!  Treat it to some testing and make sure you’re up to date on how to best care for yourself and others.  Have fun, remember that safer sex including the use of barrier methods are always available options and usually the best way to keep a separation between what’s yours and what’s theirs.  Get tested regularly (every 3-6 months or with each new partner perhaps), have a wonderful play life, and I wish many trustworthy and responsible mates unto you.

To Breath and Being,
~ Karin

If you like my blog, please check out my Patreon Page and consider supporting me, or just click here: Support the Artist

~Thank you.

###

Be an ABCs contributor: Do you have a story or perspective to share about kink or would you like to promote a kinky event? Email Karin directly at: Karin @ ABCsOfKink . com or fill out the as-anonymous-as-you-want-it-to-be feedback form below and you could see your writing published as a part of Wednesday’s “Perspectives on Kink: Conversations with the Community” blog on this site. Don’t know what to write about? Consider answering some of the Survey Questions I posted recently. Happy writing, and thanks!

You Gotta Be Responsible

"AIDS awareness - HIV testing and treatment" mural from Mozambique. Photo by Jacopo Werther

“AIDS awareness – HIV testing and treatment” mural from Mozambique. Photo by Jacopo Werther

It’s been about three months since my last STI testing post, and my next appointment is already in the calendar for next week.  Today’s post is a nudge to you to think about how important it is to keep up on your personal health care.  Your status may not be something you think about a lot, but it is important for you and any and all of the partners and partners of partners you may be connected to…

Look at the National HIV and STD Testing Resources website if you don’t know where to get checked out.  They’re a great resource, especially for travelers like myself, the newer to non-monogamy types, those who’ve just changed partner status recently, and really anyone at all who wants to know what’s going on with their body.  Get tested as a treat to yourself.  Take a mental health day, walk in the sun, eat your favorite foods, take yourself out to something fun, and make an appointment to get your blood drawn, your urine tested, and have a quick chat with a healthcare professional who can answer some questions about your lifestyle realities including risk factors.  My love and support to you on that day.

In response to my post last wednesday, a friend posted this article from The Advocate on my FB page:  STUDY: Biphobia Puts Bisexual Men at Risk for STIs.  I have gotten a bunch of responses from people since last week’s post, and I thank you all very much for offering me your insights on the subject.

Please feel free to post/publish/share last week’s post far and wide: Male Sexuality as it Pertains to Other Men.  After an in person interview, a few chats, some personal accounts written to me, and other tidbits of fun, I’m ready for more!  Happy summer my friends.

To Breath and Being,
~ Karin

If you like my blog, please check out my Patreon Page and consider supporting me, or just click here: Support the Artist

~Thank you.

###

Be an ABCs contributor:  Do you have a story or perspective to share about kink or would you like to promote a kinky event?  Email Karin directly at: Karin @ ABCsOfKink . com or fill out the as-anonymous-as-you-want-it-to-be feedback form below and you could see your writing published as a part of Wednesday’s “Perspectives on Kink: Conversations with the Community” blog on this site.  Don’t know what to write about?  Consider answering some of the Survey Questions I posted recently.  Happy writing, and thanks!

Age Verification: www.ABCsOfKink.com addresses adult sensual and sexual information, including imagery associated with a wide variety of BDSM topics and themes. This website is available to readers who are 18+ (and/or of legal adult age within their districts). If you are 18+, please select the "Entry" button below. If you are not yet of adult age as defined by your country and state or province, please click the "Exit" link below. If you're under the age of consent, we recommend heading over to www.scarleteen.com — an awesome website, which is more appropriate to minors looking for information on these subjects. Thank you!