Does The Use Of Prep Lead To More Stis
Whether PrEP actually leads to further increases in STIs, or is instead being adopted by people who would already be likely to get them, is unclear on an epidemiological basis.
Some randomised and cohort studies of PrEP have found rises in STIs following the initiation of PrEP. Others have found no increase. And in some, high rates of STIs preceded the adoption of PrEP, suggesting the diagnoses may have been motivators for people to start PrEP.
People taking part in PrEP studies have certainly had very high rates of STIs. The proportion of subjects diagnosed with a bacterial STI during follow-up was 43% during the Ipergay study and 57% during the PROUD study in people taking PrEP. In the DISCOVER study, the annual incidence of bacterial STIs was almost 100% this does not mean everyone in the study caught an STI but that the annual number of STI diagnoses nearly equalled the number of participants in the study.
However, only one of these studies, PROUD, was designed to detect whether PrEP influenced sexual risk behaviour, by comparing participants who knew they were taking PrEP with ones who knew they were not. The proportion diagnosed with STIs during follow-up was 57% in participants allocated to start PrEP immediately and 50% in those allocated to start it a year later. This difference was not statistically significant, and there was no significant difference between arms for individual STIs either.
Are Men Living With Hiv At Higher Risk
Rates of sexually transmitted hepatitis C are certainly higher among HIV-positive men who have sex with men than HIV-negative men who have sex with men, although its difficult to prove exactly why.
Fierer reasoned that more men living with HIV end up getting HCV through sex because HIV is much more efficient at transmission through sexwhich means that people at risk for getting HCV through sex are more likely to be those who have already been exposed to HIV.
If an HIV-negative man is at risk for acquiring hepatitis C through sex, that means he also might be at risk for acquiring HIV through sex. Chances are, hes going to become infected with HIV first, which is why these cases of hepatitis C appear as though theyre largely affecting HIV-positive men, he said.
The question is, with PrEP breaking down barriers between HIV-negative and HIV-positive men, will the number of hepatitis C infections among HIV-negative men start to rise?
Thats what Ive been saying, said Fierer. We are going to see more cases of sexually transmitted hepatitis C with increased use of PrEP. I dont have a prospective cohort to prove it, but its biological. The sun rises, the sun sets, and infectious diseases are transmitted.
How Do I Explain This To A Sexual Partner
If you have sexual partners who are not living with HIV, explaining U=U to them is likely to be mutually beneficial. If you had previously relied on other means of preventing HIV transmission , you may jointly decide that these methods are no longer necessary because of U=U.
It may take some time for an HIV-negative partner to accept the U=U message and to rely on it as the sole method of preventing HIV. Some HIV-negative people may reject the message or deny its accuracy. It may be helpful to direct your partner to information resources that explain the accuracy and significance of U=U. NAM has also produced a page for people who dont have HIV to help them understand the impact of an undetectable viral load on HIV transmission.
Another option could be for your partner to hear about U=U from a healthcare worker or another reliable and trusted source.
Despite sharing this information, some people may still not accept that U=U. In this kind of situation, it is important to find a balance between providing your partners with information and taking care of yourself.
Many people find it difficult to talk about sex, even with the person who is closest to them. If this is the case, you might want to discuss your concerns with someone at your HIV clinic, sexual health clinic or a support organisation. This can help you clarify your thoughts and what youd like to say.
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Does U=u Apply To The Non
This page is about HIV transmission during sex.
But an undetectable viral load is also crucial for conception, pregnancy and birth. If you maintain an undetectable viral load during pregnancy, the risk of HIV being passed on to your baby is just 0.1%, or one in a thousand.
During breastfeeding, an undetectable viral load greatly reduces the risk of passing HIV on, although it does not completely eliminate this possibility. In the UK and other countries where clean water and sterilising equipment are available, bottle feeding with formula milk is the safest way to feed your baby.
If you use injection drugs and or other equipment, taking HIV treatment and having an undetectable viral load greatly reduces the risk of passing HIV on, but we dont know by how much.
Does Prep Have Any Side Effects
In some people PrEP can cause minor side effects like nausea, vomiting, fatigue and dizziness, but these usually disappear over time.
In rare cases PrEP can also affect kidney functions.
If youre taking PrEP and experience any side effects that are severe or dont go away, tell your healthcare professional.
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How Would I Pay For Prep
Medicaid will cover the cost of PrEP without co-pays. This includes the medication, medical appointments and lab tests associated with PrEP. Many health insurance plans with prescription drug coverage also cover all costs associated with PrEP without co-pays. For people without access to health insurance with prescription drug coverage, a number of options for financial assistance are available. If you need information about financial assistance options for PrEP, visit the NYSDOH website.
A New Hypothesis Of How Hepatitis C Is Transmitted During Sex
In 2016 and 2017, a team of researchers at the Icahn School of Medicine at Mount Sinai in New York published two research studies challenging the idea that blood needed to be present during sex for hepatitis C transmission to happen. Prior to that point, it was widely believed that only traumatic sex acts like fisting that produced blood put people at risk for hepatitis C.
