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I USE CONDOM AND LUB
The condom it is the most “versatile” means of prevention”: in penetrative intercourse it is highly effective in blocking the transmission of many infections: HIV, hepatitis (B and C), syphilis, gonorrhea and even HPV (condylomas) if the infectious site is covered by the condom. The use of lubricant in anal intercourse is equally important To prevent the condom from breaking, but also for easier penetration. But remember: It is important to ALWAYS use it at least in occasional anal and vaginal intercourse, or you lose the advantage given by its high protection. If you can't use it all the time, consider other alternative or complementary options. like PrEP, or TasP if you have a partner with HIV, and increase the frequency of checks you have. If your condom breaks In case of high-risk anal intercourse, ask for PEP. Also, a condom. for oral sex is also the only defense we have when we want to protect ourselves from infections which can actually be transmitted through oral sex, such as syphilis and gonorrhea.
I DO THE TEST EVERY 6 MONTHS
Take the test at least every 6 months or even more often (depending on your sex life), it's always the right choice. Today we know what to do. The test makes life easier in any case, whatever the outcome. If it's negative, you can breathe a sigh of relief. and continue to protect yourself by choosing the most suitable means, If the result is confirmed positive, therapy can be started immediately, which has several advantages: it blocks and suppresses the replication of the virus, immediately limiting the damage it can cause in the long term, maintaining or restoring your immune system to an excellent state, and within a few months you become effectively non-infectious when the virus is undetectable in your blood. So why be afraid? It's understandable to always have some, but that shouldn't stop us from doing it! There are various types of tests currently in circulation, always ask “what generation am I from”: The fourth-generation tests allow you to detect any infections as early as 1 month after risky intercourse, while with the second- and third-generation tests you have to wait 3 months.
I NOT I ASK NEVER “ARE YOU HEALTHY?”
Sometimes, before or after intercourse, he asks himself “are you healthy?”. But there is no less useful and appropriate question. In casual encounters, especially if you don't have HIV or assume you don't, asking someone about their health status (whether they have HIV or other STIs) and based on that answer deciding how much and how to protect yourself doesn't make much sense. On the one hand, because many people with HIV, or other STIs, don't know they have them., and therefore they will answer you convinced of a situation that is not real. On the other hand, because you can't reasonably expect people who know they have HIV to tell you, given the high level of fear and stigma, often completely irrational, that surrounds them. There's not even a legal obligation to "tell" them. The real risk with HIV is with those who don't know they have it., because he will have a lot of virus in his blood since he is not undergoing therapy: the peak of infectivity is absolutely highest in the first two months after infection, when it is also likely that he has not yet been tested. On the contrary, a person with HIV who is regularly treated and has an undetectable viral load for at least six months, not only is he probably doing very well, but it doesn't even transmit the virus: so what should it tell you? In short: just protect yourself!
I USE THE PrEP
If you have difficulty, for a thousand reasons, in consistently using a condom in anal intercourse, you could start to find out about the possibility of taking PrEP (Pre-Exposure Prophylaxis) as a complementary or alternative strategy HIV prevention. PrEP it's a drug (original trade name “Truvada”, components “tenofovir DF” and “emtricitabine”) which prevents the replication of the HIV virus when you come into contact with it and can have a very high efficacy around 99% if used perfectly as prescribed. To be effective it must be taken consistently every day, or with a dosage of 4 pills "as needed"“ (2 pills in the 24 hours before risky intercourse and another 2 approximately 24 and 48 hours after the first dose): the principle is that there must be enough drug in the blood for it to be effective. But you need to know a few things. First of all, PrEP does not protect against other STIs, but only from HIV, and then consider also getting regular checks for other STIs if you use it because you don't use condoms. Also, before using it You should do some tests, and definitely the HIV test., because if you start PrEP and you already have HIV, your virus would become resistant to that drug, and it is an important drug in the treatment of HIV (it is not the only one, but it is important). Finally PrEP requires a medical prescription from an infectious disease specialist. Until it is fully or partially refundable by the State, It can be purchased in a pharmacy upon presentation of a medical prescription Taken by an infectious disease specialist and paid for personally. The price of the original Truvada is over €700 per pack, but generic versions are now available for around €115 (30 pills): the one currently available is DOC (drug code: 044113013). For more information on PrEP, visit www.prepinfo.it.
