PrEP
PrEP is an HIV prevention pill. PrEP is taken daily or around sex. If you use chems during unprotected sex, it is highly advisable to use PrEP. The risk of HIV transmission increases when you are under the influence of chems. Remember to keep taking PrEP every 24 hours during prolonged sex sessions. Click here for more information on PrEP.
Note: PrEP only provides sufficient protection against HIV (more than 90% protection) if taken according to a strict dosing schedule.
Daily PrEP intake: take one tablet at approximately the same time daily.
Set an alarm on your phone for every time you need to take PrEP. This will prevent you from forgetting, even during a sex date.
Taking PrEP around sex: Take at least four tablets spread over several days. Take more tablets if you go on longer. Read more about the correct dosing schedule here.
Consider taking PrEP daily if you regularly use chems during sex, as there is a risk that if you continue with chemsex for a long time (followed by the crash), you will forget to take the tablets. A daily dosing schedule is more beneficial in that case.
Keep extra tablets in a coat, bag or keychain container.
When you crash, make sure your phone is charged and at hand; this makes you more likely to wake up from the alarms. Have your PrEP tablets and water ready nearby so you don’t have to get up for them.
Apply risk reduction strategies
If you are having unprotected sex and not using PrEP but want to reduce the risk of HIV transmission, you can still apply risk mitigation strategies. These strategies are not foolproof but recommendable. Risk-reduction strategies can provide additional protection even if you do use PrEP. Decide for yourself which strategy or strategies best suit you.
Viral load sorting
You are having unprotected sex with HIV-positive people who have an undetectable viral load due to successful treatment.
Pros:
HIV can no longer be transmitted thanks to successful treatment.
Cons:
You are never sure whether your sexual partner’s viral load is truly undetectable. This is a trust issue, especially if you do not know someone well. Never assume that the other person has an undetectable viral load; always ask.
Top only
You have unprotected sex but are never a bottom.
Pros:
You are less likely to get an HIV infection as a top than as a bottom.
Cons:
You can still contract HIV as a top; the risk is much lower, but it still happens.
Do not ejaculate inside each other
You have unprotected sex, but never ejaculate inside each other.
Pros:
It is safer if you do not ejaculate inside each other.
Cons:
HIV can be transmitted from top to bottom, even without ejaculation.
Two risk-reducing strategies that are NOT recommended
1. Not recommended: serosorting
You have unprotected sex with sexual partners who say or think they are HIV-negative like you.
Pros: This strategy is safe for HIV if you know someone very well and can trust that they do not have HIV—also because you know when their last HIV test was.
Cons: Serosorting can be risky. Your sexual partner may have recently contracted HIV without knowing it. Only twenty per cent of all HIV-negative people get tested every six months. Recent HIV infections are highly contagious, as an HIV-infected person’s viral load is incredibly high. Most infections are transmitted by people unaware of their recent HIV infection.
Conclusion
Serosorting involves too many uncertainties. You are at high risk of contracting HIV.
2. Not recommended: PrEP sorting
You are HIV-negative and have unprotected sex with HIV-negative sexual partners who use PrEP, but you do not use PrEP yourself.
Pros: If your partner protects themselves against HIV with PrEP, you cannot be infected either.
Cons: You do not know if your sexual partner is really taking PrEP. You can control the use of condoms by the other person, but you have no control over their PrEP use. You also do not know if your sexual partner is taking PrEP consistently and may have contracted HIV without knowing it.
Conclusion
PrEP involves too many uncertainties. You are better off protecting yourself by starting PrEP.