Sex Outside a Relationship without Condoms You Better Know PrEp

                                                                              

No guarantees: Condoms only work when someone is wearing them. Gay guys who claim to use condoms all the time reduced their HIV risks by 70 percent. Rule out the guys who seem to be forgetting the nights they skipped the condoms, and protection is much higher. Condoms break or slip off in as few as 0.4 to 0.6 percent of uses, and that’s because these numbers include the people who fumble with them drunk or use wildly inappropriate lubricants. Still, if you just can’t stand using condoms, there are other choices.

PrEP: Never heard of it? You will. With PrEP, an HIV-negative guy takes the anti-HIV combination medicine that people living with HIV take. The difference is that he takes it every day before a possible exposure to HIV.  That’s the “pre” in PrEP.

Best case: PrEP can offer almost complete protection from an HIV exposure. In the largest studies conducted, none of the guys who took at least most of their PrEP medications became infected. PrEP does take advance planning, though. You can’t start taking PrEP the day you’re planning to have sex (it takes about a week to build up in the body).

No guarantees: Truth is, in the largest PrEP study, new HIV infections were only reduced by 44 percent, mainly because some people who said they were going to start PrEP never did, or they only took a few of their pills.  So just like condoms, you have to use it to get the benefits.

Treatment as Prevention: If your HIV+ partner is taking anti-HIV medications, that helps him and protects you. Less virus in his bloodstream makes him far less contagious. The first large study said that the risk of catching HIV from a treated person drops 96 percent.

Best case: taking anti-HIV treatment is something many positive guys are already doing.

No guarantees: there’s no way to see if the other guy is taking his treatment the way you could check for a condom. Once they’re off the meds, the drugs start draining out of their system, and that means you’re not protected anymore.

Test twice, Talk, and Trust: This is not the same as only hooking up with guys you think are HIV-negative. Here, you take an HIV test with your partner, and discuss whether you’re both comfortable having a “closed” relationship (or open only with protection).  If you both are, you test again to confirm neither had a new HIV infection that the first test missed, and then you may choose to take the condoms off.

Best case: Many guys have been using this strategy for years (including me), and it appears to work for those who follow all the steps.

No guarantees: If you do allow “playing,” remember that condoms protect better against HIV than against some other STDs that are easier to transmit.

PEP:  Whichever safer selfie method you choose, if something goes wrong and you realize you’ve been exposed to HIV, there’s one more option. If you get on a six-week prescription of anti-HIV medicines right away (“post-exposure”), you can often stop the virus from “latching on.”

Best case: Officially, you have 72 hours to start treatment, and your odds of becoming HIV+ drop by about three-quarters.

No guarantees: Don’t take the deadline too literally, and wait the whole weekend. The same studies show that the earlier you start PEP, the better the protection.

Why choose any option?  Maybe you just don’t consider staying HIV-free that important anymore. If and when you catch it, you’ll just take a pill a day, and live forever. Well, you’re not entirely wrong, but there’s more to it than that.

Best case: If keep to your doctor’s appointments and take your medicines faithfully, you can live a long life these days with HIV. Some studies predict that people can live with HIV for three or four decades, or even up to 53 years.

No guarantees: HIV treatments still cause side effects, from the unpleasant and common ones (diarrhea, fatigue, sleeplessness) to the silent bodily changes that can add up over time to cause other serious health problems in some people to trigger cardiac events, kidney failure, liver failure, and bone fractures.

Whichever safer option you choose, the best thing you can do is just to make a choice.  Condomless sex is up 20 percent among gay men over the past five years. HIV is still causing the equivalent of five 9-11s in U.S. deaths each year. Almost all new HIV infections are happening to guys who aren’t following any of these strategies. So pick one, stick to it, and make a safer selfie.

Most Important down to earth advice comes from Rich Juzwiak who rites in Gawker:

But what hasn't harmed you in the past, if you're one of the luckily negative like I am, could still harm you when you do it in the future. Owning up to this fact is a crucial step in choosing to take  {Truvada }, the antiretroviral drug cocktail of tenofovir and emtricitabine that’s manufactured by Gilead. For years, Truvada had been used to treat HIV, but in 2012 it was also approved as pre-exposure prophylaxis (PrEP), to protect HIV negative people from picking up the virus. A study suggests that taking Truvada everyday reduces HIV transmission risk by 99 percent.

For some—say barebacking enthusiasts, sex workers, or people in serodiscordant couples (in which one person is HIV positive and the other is negative)  {Truvada} is a no-brainer. There are plenty of us, though, who occupy a gray area, in which barebacking isn't exactly a lifestyle, and in which contracting HIV doesn't exactly seem like an inevitability. For those of us in that group, the kind of introspection that Truvada requires is hard.

The understanding that I might benefit from using Truvada dawned on me slowly, like I was stuck permanently at 6 a.m. for a few months. It was other guys who helped prompt my decision, like the ones I had the sense not to fuck raw when they assumed that's what we'd be doing on first meeting, or the ones who tried to fuck me bare so casually, it was like they were going in there to check their mail. It was the guy who told me, "Yes, I'm negative—I was tested in February," in October. It was the guy that I hooked up with who then proposed a threesome via text: "My friend said he wants to fuck raw." This was a few texts after I told him, "I play safe," and he said, "Yeah, me too." A few texts later, he admitted he'd already fucked raw with our prospective third.

And it was the condoms that have come off or broken during sex, rendering that session raw anyway.