WE USE THE TasP
People with HIV who consistently follow an effective therapy and who have “undetectable viral load” (i.e. complete undetectable or less than 200 copies) they do not transmit the virus. It is the principle of TasP (in English ’Treatment as Prevention“, in Italian Therapy as Prevention). This has been said since 2008 and several studies have now been carried out to confirm this. The Atlanta CDC also recently came out with this position. Viral load (or “viremia”) is the amount of HIV virus that a person with HIV has in their blood.. Every 4 or 6 months, a person with HIV typically undergoes checks not only to ensure that their immune system is improving or stable, but also to “count” this amount of virus, which is measured in “copies.”. “Undetectable” (in English “undetectable“) It means that there is so little virus in the blood that the tools used to quantify it cannot even count the copies., but the strategy is effective even when they can be counted but are less than 200. Usually, those who take the therapy correctly are stably “undetectable” after a few months from the start of the therapy or may have slight fluctuations in detectability below 200 copies. Those who have a partner with HIV who is taking therapy correctly and is therefore "undetectable" can use TasP as a complementary or alternative strategy to the condom, knowing obviously that even in this case there is no protection compared to other STIs if you don't use a condom.
I NOT I AM AFRAID
Today there are many tools to manage risk and prevent HIV: condoms and lubricants, PrEP, TasP, PEP. Reacting with irrational fears, avoidance, and denial when meeting someone who tells us they have HIV, or who we know has HIV, it hurts The collective effort we all make towards prevention is detrimental to the person with HIV, and we may even have missed the opportunity to find the right person. For sex or for life. Furthermore, creates a climate where a person with HIV feels they have to hide their HIV status with the people they meet. If for any reason a person with HIV is not on treatment and therefore has a detectable viral load or higher than 200 copies/mL, you can use a condom and lubricant, and in the unfortunate event that it breaks during anal sex, you can ask for PEP for the person who does not have HIV. If, however, they are on treatment with an undetectable viral load, they are not transmitting the virus, and you can make your own decisions about how much and how to protect yourself with a condom, for HIV or other STIs. In any case, have a rational, open and informed attitude on the HIV topic It will also reassure the person with HIV who may not initially tell you, but then, faced with your attitude, may decide to tell you. The only thing none of us need is to live in fear!
I ASK FOR THE PEP
PEP (Post-Exposure Prophylaxis) it's a therapy that a person who believes they have just run a high risk can ask the health facilities. It is based on the administration of the same drugs that are normally taken by people with HIV. Immediately after the risk, you must start taking PEP and continue for a month: Since the drug works to the extent that it interferes with the replication of the virus that has just entered the blood (if it has entered), it is important that you start right away, within 4 hours for maximum effectiveness, and in any case better if not beyond 48 hours. The sooner you go, the better. If your condom breaks during anal sex, for example, You can request PEP in services that normally treat people living with HIV (infectious disease departments, HIV screening services that also provide "care"), or in the emergency room. If the potentially infectious event occurs at night, the emergency room is likely the only option left. PEP is recommended for high risk in the following conditions: internal ejaculation (anal, oral – blowjob – or vaginal) by an HIV-positive partner not on therapy and with a detectable viral load or whose serological status is unknown, but with a history or pathology that suggests a recent risk; insertive anal or vaginal intercourse (to have put it) or receptive (averlo preso) non protetto (anche ad esempio perché si è rotto il condom), con partner HIVpositivo non in terapia. Considera comunque che è una terapia completa a tutti gli effetti con tutti i suoi possibili effetti collaterali a breve termine: non è la pillola del giorno dopo.
