The reality of chemsex is that it is linked to higher chances of sexually transmitted infections (STIs). This is because for many people chemsex involves sex with multiple different partners, sometimes in a very short period of time, and having lots of sex will increase risk of catching an STI. Also, one of the highs that chems such as Tina or G can bring 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:
1 - 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
2 - IF YOU ARE LIVING WITH HIV AND YOU ARE HAVING LOTS OF SEX
3 - IF YOU ARE HAVING CONDOMLESS SEX REGARDLESS OF HIV STATUS
- Bacterial STI protection (DoxyPEP)
- Regular Testing
- Vaccinations
4 - 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 often hear the term “safe sex” – and while we often understand that to mean sex with condoms, there are other ways we can ensure safety during sex. These are some of the methods we can use to protect ourselves from STIs and HIV.
PrEP (Pre-Exposure Prophylaxis)
PrEP is a pill you can take every day, or before and after sex, to prevent HIV infection. It is free from a sexual health clinic in the UK regardless of your immigration status, so please check how things are in the country where you live if this is not the United Kingdom. If it is, you will need to take a full sexual health screen and have a kidney function blood test when you start PrEP.
One important thing to remember; PrEP protects against HIV, but not against bacterial STIs such as chlamydia, gonorrhoea, syphilis and other BBVs such as Hep C.
PrEP taken correctly is the most reliable way to prevent HIV for someone who is HIV negative, as we know condoms might be less likely to be used during chemsex sessions, or might be prone to breaking after particularly long sessions.
If you do use condoms, it’s best to change them between partners and after no more than 30 minutes of continuous sex. Also not to utilise oil-based products and lubricants with condoms, as these can degrade their quality.
While PrEP is extremely effective at preventing HIV, it is only protection for the person taking it. It is important not to rely on partners taking PrEP, as they may not be taking it correctly, they may have had a risk not covered by PrEP, or they may not be telling the truth. Fortunately PrEP is widely available and it is easy to start PrEP by visiting a sexual health clinic.
HOW DO YOU TAKE PrEP?
For people who are having anal sex either as the top (insertive) or bottom (receptive) partner, as well as those having insertive vaginal/frontal sex, there are 2 options – daily dosing or event based/2-1-1 dosing.
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, 2 hours 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.
Daily PrEP is the best method for people who have a lot of sex, people who are unable to predict when they might have sex and also those who are a bit forgetful when it comes to taking medications, as it is possible to miss or take late doses and still have enough PrEP to be protected.
Some people have sex/chemsex less often, and might prefer ‘event based’ or 2-1-1 dosing. This requires a similar approach to quickstart above. You take 2 tablets, 2 hours before sex (can be anytime 2 – 24 hours before sex) and then take another 24 hours later, another 24 hours later. If the sex lasts all weekend, same as above, you just ensure you have taken 2 daily doses after the last exposure. So 2 on the first day, 1 on the second and 1 on the third, hence the name 2-1-1.
Ideally you don’t want to be more than 2 hour late for your event-based doses, or you may need to consider PEP (see later on this page).
This method is best for those who are good at remembering to time their doses, those who can predict when they will have sex; for instance, those who plan sauna/sex club visits etc.
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, ideally with no more than 48 hour gaps, so there is some room for error/forgetting a dose.
For people having receptive vaginal/frontal sex, then you can either do daily dosing in the same way as above, but instead of 2-1-1, you have to do an option call 2-7 dosing. This involves taking 2 tablets 2 – 24 hours before sex, then taking 1 PrEP for the next 7 days at the same time each day.
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 or you may have taken PrEP incorrectly, then within 72 hours of exposure (within 24 hours is best) you need to commence PEP (Post-Exposure Prophylaxis)
HOW DO YOU TAKE PEP?
PEP is a 28 day course of medication that can reduce the chances of contracting HIV after a possible exposure. In the UK, this can be accessed for free from any sexual health clinic, or if out-of-hours, any Accident & Emergency (A&E) department.
