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Spotlight Center on HIV Prevention Today

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Let's Talk About Sex

Fall 2016

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PrEP

PrEP (pre-exposure prophylaxis) is the use of the HIV medication Truvada by an HIV negative person to prevent HIV transmission. With Health Canada's approval of Truvada for this purpose in February 2016, the drug will likely soon become more widely available to HIV-negative people (it was previously used only to treat HIV).

At the time this article was published, the daily use of oral Truvada is the only type of PrEP that has been found to be effective in multiple studies. However, other forms of PrEP are being investigated and may become available in the future.

How well does it work?

PrEP has been called a game-changer because it can drastically decrease the chance of HIV transmission during sex. When taken correctly and consistently, Truvada is a highly effective HIV prevention strategy. If it is taken every day and used with treatment as prevention or condoms, the chance of transmission is reduced even further.

What happens if someone forgets doses?

If a person forgets to take their PrEP pills, the chances of transmission increase. Also, Truvada is not effective against strains of HIV that are resistant to Truvada. For example, a Canadian man who was taking PrEP religiously became HIV positive with a drug-resistant strain of the virus.

While PrEP is a highly effective strategy for preventing HIV, it does not work against other sexually transmitted infections (STIs). It is therefore recommended that PrEP be used along with condoms.

Who can take PrEP?

  • PrEP should only be taken by people who are HIV-negative and at high risk for HIV -- for example, people whose sex partners are HIV-positive and have a detectable viral load or people who have condomless sex with partners of unknown HIV status. (If an HIV-positive person takes Truvada without other HIV drugs, they could develop a drug-resistant strain of the virus.)
  • PrEP should only be taken by someone who has a prescription and sees a healthcare provider regularly (at least every three months).

Why is it important to see a doctor regularly?

Guidelines recommend that a person on PrEP see a healthcare provider regularly to check in about taking the medication on schedule and for risk-reduction counselling, as well as regular HIV and STI testing. The healthcare provider can also work with PrEP users to keep an eye out for possible side effects and drug toxicity.

Is the cost covered?

Only Quebec's provincial health plan currently covers the cost of Truvada for PrEP. People with workplace drug plans may have access to PrEP through their private insurance (check with your provider). Status First Nations people and Inuit are already covered under the Non-Insured Health Benefits (NIHB) Program.


Condoms

Condoms have been a mainstay in the safer-sex toolbox since long before the HIV epidemic, and they continue to play an important role in preventing HIV transmission.

How well do they work?

In addition to preventing pregnancy, condoms remain a highly effective way to prevent the transmission of HIV provided that they are used correctly and consistently. Condoms -- both external (male) and internal (female) -- create an impermeable barrier that prevents the exchange of fluids between sex partners. HIV, which can live in vaginal and anal fluids as well as in semen (including pre-cum), cannot pass through latex or polyurethane condoms. Condoms are also the only effective way to prevent many other sexually transmitted infections (STIs), such as syphilis, gonorrhea, herpes and chlamydia.

Using condoms in combination with treatment as prevention or pre-exposure prophylaxis can further reduce your risk of contracting HIV. So, it is in your and your partner's interest to keep condoms in your toolbox of HIV prevention strategies.

(Note that lambskin condoms do not reduce the risk of HIV and other STIs.)

Are they foolproof?

No. Although condoms are impermeable to HIV, they can fail if they break, tear, slip or leak during use. This can give HIV the opportunity to catch a ride with any fluid that makes its way through. This is why correct condom use is critical, especially when other prevention strategies are not part of the picture. You can reduce the chances of this happening by knowing how to properly put on a condom and use it during sex.

Getting it on right

Here are some tips for using external condoms:

  • Store condoms at room temperature and never use one past its expiry date.
  • Put it on before you put it in! It may sound obvious but slipping it in for just a moment can give many STIs the perfect opportunity.
  • Open the package carefully, making sure not to tear the condom.
  • Place the condom on the tip of the penis the right way around!
  • Squeeze the tip of the condom to remove air and leave space for semen. Then unroll it all the way to the base of the penis.
  • Make sure you've got the right fit and feel.
  • Have fun!
  • Use one condom per use, per partner. Don't recycle! And don't double up: Two condoms together can tear.
  • Use lots of lube. Water- or silicone-based lubricants only though -- other types can weaken the condom.
  • Immediately after sex, hold onto the condom while pulling the penis out of the vagina or anus.
  • Carefully pull off the condom when there is no further contact with your partner's body.

Internal condoms have a closed inner ring that is inserted into the vagina or anus before sex. They can provide similar protection. Be sure to use it instead of, not at the same time as, a traditional external condom.

Practice makes perfect!

Studies have shown that repeated condom use tends to reduce the number of condom failures over time. Water- or silicone-based lubricants not only make sex with condoms more fun, they also decrease the likelihood of tears by reducing the amount of friction applied to the condom.


Rob Easton is a freelance journalist, filmmaker, Trekkie and dog owner. He is also the former host of the TV show Don't Quit Your Gay Job.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.


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