All posts by jmascari

STDs/STIs

Curious and Careful: About PrEP

Dear Sexpert,

Pill icon

I’ve seen a couple of ads for a drug for people at risk for HIV. What exactly qualifies as “at risk” and how safe/effective is this drug?

Signed,
Curious & Careful

Dear Curious & Careful,

You’re right, PrEP, or Pre-Exposure Prophylaxis, can be used in prevention of human immunodeficiency virus (HIV). PrEP is a prescription pill (commonly sold under the name Truvada®) designed for daily use by people who are HIV-negative and at substantial risk for HIV exposure. PrEP is a combination of two drugs, tenofovir and emtricitabine. If used correctly and consistently, it has been shown to reduce risk by up to 92%. Additionally, many health insurance plans cover PrEP.

There are several situations that can qualify a person to be considered at substantial risk. The Centers for Disease Control and Prevention (CDC) recommend PrEP for anyone who meets any of the following circumstances:

  • is in an ongoing relationship with an partner who is HIV-positive;
  • is not in a mutually monogamous relationship with a partner who recently tested HIV-negative;
  • is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the last six months;
  • is a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status, who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners); and
  • has injected illicit drugs in the past 6 months and who has shared injection equipment or been in drug treatment for injection drug use in the past 6 months.”

If you fall into any one of these categories, or feel that you may benefit from PrEP, schedule an appointment at Sexual Health and Wellness (SHAW) or your primary health care office to discuss with a clinician whether this is an option for you. It’s important to keep in mind this is solely a preventative drug for people with on-going risk of being infected with HIV, and is not recommended for those who have had a single incidence of potential, high-risk exposure.  (There is a different medication, called PEP, or post-exposure prophylaxis, in those instances.)

Additionally, PrEP is a drug that needs to be taken on a daily basis. Like birth control or other daily-prescribed drugs, irregular use will decrease its effectiveness. Anyone prescribed PrEP should return

to their health care provider every three months for consistent HIV monitoring and follow up. PrEP is not 100% effective at preventing HIV acquisition and does not protect you from other sexually transmitted infections (STIs). Precautions should still be taken to reduce your risks, including using a condom with every intercourse, getting HIV tested with your partner(s), practicing less risky sexual behaviors (e.g., oral sex while using a barrier method), reducing your number of partners, and/or sterilizing injection equipment or joining a substance treatment program.

Best of luck and be safe,
The Sexpert

Information regarding PrEP retrieved from Centers for Disease Control and Prevention (CDC).

Contraception

Condom Queen: What if my partner doesn’t want to use a condom?

Dear Sexpert—

I just started dating a new guy, and he’s really great! But there’s one thing he does that makes me kind of uneasy: he’s really resistant to wearing condoms when we have sex. He always comes up with some excuse and tries to make me feel good about it, and sometimes I go along with it. Usually, I am a real stickler about condom use, so it worries me that he is so against using them. On the one hand, I want to tell him to wear one; but on the other, he’s made it seem like wearing one is a deal-breaker and I don’t want to lose him over it. What should I do?

–Condom Queen

 

Dear Ms. Queen,

There are a lot of different factors and attitudes that go into decision making and preferences, especially when it comes to something as intimate as sex. You have already decided that your preference is to use a condom every time, without exception. However, your boyfriend has other preferences.

Communication is the best way to improve sex. Talk with him about his dislike of condoms at a time when you’re not engaging in sexual activity. Figuring out his reasoning questions may help the two of you to come to an agreement about condom use. It is possible that he has had a bad experience with condoms in the past, or maybe he has not found one with the right fit. Trying out different condom styles or having open communication about wants and needs is a great way for him to see the fun of safer sexual experiences.

It seems like that you are concerned your boyfriend will end things if you push him. You have the right to make a decision for yourself, and he has the right for himself; but when you are making decisions that impact your partner, any and all decisions must mutually be agreed upon. I know it feels like saying something may put your relationship with him in jeopardy, but not saying something could also put your and his safety at risk (See the Sexpert archives.).

Be prepared with a response for the excuses, like “You’re just so sexy, I can’t wait” or “It’ll feel so much better without one”. Having condoms on-hand will discredit his “I can’t wait” argument, and it’ll make it easier for you to stay strong in your decision. Keep some condoms in your purse or bedside table for easy access. (You can get 10 FREE condoms, daily, at McCosh.) Also, there are many ways in which using condoms can be a fun part of the fun of your sexual experiences. Using the ultra-thin, ribbed, or heat-activating varieties or even adding a dab of lube to the inside and outside of the condom can all enhance the overall sexual experience for you both. If you aren’t interested in trying these options, you can always refer to the recent study published in The Journal of Sexual Medicine that stated that both men and women enjoy sex as much with condoms as without. This might alleviate his concerns, or at least make him more open to trying condoms.

When communicating about safer sex with your partner, feel free to be creative with ways to cooperate and come to a conclusion that makes you both happy. Just being willing to acknowledge his desires or worries may get him to acknowledge yours.

Good luck,

~The Sexpert