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NOI STIAMO INSIEME E FACCIAMO SEMPRE IL TEST
Fare il test HIV regolarmente è un’abitudine che conviene sempre mantenere anche quando si è in coppia, soprattutto se si è deciso di smettere di usare il preservativo nella coppia. Se all’inizio entrambi non avete l’HIV e usate dei mezzi di prevenzione (condom e lub o PrEP), potete fare il test per decidere se e da quale momento smettere di usarli in base agli accordi che riterrete sul modello di coppia che vi è più consono, chiusa o aperta, classica o poliamorosa, ecc… L’arcobaleno degli amori nella nostra comunità è molto vario, ma qualunque sia la vostra preferenza di modello di coppia, continuate a mantenere l’abitudine di fare il test HIV almeno una volta all’anno! Allo stesso modo, se siete una coppia siero-discordante (uno ha l’HIV e l’altro no) e usate la TasP, il test per la persona senza HIV è ancora più opportuno per monitorare la situazione ed essere sicuri che tutto stia andando bene: in quel caso, ovviamente, i controlli sulla viremia del partner con HIV sono la parte più importante e potreste anche valutare se farli più frequentemente per rassicurare entrambi (ad esempio ogni 4 mesi anziché, come da prassi sempre più in voga, ogni 6 mesi). In ogni caso, sia che entrambi non abbiate l’HIV, sia che lo abbia solo uno di voi, il test regolare annuale da fare da soli o insieme è una buona abitudine da mantenere come atto d’amore verso voi stessi, come singoli e come coppia!
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IO MI VACCINO E FACCIO I CONTROLLI PER LE IST
Per le IST (Infezioni Sessualmente Trasmissibili) diverse dall’HIV ci sono altre cose che puoi fare, oltre ad usare il condom. Ad esempio puoi vaccinarti per alcune di loro. Puoi vaccinarti gratuitamente (se dichiari di essere gay o di fare sesso con uomini) per epatite A (HAV) e B (HBV). A seconda delle regioni, puoi vaccinarti a prezzi variabili per l’HPV, cioè il papillomavirus responsabile di condilomi e/o cancro: ci sono tanti tipi di HPV e c’è un vaccino nonavalente (efficace su 9 tipi) che protegge dalla maggior parte dei tipi responsabili di condilomi o cancro. Considera che l’HPV circola molto facilmente e quindi il vaccino, per una maggiore efficacia, è consigliato soprattutto ai più giovani che con maggiore probabilità non l’hanno ancora contratto. Tuttavia, potresti comunque considerare di farlo anche nel caso ipotetico in cui tu avessi già contratto l’HPV negli anni: magari hai contratto alcuni tipi, ma non ne hai contratto altri da cui saresti invece protetto col vaccino. E poi ci sono i controlli periodici che puoi fare per le altre IST. Per l’Epatite C (HCV) puoi fare il test sopratutto se hai rapporti anali non protetti da condom o fai pratiche un po’ più hard (fisting ad esempio). Oggi c’è una cura definitiva che eradica il virus, anche se molto costosa per lo Stato e quindi l’accesso non è immediato. Anche per la sifilide puoi fare il test ed è opportuno perché si può trasmettere anche con i rapporti orali non protetti (sia quando fai un “pompino”, sia quando lo ricevi). Lo stesso per gonorrea e clamidia, i cui controlli cambiano in base alla possibile localizzazione dei batteri: si fa il test delle urine nel caso in cui i batteri fossero nel tratto urinario, o il tampone nei caso in cui fossero in gola o nell’ano.
There prevenzione combinata e il programma Sexperts di Arcigay
There prevenzione combinata è un approccio che mette insieme vari strumenti di prevenzione. Parlarne e informarsi prima di tutto. Ma poi anche il preservativo o le strategie di prevenzione farmacologica (PrEP, TasP, PEP). E soprattutto: test HIV!
Sexperts è un programma di Arcigay per la formazione e costruzione sul territorio di gruppi di peer-educators specializzati in ambito prevenzione e lotta all’HIV.
Grazie a:
- i volontari e attivisti di Arcigay Roma e di Arcigay Vicenza per la disponibilità;
- Martina Pullin per lo shooting fotografico professionale.