Sexual Health Tips

Getting tested is super important and a great way to stay informed and know what the best harm reduction strategy is for you.

If you are partying and not using condoms, your risk of contracting STIs is quite high as sessions tend to be longer and involve multiple partners. With HIV it's a little different as there are other ways to prevent transmission than condoms - the following sections will go into prevention. If you are living with HIV, you are still at risk of other STIs - so regular screenings are essential.

Not every STI has symptoms and having one increases the risk of getting others.

Ensure you have a comprehensive sexual health check at least every six months (every three ideally) with swabs and a blood test. If any come back positive - get connected to treatment immediately. Burnett Foundation Aotearoa can help with this and provide support. You can also test at a sexual health clinic or book in to see your GP.

Make sure you are getting the following tests whenever you have a sexual health screen:

• Urine sample plus throat and rectal swabs for chlamydia, gonorrhoea
• Blood tests for HIV, syphilis, hepatitis C (especially important if you have been injecting drugs)
• It's also a good idea check you have up-to-date hepatitis A & B vaccinations as well as HPV

If you aren’t on PrEP and didn’t use another form of HIV prevention (such as condoms, or are unsure if your partner has an undetectable viral load), there’s another way to reduce your risk of contracting HIV. PEP (post-exposure prophylaxis) means taking medicine to prevent HIV infection after a possible exposure. It needs to be taken within 72 hours of possible exposure, the sooner the better.

Head to your GP, your local after-hours clinic, or the emergency department at your local hospital as soon as you can – as the longer you leave it, the less chance it will be effective.

Your GP or the clinical staff at the after-hours or the emergency department may need to ask you some pretty personal questions to assess your likelihood of exposure – this may feel a little awkward, but they’re just trying to make sure you get the care you need. So, it’s important to be honest.

If you go to after-hours or the emergency department, the first people you encounter may not have heard of PEP but make sure you insist that you have potentially been exposed to HIV transmission and would like to see someone who knows about PEP so you can start within 72 hours of your exposure. Most A&E/Emergency departments should have a supply of PEP but may need a little time to get prescription approvals.

Some pharmacies may also stock PEP. This site includes a list of all pharmacies that may stock PEP, however it's best to call in advance to ensure they actually have stock when you need it

Initiating PEP should be completely free for those eligible for publicly funded healthcare in New Zealand who meet one or more of the following PHARMAC criteria:

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• You have had condomless anal intercourse or receptive vaginal sex with someone living with HIV with an unknown or detectable viral load.
  
• You have had condomless anal intercourse with someone from a high HIV prevalence country or high HIV risk group with an unknown HIV status.
• You have shared intravenous injecting equipment with someone living with HIV
• You have had non-consensual intercourse and your doctor thinks PEP would be suitable

A lot of chemsex sessions are condomless, but remember it’s your right to have condoms in the picture if you want them. Consent always involves a conversation, so if you want to use a condom, you’ll probably need to start a conversation. If your sexual partners are not into using condoms, that’s their choice and either of you can exercise your freedom to respectfully decline the encounter if you can’t agree on a prevention method that works for you both.

If you are HIV-negative, using PrEP (Pre-Exposure Prophylaxis) will significantly reduce the risk of acquiring HIV (up to 99%). If you are partying, and you can access public healthcare in New Zealand, you already meet the criteria to receive publicly funded PrEP and can get a prescription at your local sexual health centre or GP. It costs nothing to fill a prescription that lasts for 3 months, so it’s a really affordable and incredibly effective HIV prevention method. You can find out where to get a prescription near you, here.

HIV can also be transmitted through sharing injecting equipment. Though PrEP is very effective at preventing HIV transmission through sex, it is slightly less effective for preventing transmission through injecting drug use – reducing the risk by approximately 74%. If you are injecting, remember to use sterile equipment and never re-use or share – check out the Needle Exchange for safe ways to access sterile gear and dispose of used needles, as well as resources about safer injecting practice.

If you are living with HIV, the best thing you can do for your own health and to protect your sexual partners is to take your HIV medicine as prescribed. If you have a sustained undetectable viral load (the vast majority of people living with HIV who have access to medicine will have a sustained undetectable viral load), then HIV cannot be transmitted sexually. This is especially important in chemsex environments where condomless sex is very common and often involves multiple partners. Keep in mind that you could still be at risk of other STIs and there is still a risk of HIV transmission if needles are being shared.

If you're HIV-negative, you still need to know about the wonderful news that Undetectable = Untransmittable. Research shows that there are a decent amount of guys living with HIV who have chemsex, so it's likely you'll encounter people in the scene talking about Undetectable = Untransmittable (U=U) as way of preventing HIV transmission. U=U means there is no risk of sexual transmission if a guy living with HIV has a viral load that can't be detected by standard HIV tests.

DoxyPEP (doxycycline post-exposure prophylaxis) is a new tool to prevent syphilis and chlamydia (though importantly, not gonorrhoea).

It involves taking 2 pills (or 200mg) of doxycycline within 72 hours after sexual activity, and has shown to reduce the chances of acquiring syphilis by 70-80% and chlamydia by 70-90%.

If you’ve had STIs in the past twelve months or have a time coming up where you have a higher chance of acquiring an STI (for example a gay cruise or a pride festival) then DoxyPEP could be suitable for you.

We encourage you to speak with your healthcare provider to discuss if DoxyPEP could be right for you. As it is relatively new, many won't know what it is, so Burnett Foundation have a letter you can take with you to guide them to the best evidence to support discussing DoxyPEP with you.

Currently, DoxyPEP is only proven to be effective for cisgender men who have sex with men (MSM) and transgender and non-binary people assigned male at birth who are having sex with MSM. It is relatively new, and research is still emerging about the risks and benefits.

Because doxycycline is an antibiotic, the use of DoxyPEP might contribute to making some bacteria resistant to doxycycline. Most gonorrhoea in Aotearoa is already resistant to doxycycline, and this is why DoxyPEP is not likely to prevent gonorrhoea. Other bacteria in your body may also have a higher chance of becoming resistant to doxycycline. Your prescriber will discuss this potential risk with you.