Chemsex many times involves sex with many different partners, sometimes in a very short period of time, and having lots of sex might involve lots of risk. We can’t forget that at the end of the day, one of the things that we get when using chems like Tina is this sense of feeling invincible and that nothing bad can harm us, and unfortunately that is just a sense, because we can be taking risks without even thinking about it.
Fortunately, nowadays there are a number of strategies we can implement to ensure our own safety and the safety of our sexual partners also, and that doesn’t necessarily mean that the sex that you want to have has to put you at any risk.
You will find here:
- IF YOU ARE HIV NEG AND YOU ARE HAVING LOTS OF SEX
- How can you protect yourself BEFORE having sex (PrEP)
- How to take PrEP
- How can you protect yourself AFTER having lots of sex (PEP)
- How to take PEP
- How can you protect yourself BEFORE having sex (PrEP)
- IF YOU ARE LIVING WITH HIV
- IN BOTH CASES
- Testing options (London)
- Free home testing
- In person testing
- Testing options (London)
- MEDICATION (HIV MEDS, PrEP, etc.) AND CHEMSEX
1: IF YOU ARE HIV NEG AND YOU ARE HAVING LOTS OF SEX
▸ HOW CAN YOU PROTECT YOURSELF BEFORE HAVING SEX (PrEP)
We all know that to protect ourselves from STI’s in general the best way is by having always safe sex, but when you are meeting people to have chemsex you may encounter people having sex without condoms, and there are a number of reasons for this. They might be on PrEP, be undetectable, or just don’t like condoms, or just that there are no condoms available after being having sex for such a long time. Unless you discuss first you won’t know, and it is not safe to assume; it’s not enough to rely on others to be using PrEP to keep you safe from HIV transmission.
To control your own protection from HIV the best way is to take PrEP yourself. If your plan is to keep having lots of sex with multiple partners, using PrEP might be a wise decision to protect you regardless of your sex partners status (and reduce post-sex anxiety about risks that have been taken). You will also be safe if you don’t like condoms, or don’t feel able to ask others to wear them.
Just remember, PrEP protects against HIV, but not against STI’s and Hep C.
• HOW DO YOU TAKE PrEP?
With daily and event based dosing, you can ensure you stay negative, whilst having the sex you enjoy. The following guidelines relate to bottoming (anal) and topping only. For vaginal or frontal sex, please see link at the end of the page.
DAILY DOSING is as simple as it sounds. You take 1 tablet daily, and you are protected. You can have as much sex as you like, for as long as you like, and the protection from HIV transmission is the same.
The best way to start daily PrEP is to ‘quickstart it’. You take 2 tablets, 2hrs before sex, and then continue on with daily dosing from there. If you wish to stop taking PrEP, just ensure you have taken 2 daily doses after your last exposure to maximise the protection.
Some people have sex/chemsex less often, and might prefer ‘event based’ dosing. This requires a similar approach to quickstart above. You take 2 tablets, 2hrs before sex (can be anytime 24-2hrs pre sex) and then take another 24hrs later, another 24hrs later. If the sex lasts all weekend, same as above, you just ensure you have taken 2 daily doses after the last exposure.
If EVENT BASED DOSING sounds at all confusing, then perhaps daily dosing is simpler. And the great thing about daily dosing is that research shows we need a minimum of 4 doses in 7 days to be protected, so there is some room for error/forgetting a dose.
PrEP is available for free on the NHS via your local sexual health clinic.
There are links for further reading about PrEP at the end of the page.
▸ HOW CAN YOU PROTECT YOURSELF AFTER HAVING SEX (PEP)
If you think you have been exposed to HIV, and you are not on PrEP, then within 72hrs of exposure (within 24hrs is optimal) you need to commence PEP. PEP is easiest accessed from Accident & Emergency departments and sexual health clinics.
• HOW DO YOU TAKE PEP?
PEP is a 28 day course of medication that aims to stop the process of an HIV infection following an unprotected exposure. Often after having chemsex with a variety of strangers, we don’t have the luxury of being able to ask their HIV status. With that in mind, any unprotected sex with a person whose HIV status you don’t know, and aren’t able to verify with them, should be presumed as an HIV risk.
