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Sexual health poll #2 - answers
mini me + poo
lovingboth
Answers to polls here (public, livejournal_uk community) and here (friends-locked).


Q1. An equivalent of the "morning after pill" for HIV?!?

Would I lie to you? :) Yep, there's a 'morning after' treatment which will reduce your chances of being infected with HIV. It's commonly called PEP - Post-Exposure Prophylaxis, or PEPSE - PEP following Sexual Exposure (as opposed to occupational exposure, like medical staff having a needle-stick injury).

The good news is that it looks like it substantially reduces your chances of being infected. Once it's entered you, HIV takes up to two or three days to enter your immune system, where it reproduces, and if it can be disrupted in that period, your immune system won't become infected = it'll just die off.

Unfortunately, there's quite a long list of bad news.

Like the morning after pill, the sooner you start this, the better. With needle-stick injuries, that's typically within a couple of hours, and even then it doesn't always work. For sexual exposure, it is more usually nearer 24 hours. After 72 hours, it's probably too late.

Unlike the 'morning after pill', which is usually now a single pill, PEP is a month-long course of anti-HIV drugs, often ninety or more tablets. You need to complete the course (if you don't, and are infected, you could end up having drug-resistant HIV, so less treatment options in future). There may well be severe side-effects: when giving PEP for sexual exposure was first suggested, some thought that people would stop using condoms and just take PEP repeatedly, but in fact after taking PEP once, people tend to have more consistent condom use - they don't want to take PEP again.

Various things also mean you may not be offered the treatment. If your partner is known to be HIV+, then it's 'recommended' for unprotected vaginal or anal sex, and 'considered' for fellatio if he's come in your mouth. Is the low risk of infection in some of those cases worth the downsides of taking PEP? It'll be up to you.

If your partner is not known to be HIV+, then it will depend on their risk factors for having HIV. If they're not a man who has sex with other men, from sub-Saharan Africa or an injecting drug user, it probably won't be offered to you - the guidelines say it should be 'considered' only in the case where you've been the 'bottom' for anal sex.

If they are in those groups, then it's 'recommended' for receptive anal sex and 'considered' for other intercourse and fellatio with ejaculation.

The other use is following rape: the physical damage that often accompanies rape will increase the chances of HIV infection, should the rapist be HIV+.

The guidelines were officially published, following a long consultation procedure, earlier this year: http://www.bashh.org/guidelines/2006/pepse_0206.pdf Unfortunately, the authors and editors missed a couple of mistakes in one of the tables, so this may be updated and have its name changed.

There's more on PEP at www.chapsonline.org.uk/pep - but note that it's a site aimed at gay men and they ignore vaginal intercourse to the extent of editing out the guidelines covering it, despite the fact that substantial numbers of gay-identified men have sex with women.

So the short version is - the risk of infection following what you've done must be significant, or you won't be offered it; you'll need to show up at a sexual health clinic or A&E as soon as possible afterwards; and the side-effects can be nasty.

Q2. I'd expect anyone who is HIV+ to tell me before we had sex...

OK, there is an ambiguity in the question - does it mean "I think they should disclose" or does it mean "I think they would disclose"?

An even more ambiguous version has been repeatedly asked somewhere else (it allows for the meaning of "I expect at least one person to tell me at some point"), but I think it's clear that most have taken it to mean 'should' disclose.

As I expected, it looks like most (over 90% at time of writing this) of the general LJ population who've answered this think that people with HIV 'should' tell, even before safe sex. But...

Q3. If someone did disclose

... many of you would run away screaming. For the public poll, over 40% do not want to knowingly have any form of sex with someone who's HIV+ and all the rest would be "be extra careful".

Bearing in mind that this is after having posted about the actual risks for various activities, I suggest this is a crap strategy for avoiding infection for at least three reasons:

a) This is why many people with HIV do not disclose at least at first. You may want them to, but if your reaction is going to be running away screaming, what reason do they have for feeling safe to do so?

I'm HIV-, as far as I know, but I know that disclosure is a really difficult issue. The context of some sex doesn't include much talking, full stop, never mind discussions about assorted infections. You can never 'untell' someone. Plus what is the person told going to do with the information - tell everyone?

Particularly where the risk is tiny to nil (e.g. when using condoms or for oral sex), or it's casual sex, or if you're willing to fuck without condoms without talking about HIV (why would you do that, if you're not HIV+ too??) then disclosure is even less likely.

For more of the issues around disclosure, have a read of this report, A telling dilemma: HIV disclosure among male (homo)sexual partners. (Again, it's talking about men having sex with men, and is out of date regarding the legal situation.)

Interestingly, it looks like the more a person thinks someone 'should' disclose, the less likely anyone is to disclose to them.

b) Around 60% of you are not having sex that's as safe as you'd really like it to be. If you were, why the need to change things, simply because someone does disclose?

c) Many people with HIV do not know it. For some, this will be because they've just been infected themselves and are at their most infectious. For others, it will be because they've never tested, or have become infected since their last test.

Q4. How many people in the UK have HIV?

About 70,000. It's increasing because fewer people are dying - anti-HIV drugs may not always be pleasant to take, but they're working - and more people are infected.

Q5. How many don't know?

About a third, 33%.

How do we know? Because some blood is tested anonymously and the results from this are compared to the results from non-anonymous testing (i.e. when you've asked for an HIV test).

At one time, some people reckoned that having an HIV test was at best pointless, as there were no treatments. But that's no longer the case: at the moment, when someone dies because of HIV/Aids, it's usually because they weren't diagnosed soon enough.

Q6. Of HIV infections that happen in the UK, how many are the result of sex between men?

It's about 75%.

You'll probably have heard headlines about 'now more heterosexual people with HIV than homosexual men in the UK', but that's ignoring the question of where they were infected. For most of the 'heterosexual' cases, it was abroad. And that's not, as some papers love to suggest, mostly 18-30s on holiday by the Med, but people who've lived in sub-Saharan Africa, were infected there, and later came here.

If you've any questions, I'm screening comments for this post (i.e. only you and I will be able to see your comment), unless you say you're ok about making them public.

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