The sexual landscape is changing. While there is still no cure for HIV, modern technologies are available that reduce and stop the transmission of the virus. These technologies will impact on how we navigate our sexual encounters.
First there was PEP (Post-Exposure Prophylaxis), which is a short-term anti-retroviral treatment that reduces the likelihood of HIV infection after a potential exposure to the virus. PEP should be started as soon as possible and definitely within 72 hours of the exposure.
Now there is PrEP (Pre-Exposure Prophylaxis), which will soon be more readily available in Perth via a trial. The PrEPIT-WA trial uses a generic version of the medication "Truvada", which has been shown to be extremely effective, when taken daily, to prevent contracting the virus. To be eligible for the trial, certain criteria must be met, therefore, some people will not be able to access the medication unless they order it online fom overseas.
On top of this, scientific research has now demonstrated that a person whose viral levels are undetectable is unable to transmit the virus to another person through sexual activity. This is the basis for the U=U campaign or Undetectable = Untransmissible. Undetectable status can be reached by being on the appropriate treatment for a period of time and being tested for viral load levels.
The importance of PrEP and U=U cannot be underestimated, particularly for men who are HIV positive. In the past, sexual activity was often complicated by anxiety as to whether to disclose one’s status or not, and the fear about transmitting the virus to other people. However now, men who are HIV positive with an undetectable viral load can have confidence they will not infect another person with HIV through sex. PrEP can be taken as a precaution when having sex with someone who's HIV status is positive (with a detectable viral load) or unknown.
While advances in technology comes with many benefits, there are also potential downsides as well. With more men taking up PrEP and the message of the U=U campaign, there is more incentive to “bareback” or not use condoms. The danger is that we are still at risk of picking up other sexually transmitted infections (STI’s). As much as we don’t want to think about it, some STI’s are increasingly becoming resistant to antibiotics that once treated them, some are painful with nasty symptoms, and all can mess with your sex life, at least for a while.
Sex is and should be a pleasurable activity. We should be able to totally engage in sex without fear, guilt or anxiety. PrEP and U=U play a large role in redeeming sex from the arena of guilt and anxiety back to a place of joy and pleasure. However, as positive as this is, we still need to take precautions, to do what we can to avoid STI's, and to get tested regularly, otherwise STI's may get in the way of enjoying our best sex life.