Their first study showed that about one third of HIV-positive men who have sex with men, with recent HCV infection, have hepatitis C virus in their semen.
About one-third to one-half of men with HCV shed HCV into their semen, Daniel Fierer, MD, the lead investigator of the study explained to BETA. And some men just dont. The message is that if HCV is in someones semen, and the semen gets into a persons rectum, that person may acquire hepatitis C.
In the journal article, Fierer and colleagues explain that because 10 to 20 HCV particles is enough to establish a parenteral infection, an average ejaculate of virus) could plausibly be enough to establish an infection. These seemingly low HCV levels could play a significant role in sexual transmission of HCV when deposited into a rectum whose surface epithelial layer has been disrupted through anal intercourse, they said.
The results of this study explain how men who bottom without a condom might acquire hepatitis C. But what about when men topare they at risk for acquiring hepatitis C if they top without a condom?
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Who Should Consider Taking Pep
If you are HIV-negative and you think you may have been recently exposed to HIV, contact your health care provider immediately or go to an emergency room right away.
You may be prescribed PEP if you are HIV negative or don’t know your HIV status, and in the last 72 hours you
- Think you may have been exposed to HIV during sex,
- Shared needles or drug preparation equipment, OR
- Were sexually assaulted
Your health care provider or emergency room doctor will help to decide whether PEP is right for you.
PEP may also be given to a health care worker after a possible exposure to HIV at work, for example, from a needlestick injury.
How Often Do I Take The Prep Medication
You and your healthcare provider can work together to decide the best way for you to use PrEP.; There are two different ways that people take PrEP:
Daily PrEP: ;Daily PrEP involves people of any gender identity taking 1 pill once a day, every day. With daily PrEP, a person can feel protected from HIV whenever they have sex or inject substances. It is for people who have possible exposure to HIV on a frequent basis, or an unpredictable basis. An important benefit of daily PrEP is that the person is always protected and can establish a daily habit of taking the medication. Daily PrEP with Truvada is the only method proven to be effective for cis-gender women and transgender men who have vaginal intercourse.
It is important to talk with your healthcare provider about whether daily PrEP or on-demand PrEP is right for you.
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Might Frequent Testing And Treatment Reduce Stis
It is clear that high rates of testing and treatment for HIV are starting to produce substantial falls in HIV incidence in some countries and communities, as the proportion of people with HIV who are infectious shrinks. Might the same apply to STIs?
A couple of mathematical models suggest that, if large numbers of the gay and bisexual men and trans people most at risk of both HIV and STIs are enrolled in PrEP programmes, then the frequent STI testing that should result might lead to substantial drops in STI incidence.
A modelling study presented in 2017 found that if PrEP became widespread among gay men in the US, diagnoses of STIs would rise in the first year, but would fall thereafter.
If the testing interval was once every six months, for instance, the annual incidence of all STIs in all gay men would fall from about 5.4% a year after starting a PrEP programme to 4% after three years, and to less than 2% after ten years.
This was based on an assumption that 40% of all sexually active gay men take PrEP, but also that condom use in gay men on PrEP would fall by 40%. Incidence would decrease further if condom use did not fall.
There was no support for the hypothesis that PrEP and reduced condom use would lead to rises in STIs. In this model, even zero condom use under PrEP could not transform the STI rates seen in the general gay population into the rates seen in PrEP seekers.;
Can I Get The Prep Medication From My Regular Healthcare Provider Or Do I Have To Go To A Special Doctor
It depends on your doctor. Any physician, nurse practitioner or physician assistant can prescribe PrEP. It is important to have a healthcare provider who you can work with to individualize PrEP to your needs and circumstances. The New York State Department of Health has prepared a directory of healthcare providers that prescribe PrEP that can be found online.
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Visit Your Doctor Every 3 Months
It is recommended to see your doctor every 3 months for repeat HIV and STI tests and for a new PrEP prescription.
PrEP can have some side effects, so work with your doctor to monitor your general health.
PrEP does not provide protection against other STIs
Condoms and lubricant can provide protection against and reduce the risk of spreading a STI.
It is important to have a sexual health test every 3 months while on PrEP, even if you have no symptoms.
To find out about more about PrEP, how to access it and the costs, visit PrEP Access Now.
Would I Have To Take Prep For The Rest Of My Life What If I Want To Stop
PrEP is not intended to be a life-long program. Rather, it is a program where the healthcare provider works with you to develop an individualized plan with as many renewals of the prescription as you and the healthcare provider agree to. For many people, life circumstances change over time and the risk for HIV may be reduced or eliminated. You should discuss the issue of how long you want to take the PrEP medication with your provider. If for any reason you want to stop taking the PrEP medication, consult with the healthcare provider who prescribed it, or another provider who is familiar with PrEP. Generally speaking, cis-gender men taking on-demand PrEP should continue taking the PrEP medication for at least 2 days after any possible exposure. Anyone taking daily PrEP should continue taking the medication for 28 days after the last possible exposure.
