About Last night. Do we still have to wear condoms to avoid STI’s?

July 31, 2017

Q. Ever since the “Grim Reaper” ads of the ’80s, the mantra in safe-sex messages has been “Wear Condoms – if it’s not on, it’s not on”. I hate condoms, but I’ve been responsible, and used them most of the time. It surprised me when a gay friend told me there is now a condom-free option to avoiding STIs. Is this true, and what is it?

A. Unfortunately, the short answer is “No!”. It would be great to pop a pill and become immune to all sexually transmitted infections, but that is a dream.
The treatment your friend is referring to is called PrEP, and it is very effective, but only in protecting you from the HIV virus. Detailed information is available on the Victorian AIDS Council’s website (vac.org.au/hiv-aids/pre-exposure-prophylaxis-prep). “PrEP (Pre Exposure Prophylaxis) is the use of medication to prevent HIV. By taking PrEP, people who are HIV-negative (meaning they do not have HIV) can reduce the chance of getting HIV by up to 99%. Right now, only one medication can be used as PrEP: Truvada … that has been used to treat HIV for many years. In 2009, a large study showed that not only was it effective at treating HIV, but also at preventing HIV when taken every day. Since then, several studies have confirmed that it is incredibly effective at preventing HIV”.

PrEP is most suitable for people who do not have HIV, but who are at risk of contracting the disease because of a range of risk factors.” The level of risk is different for every person, but people who are at highest risk are men who have sex with men, injection drug users, and transgender people. Women can also be at high risk if they or any of their sexual partners are injection drug users, or if any of their sexual partners are men who have sex with men.”
The treatment works by: ” … stopping HIV from duplicating inside the body. Without the ability to duplicate, the virus eventually dies off, and can no longer infect you”.

PrEP is not just a convenient alternative to other precautions, such as condoms. It is a continuous course of medication that must be taken every day. Like the female contraceptive ‘Pill’, forgetting to take it, a dose of gastro, or suchlike can compromise its effectiveness.Embarking on a life of taking a powerful drug is a commitment that many people would be unlikely to choose if their exposure risk was low.

As it does not protect you from other STIs, the official advice remains the same.

“The best way to prevent other STIs is by going in for regular sexual health checks at least every three months and by using condoms … condoms are still a very good idea. When used properly and regularly condoms are the most effective method for preventing STIs like gonorrhea, chlamydia, syphilis, hepatitis, and herpes.”

There are any number of reasons given for disliking condoms. They kill spontaneity. They reduce sensation. They are difficult to put on if you lose your erection. Sometimes it seems too embarrassing to bring the subject up. Sometimes your judgement is impaired by alcohol and drugs.

If someone does contract an STI it can cause shame, or provoke censure. This is not helpful.

“There are a number of reasons people can’t, don’t, or won’t use condoms. Ultimately the decision whether or not to use condoms is a very personal one, and depends on each person’s particular circumstances. Instead of focusing on what other people do – or what you think they should do – it’s best to focus on your own individual sexual practices. Informing yourself about your own personal risk and the different ways you can reduce that risk will help you make decisions that improve your own wellbeing.”

You would need to consult a doctor to see if PrEP is suitable for you. If you want to find a doctor who is familiar with this, and other HIV-related issues you can ask the Victorian AIDS Council. (03 98656700 or 1800134840).

Email your questions to abtlastnight@gmail.com

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