People having chemsex are much more likely to acquire HIV, so it is important to consider PEP for any sex which is not protected by PrEP or condoms. This is particularly important if you don’t know the partners, or meet them at a chemsex session and can’t follow up with them.
PEP is most effective if started within 24 hours, so although it can be accessed up to 72 hours, it is best not to wait as it is over 80% effective if started quickly and taken properly.
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. There is really excellent evidence now to show that people living with HIV who are consistent with their medication are not at risk of transmitting HIV. After starting HIV medications, most people reach an undetectable viral load (or undetectable) for short within 3-6 months of starting treatment. There is a huge amount of evidence for undetectable = untransmissible which can be found at the end of this page.
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, free from complications or infections related to their HIV.
If you are living with HIV, the most important thing you can do is to continue taking your medication during chemsex sessions, to protect yourself and everyone around you.
3. IF YOU ARE HAVING COMDONLESS SEX REGARDLESS OF HIV STATUS
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 people 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.
▸ BACTERIAL STI PROTECTION (DoxyPEP)
There is some emerging evidence that taking an antibiotic named doxycycline, which is given to treat the STIs chlamydia and syphilis, can reduce your chances of getting a bacterial STI. This involves taking x2 100mg pills of doxycycline within 72 hours of unprotected sex.
Studies have also shown that DoxyPEP reduces the chance of getting chlamydia and syphilis by around three-quarters and the risk of gonorrhoea by around half. However, it does not protect against any infections caused by viruses such as HIV, Hepatitis A/B/C, herpes or warts.
More information around DoxyPEP can be found at the end of the page.
▸REGULAR TESTING
For many, chemsex involves such with multiple partners, for long period of time, and often without condoms. This means it’s important to test regularly as the chances of acquiring STIs increases.
There are many options for testing – kits to do at home, instant tests for infections such as HIV, and visiting a sexual health clinic.
We recommend doing a test every 3 months. 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 we should normalise taking contact details of partners so we can inform people about the need to test for infections if someone tests positive; it’s less about blame and more about staying protected as a community.
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 is also best if you have no symptoms; if you do, it may be better to book an appointment at a sexual health clinic instead so you can be properly diagnosed and treated for those symptoms.
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) as the sex we have increases our 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.
▸VACCINATIONS
Vaccinations commonly offered in a sexual health clinic are Hepatitis B (Hep B), HPV and MPOX. These are all free of charge in the UK..
Hep B vaccination can be offered to any gay, bisexual or man who has sex with men, trans and non-binary people and anyone having anal sex, anyone using sex-on-premises venues or going to community kink/fetish events. This is usually a course of 3 vaccinations plus a booster 1 year later and it usually gives lifelong immunity to Hepatitis B.
HPV is a large group of viruses which cause genital warts. Some strains of HPV are linked to cancers. The HPV vaccine can be given in a sexual health clinic to any gay, bisexual or man who has sex with men, or trans and non-binary people under the age of 46 years old. Recently, this can also be offered to women under the age of 25 also.
In the past few years, we have seen cases of MPOX (formerly known as Monkeypox) which have been transmitted through skin-to-skin contact, including sex. Most cases have been in gay, bisexual and men who have sex with men, as well as some in trans people. Fortunately, cases remain low in the UK, but it is possible to get vaccinated for MPOX. This is the smallpox vaccine, which provides some protection against MPOX, and all gay, bisexual and men who have sex with men as well as trans and non-binary people are eligible for the vaccine.
For further reading about Hep B, HPV and MPOX, there are links 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!
It’s best to have your own supply of medications rather than to take someone else’s. If you have any concerns that you might have missed taking your HIV meds, PrEP or other sexual health related medication, it’s best to contact a sexual health clinic for advice.
Further reading:
If you would like more information about PrEP, click here NHS PrEP
For vaginal or frontal sex click here PrEP guidelines for Frontal sex
Examples of 2-1-1 and 2-7 dosing
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
Home testing:
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 & vaccination:
In person testing & vaccination:
Find an NHS Sexual Health Clinic
Hep B vaccination
HPV vaccination
MPOX information and vaccination
* 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.