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What We Know About Injecting Silicone
Silicone injections can be done safely by a health care provider, but sometimes people inject silicone with friends or acquaintances at parties. Theres a chance that someone can get or transmit HIV if an HIV-negative person uses needles, syringes, and other injection equipment after someone with HIV has used them. This is because the needle, syringe, or other injection equipment may have blood in them, and blood can carry HIV. Likewise, youre at risk for getting or transmitting hepatitis B and C if you share needles, syringes, or other injection equipment because these infections are also transmitted through blood.
More information:More information:
More information: Hepatitis B and C are viruses that infect the liver. Many people with hepatitis B or C dont know they have it because they dont feel sick. Even if you dont feel sick, you can transmit the virus to others. The only way to know for sure if you have hepatitis B or C is to get tested. Your health care provider will recommend a hepatitis B or C test if you have risk factors for these infections, such as injection drug use. If you dont have a health care provider, click here;to find contact information for your local health department.
If a person with HIV takes their HIV medicine as prescribed and gets and keeps an undetectable viral load , their chance of transmitting HIV through sharing needles, syringes, or other drug injection equipment is reduced.
More information
Explore other resources from CDC:
What Can Be Done To Reduce The Risk Of Transmission During Sex
When people have high levels of HIV in their blood, its easier for them to transmit HIV to their sexual partners. Antiretroviral medications can be used to stop HIV from replicating, or making copies of itself, in the blood.
With these medications, HIV-positive people may be able to achieve and maintain an undetectable viral load. An undetectable viral load occurs when an HIV-positive person has so little of the virus in their blood that it cant be detected by tests.
People with an undetectable viral load have effectively no risk of transmitting HIV to their sexual partners, according to the CDC .
Condom usage, as well as preventive medication for the partner without HIV, can also decrease the risk of transmission.
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Are You At High Risk
PrEP is a medication that is recommended for people who are at a high risk of HIV transmission. Some of the leading causes of HIV transmission include:
- Engaging in unprotected sex with a partner who is HIV positive or whose HIV status is unknown.
- Engaging in unprotected sex with partners who have additional sexual partners.
- Having unprotected sex if you have been diagnosed with an STI.
- Sharing needles or syringes.
The only way HIV can be transmitted to another person is through contact with blood, semen, or vaginal fluids. It is also important to note that uncircumcised males are at a slightly higher risk of contracting HIV since they are more prone to bacteria and infections. There is evidence that male circumcision can also reduce the risk of HIV transmission.
Homosexual and bisexual males are typically at a higher risk of contracting HIV. The transmission rate through anal sex is more than ten times greater than through vaginal intercourse. Receptive anal sex also has a higher transmission rate, meaning that the risk of HIV transmission is higher for bottoms than for tops.
However, this does not mean that tops are not at risk as the insertive partner may also contract HIV through anal intercourse. So, whether you are a top, a bottom, or versatile, you could be at a high risk of HIV transmission, and you should consider taking PrEP.
What We Know About Oral Sex
The chance an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low. However, its hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. The risk is even lower if the HIV-negative partner is taking medicine to prevent HIV . If the partner with HIV is taking HIV medicine as prescribed and keeps an undetectable viral load , they have effectively no risk of transmitting HIV through sex, including oral sex.
But you can get other sexually transmitted diseases from oral sex. And, if you get feces in your mouth during anilingus, you can get hepatitis A and B, parasites like Giardia, and other bacteria like Shigella, Salmonella, Campylobacter, and E. coli.
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Who’s A Good Candidate For Prep
Currently, the majority of people on PrEP are gay men, specifically white gay men, according to Harvard Medical School. But gay men are not the only people who are at risk for HIV. Someone’s actions not their sexual orientation or gender or race are what determine their risk of HIV and AIDs, says Rymland.
“There a huge misconception that HIV is only a disease that afflicts gay men,” says Dr. Pena. This misconception is connected to the fact that when HIV first started afflicting people, it primarily impacted gay men, she explains. In fact, between 1981 and 1982, before AIDs was known by that name, it was called GRID, which stands for Gay-Related Immune Deficiency.
“This pervasive cultural misconception has been a huge disservice to straight men, women, and non-binary people,” says Dr. Pena. And not just that it’s scientifically and statistically inaccurate. Today, in the United States, of the more than 1.1 million people living with HIV, 23 percent are women, according to the CDC. And worldwide, of the 17.8 million people living with HIV, 52 percent are women, according to UN Women.
Does that mean anyone not in a monogamous relationship should be taking PrEP? It’s impossible to make broad-sweeping statements here. Because ultimately, it depends on your current STI status, what level of risk you’re comfortable assuming, and what STI conversations you feel comfortable having. When in doubt, talking to your doctor is always a good idea.