SEX: THE SAFETY INSTRUCTIONS

It’s been said that these days you have three seconds to captivate your reader. So here goes: SEX! SEX! SEX! Are you still reading? Everyone likes it, everyone wants it but it doesn’t come with any safety instructions.

That’s why fear, denial, apathy and ignorance are some of the biggest contributing factors to the transmission of HIV and other STIs – with lack of knowledge at the core of all of them. Here is a list of a few of the fundamental terms that you should know and understand in order to make informed decisions for yourself and your sexual partners.

This is the moment where I am the flight attendant just before take-off: “Ladies and gentlemen, I’d like to direct your attention to the television monitors. We will be showing our safety demonstration and would like the next few minutes of your complete attention. Even if you’re a regular flyer, please take a moment to listen to the safety instructions.”

Condoms and water-based lube: These two should always be used together for anal sex. Anything with an oil base like hand cream or baby oil will damage the condom and cause it to tear. Water-based lube makes sex more comfortable and it enhances pleasure.

CD4 and viral load: The most important cells in your immune system. A CD4 count tells us how many CD4 cells there are in a drop of your blood. The higher your CD4 count, the stronger your immune system is. Viral load is a measurement of how much the HI virus (the virus that causes HIV) has spread in your body. The viral load can go up to millions. Your CD4 count and viral load influence each other. When your CD4 count is high, your viral load is usually lower which a good situation is. When your viral load is high, your CD4 count is usually low. This means your immune system is low and unable to protect your body.

ARVs: Taking antiretroviral (ARV) medication lowers your viral load and allows your CD4 count to increase. This treatment is usually started when your CD4 count is equal to or less than 350. Once you start taking ARVs you need to take them correctly as your nurse or pharmacist told you to, so that your CD4 count will stay up and your viral load will stay down.

Bareback: Unprotected anal sex puts you at high risk for contracting HIV and other STIs. Your risk increases with multiple sexual partners. Barebacking is a bigger risk for the bottom to contract HIV but other STIs (like Hepatitis and Syphilis) can be passed on either way.

Oral sex: Although safer than anal sex without a condom, there are risks associated with oral sex. To date there has not been a confirmed case of someone becoming HIV positive through oral sex published in scientific literature. However, it remains possible for transmission to occur if the person performing the blow job has small cuts or sores in his mouth and his partner ejaculates in his mouth.

PEP: Post-exposure prophylaxis (PEP) is an emergency prevention measure for people who are HIV negative and who have been exposed to the virus, like a condom breaking during sex, putting them at risk of becoming HIV positive. PEP needs to be started within 72 hours after exposure to the virus. It helps reduce the chances of HIV infection.

Undetectable viral load: Having an undetectable viral load is one important way in which people with HIV can reduce the likelihood of HIV transmission. However, achieving an undetectable viral load is not a reliable enough way to reduce the risk of HIV transmission on its own. An undetectable viral load in the blood does not necessarily equal an undetectable viral load in the semen; it’s possible to have virus in the semen even when it’s not detectable in the blood. Even though the risk of transmission is significantly lower, technically, this means transmission could still occur. Viral load is best used as one method to reduce the risk alongside others such as consistent condom and lubricant use and sero-positioning.

Sero-positioning: Men who sero-position decide what role (top or bottom) to take when having anal sex based on their own and their partner’s HIV status. For example, you would be sero-positioning if, as an HIV positive man, you decided to bottom during anal sex for a man who was HIV negative. This is because there is less risk of infection for a top as your semen will not enter his anus. Some HIV negative guys never bottom because they know there is more risk of infection being a bottom. It remains important to use a condom and water-based lube every time (regardless of whether you top or bottom).

STI: Sexually transmitted infections are a group of infections, or illnesses that can be spread from one person to another during sex. Some of these can be spread more easily than HIV and infection can take place even if there is no exposure to a partner’s semen or blood. Most STIs are either completely curable or can be managed with treatment. You can’t always tell if somebody has HIV or an STI by just looking at them. You also can’t go on somebody’s word to know whether they have an STI or HIV. Most guys who say they are negative cannot be totally sure of their status. Maybe they were infected since their last screening, or maybe they’ve never been screened. Some guys lie about their status and say they are negative because they are scared of rejection. Having an STI heightens your risk of contracting HIV.

HIV stigma: It is a labelling of an individual or group as different or deviant. The roots of stigma are often associated with fear, death and difference. This is intensified when there is a sense of perceived risk and is often based on a lack of information or misinformation. Consequently many diseases, disabilities and sexualities are stigmatised.
What does stigma look like?

• Referring to gay or HIV positive people as dirty or diseased.
• Rejecting an HIV-positive sex partner when they disclose their HIV status but having sex with them when they don’t. Discriminating against someone with HIV doesn’t make you safer.
• An attitude that HIV-positive people are guilty or a failed person.
• Gossiping about the HIV status of a person in the community and avoiding them based on the knowledge that they have HIV.