You may have heard of HIV (the Human Immunodeficiency Virus) but do you know exactly what it is and how it is transmitted?
HIV is a virus that attacks the immune system. There is currently no cure for it, although there is medication that can generally keep it under control.
A person can only become infected with HIV if certain body fluids containing HIV get into their body and pass into their bloodstream. Those body fluids are blood, cum (semen), pre-cum, anal fluids, vaginal fluids and breast milk. The way that the majority of Australian gay men have been infected with HIV is through condomless anal sex (fucking or being fucked without using condoms) or by sharing injecting equipment.
Despite increasing understanding of ways to stop HIV transmission, HIV infections continue at a fairly constant rate. Young men who have sex with men now make up around 1/3 of all new cases of HIV in Australia.
HIV is still with us. It can affect us all regardless of age, race or backgrounds; as individuals, through friends, partners or family.
While HIV may not have the same devastating consequences it had years ago, it remains a serious condition that must be managed long term.
To reduce new transmissions of HIV, we need to work together. Condoms are still the most effective way of avoiding HIV—and sexually transmissible infections (STIs)—but there are other risk-reduction measures that people can use as well. Check out the info below to work out what works best for you!
Condoms
Condoms remain the most effective, easiest and cheapest way to avoid HIV and STIs. It is important to use them correctly with either water-based or silicon-based lube. Free condoms are available at a variety of services. Click here to find out where.
PEP
If you think you have recently been exposed to HIV, there is a way you can prevent the infection taking hold—but you need to act quickly!
PEP (Post Exposure Prophylaxis) is a 28-day course of HIV medications you can take to stop HIV infection after a possible HIV exposure. PEP is not guaranteed to work but it has a high chance of working if it is taken within 72 hours of HIV entering your body. The earlier you start PEP, the greater the chance it will work, so try to get it started within 24 hours.
PEP can stop the virus from getting into your bloodstream and other tissues and replicating in your body. The remaining HIV particles that may be in your body (e.g. from having sex with an HIV-positive guy without using a condom) will die off quite quickly without producing more copies of HIV.
If you are worried you or a partner may have recently been exposed to HIV, contact your local sexual health clinic, or hospital emergency department and ask for PEP. See the Get PEP website for locations in your area and for further information. If you’re not sure whether you should start PEP, some states have PEP infolines to discuss your risk — these are also on the Get PEP website.
PrEP
There have been some significant developments in HIV prevention and treatments in recent years, the latest of which is the licensing and availability of PrEP or Pre-Exposure Prophylaxis in Australia. (Remember this is about PrEP, not PEP.)
Pre-exposure prophylaxis (PrEP) refers to taking a medication daily on an ongoing basis to prevent HIV infection before exposure, in someone who may be at ongoing risk of HIV exposure.
PrEP has proven effective in international clinical trials but its use in Australia is still relatively recent. Consequently, accessing PrEP can be tricky and/or expensive. Although the drug used for PrEP (Truvada™) has recently been approved for use in Australia, this drug is not yet covered by Medicare. A month’s course of PrEP, if bought from an Australian chemist, can cost about $700; however there are ways of importing the drugs from overseas suppliers that drastically reduce the cost to as little as about $150 for 3-months’ supply. There are also some PrEP ‘demonstration projects’ and PrEP access schemes running in NSW, Victoria and Queensland that supply the drug for free. For information on accessing PrEP in you State or Territory, contact your local AIDS Council.
PrEP is considered appropriate for people at risk of HIV, such as gay and other homosexually active men or transgender people who have condomless sex with male sexual partners, when the sexual partners are either HIV positive or are not sure about their HIV status. If you think PrEP might be suitable for you, talk to your doctor.
If you start taking PrEP it doesn’t mean that you have to take it for the rest of your life. There might be times when you’re in a monogamous relationship with another HIV-negative person, and other times when you’re not having sex at all. People can stop and start taking PrEP to suit their individual circumstances, and patterns of use may change over time. You should talk to your doctor about whether PrEP is appropriate for you, and what may be involved with regards to regular health monitoring and STI testing while taking PrEP. Your doctor will also be able to advise you on how to safely start and stop PrEP.
For further information on PrEP check out the PrEP page on the AFAO website.
Undetectable Viral Load and Treatment as Prevention
If you are diagnosed with HIV, starting treatment early in the infection will not only help to maintain your health, but will also help to reduce the risk of passing HIV onto your partner(s).
HIV treatment reduces the amount of virus found in your blood (known as ‘viral load’). The lower your viral load, the less damage is being done to your immune system. Although not all HIV-positive people are able to reach an undetectable viral load—where the amount of HIV in their blood has been reduced to an undetectable level—most people taking treatment (~90%) do.
Having an undetectable viral load also dramatically reduces the chances of passing HIV onto to your sexual partner(s). Using this approach to preventing HIV infection is referred to as ‘Treatment as Prevention’ or ‘TasP’ for short. This strategy relies on the HIV-positive partner having an undetectable viral load at all times.
If you or your partner is HIV positive and has an undetectable viral load, and you want to stop using condoms; or if you simply want to discuss what TasP may mean for your relationship, talk to your doctor.
For more information on HIV Treatment as Prevention in serodiscordant relationships, please visit Together for Better.
Other ways to reduce risk
There are also other methods some guys use to minimise the risk of HIV transmission. These include pulling out before cumming (withdrawal), and only having sex with guys that are the same HIV status (known as ‘serosorting’).
Neither of these methods of avoiding HIV is risk-free or particularly effective when compared to other prevention methods, so it is important to weigh up your options carefully so you can make an informed decision. For further information on HIV risk reduction strategies, check out the Taking a Look website.
HIV Treatment
In the past, HIV treatment involved taking lots of pills at very specific times of the day. They sometimes also caused quite severe and debilitating side-effects.
In the last decade, HIV treatments have radically improved. For many people these days, treatments now involve taking just one pill a day. They have a much lower risk of side-effects, many of which are mild, occurring only in the first few weeks while your body gets used to them. Taking treatments can be as easy as taking your daily vitamins.
These days, treatments are also much more effective at controlling HIV. They prevent the virus from multiplying in your body, allowing you to lead a long and healthy life, similar to HIV-negative people. Treatments help ward off conditions associated with HIV because they keep the immune system healthier. That means you can get out amongst it and enjoy life the way you want to!
Recent research has shown that starting treatment early increases life expectancy, improves health and prevents serious illness compared to those who delay starting treatment. Starting treatment early is now recommended for all people living with HIV regardless of when you were infected.
Telling people you’re HIV positive
There are very few situations where you are legally required to disclose your HIV status. Some guys are totally comfortable disclosing their status while others are not. Ultimately the decision is yours.
When you do, you will be disclosing something very personal so it’s important you feel comfortable confiding in that person. It is your choice but remember, once it’s out there, you can’t take it back.
It’s entirely up to you whether or not you tell your friends and family. You do not have to tell people at work about your HIV except in a couple of specific circumstances. You are required to know and notify your HIV status if you are a doctor, nurse or dentist who performs activities with a high risk of HIV infection. In some states it is illegal to work as a sex worker if you have HIV (or other STIs) even if you only practise safe sex and/or have an undetectable viral load.
In most states in Australia the law says you must take reasonable precautions to prevent passing on HIV (for example, using condoms). However, for further information about the specific laws regarding disclosure in your state or territory, please visit Gay Men and HIV Disclosure.
Communication with your partner or partners is key, and if you feel comfortable in disclosing your status, then that is your choice, as it is theirs.
