Hey, should we talk about PrEP?

15.06.2017, by Sami Tuunainen

Could PrEP be a new and important method of HIV prevention for the majority of gay men? Or, is it just for those men who take big risks and simply refuse to use a condom?

After reading a blog written by a man working at 56 Dean Street, an gay-focused clinic in London, about attitudes people have towards PrEP, I began to wonder myself: do PrEP users face the same stigma as people living with HIV? Is using PrEP a sign of responsibility or irresponsibility?

Working with gay men’s sexual health I meet a lot of different men with different opinions about condom use, sexual habits, numbers of sex partners, PrEP etc. In Finland, the knowledge about PrEP and people’s interest has only started to build since last year. We get a lot of questions about PrEP and many gay men are thinking of it possibly decreasing their risk of getting HIV.

So what does it mean to be on PrEP? Does it change a person? Do its users take bigger risks in sex and only have unprotected sex? Aren’t they worried about other STIs? Have you thought about what other people would think about you if you were on PrEP? Would you tell everyone about it or only your closest friends and maybe your steady sex partners?

Many men are wondering what other people would think if they started PrEP. They could face the same kind of stigma as people living with HIV. That’s fairly understandable because even though we know more and more about PrEP, it’s still not largely seen or discussed in different contexts or in the media. There are a lot of fears and uncertainty about PrEP. Still, it’s a long awaited addition to HIV prevention tools beside condoms, HIV testing and HIV treatment.

Even though PrEP is not currently easily accessible in Finland, I’ve had the pleasure of getting to know a few gay men who are on PrEP. They’ve told me that people are often very unaware of PrEP. People think that a person on PrEP is HIV positive or they think at least that the person is only having unprotected sex, subconsciously wants to get HIV, or is very selfish and spreads around other STIs. My acquaintances have also faced negative opinions and attitudes concerning multiple sexual partners.

Thinking about the matter and discussing it in different contexts I’ve come to the conclusion that unprotected sex or condom use aren’t simple and straightforward things for men using PrEP, just as they’re not for other HIV negative, HIV positive men, or for those who don’t know their HIV status. Sexual relationships and sex situations are always different. Despite PrEP or HIV status everyone takes different kinds of risks in their life and this also applies to sex and sexual relationships. Everyone has some kind of safe sex strategy even though they might not use condoms every time. Many men who are on PrEP still use condoms in anal sex and PrEP is a good additional protection against HIV.

If used correctly, PrEP prevents new HIV transmissions but doesn’t protect you from other STIs. In this situation we should consider if other STIs are a good enough reason to use condoms. In what kind of sex situations do we consider the risk of other STIs being so big that we use condoms and in what situations we don’t.

In any case, the testing of other STIs (chlamydia, gonorrhea, syphilis and hepatitis C) has a large and important role when PrEP comes available in Finland. STI cases are on the rise among gay and bisexual men even though condoms are quite often used in anal sex. Oral sex has a risk of other STIs and generally condoms are not used in oral sex. Perhaps the reason for this is that oral sex has a very small risk of HIV and people find it more enjoyable without condom.

Hivpoint’s Checkpoint services will start piloting a larger STI testing service for gay and bisexual men during the spring of 2017. Also the preventive work among gay and bisexual men called Miesten kesken takes active part in PrEP discussions and supports the process of getting PrEP safely available in Finland.

Let’s talk about PrEP!

Sami Tuunainen
Sexual Advisor, Coordinator of Checkpoint testing services

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