For further reading about PEP, there is a link at the end of the page.
2. IF YOU ARE LIVING WITH HIV AND YOU ARE HAVING LOTS OF SEX
Being on treatment doesn’t have to impact the amount or kind of sex you have. Starting treatment early after an HIV diagnosis allows your viral load to reach Undetectable levels, and remember undetectable = untransmittable. Most people arrive at Undetectable within 3-6 months of starting treatment. Another benefit of starting treatment early is helping you have a long and healthy life. People who take effective treatment can expect to live a normal life expectancy, free from complications or infections related to their HIV.
For further reading about undetectable = untrasmittable, there is a link at the end of the page.
3. IN BOTH CASES (REGULAR TESTING)
Remember that chems allow us to stay awake and horny for longer than usual, which can lead to a higher number of sex partners. The more guys we are with, the higher the risk of STI’s. Also, sex that lasts for significantly longer can lead to broken skin in our sexual areas, which can increase our risk of STI’s, HIV and Hep C.
It’s essential we make regular testing part of our routine so we can stay informed about our HIV status and treat any STIs early. Some guys are HIV positive, but just don’t know it. Having unprotected sex (no PrEP or condoms) with someone just on the fact they say they are negative is an unnecessary risk if you are HIV negative and would like to stay that way.
3 monthly checks allow you to stay on top of any STIs, be treated early and reduce the number of people you need to inform. We all owe it to each other to reduce STI transmission where possible. And with rapid HIV testing, there has never been a better time to start and keep up regular HIV testing.
For more information about harm reduction and HEP-C, HIV and other STI's, there is a link at the end of the page.
▸ TESTING OPTIONS - London
• Free Home testing
Home testing kits are available online, and allow you to test from the comfort of your own home. Simply return the samples via reply paid post, and you can have your results texted/emailed to you.
Home testing is particularly useful if you feel unable to leave your house and attend a face to face clinic appointment.
Home testing services are usually based upon your location, at the end of the page are some of the options available. Ensure the service you choose offers the tests that you want.
All links for testing at the end of this page.
• In person testing
One great benefit of in person testing is accessing vaccinations like Hep B and HPV. These are both free for men who have sex with men (HPV < 46yrs of age) as MSM are a risk of both.
Another benefit of in person testing is being able to access a health care professional and perhaps talk about other issues that are concerning you e.g. mental health, sexual assault, escalating chems use etc.
An NHS sexual health clinic may be able to connect you to other health professionals to help you feel better/safer/happier.
For further reading about Hep B and HPV, there is a link at the end of the page.
4. MEDICATION AND CHEMSEX (HIV MEDS, PrEP, ETC)
Forgetting daily medications (when we are high) can impact our physical and mental health.
Whether it be our HIV meds, PrEP, meds for anxiety and depression for example, these all need to be taken regularly to be effective.
Some people find it helpful to set labelled alarms to remind what to take and when. Making it as easy as possible to know what to take means less risk associated with forgetting and then dealing with the consequences later.
Oh! and make sure if you travel to someone’s house, take your meds with you!
If you would like more information about PrEP, click here NHS PrEP
For vaginal or frontal sex click here PrEP guidelines for Frontal sex
If you think you have been exposed to HIV in the last 72hrs, click here NHS PEP
undetectable = untransmittable
Harm reduction around Hep C, HIV and other STI’s, click here CCSX Harm reduction
SHL via www.shl.uk/
SH:24 via www.sh24.org.uk
Sh.uk via www.sh.uk
Virgin Care via www.thesexualhealthhub.co.uk/stis/at-home-sti-test-kit/
Free test via www.freetest.me
In person testing:
Via the NHS here www.nhs.uk/service-search/sexual-health/find-a-sexual-health-clinic
Hep B and HPV vaccinations:
* We want to thank DAN HOLLAMS very deeply for helping so much with the preparation of this document. Dan works for the NHS as a Sexual health Advisor and he is also a member of the Controlling Chemsex team as a chemsex specialist advisor.