It’s never easy writing about HIV and STD prevention. It’s a highly complex topic that has transitioned from a black and white issue of life and death to a comprehensive discussion of sexual health and holistic understanding of lifestyle.
Unlike news stories from the 1980s, 1990s and even the early 2000s, HIV is no longer a subject dripping with doom and gloom, it’s much more subtle. Stories today are about new drugs, new therapies and hope. They discuss new ways to avoid contracting HIV and how, under the care of a professional health care provider, it can be treated as a lifelong chronic disease. The disease has remained the same, but how we react to it, treat it and perceive it has changed. While this progress is welcome, we cannot forget that HIV and STDs remain dangerous threats to our health that spreads, unnecessarily, through the community.
According to a report from the Centers for Disease Control, San Diego is outpacing the nation with increased rates of sexually transmitted diseases (STD), especially among young people and men who have sex with men (MSM). Gonorrhea rates in San Diego increased 19 percent between 2011 and 2012 with the highest rates reported among men. Of the reported cases last year, 30 percent were men 20-29 years old and 32 percent were in males 30 years old and over.
The rate of primary and secondary syphilis increased locally as well, by 12 percent. Gay, bisexual and other MSM constituted 85 percent of the primary and secondary syphilis cases in San Diego. Even more troubling, 61 percent of MSM syphilis cases also had HIV infection, a 22 percent increase from 2011 to 2012.
Often, these diseases aren’t detected until symptoms become noticeable, which increase the risk of spreading the diseases to a partner. And, left untreated, these STDs can negatively impact a person’s health. For example, syphilis can cause neurologic and cardiovascular problems. Individuals with gonorrhea experience searing pain during urination and some strains of gonorrhea are showing signs of drug resistance, which is not a good sign for those seeking a cure.
To prevent the spread of HIV and STDs, we must approach them like any other disease. Take a hard look at the risk factors that could put you in jeopardy. Who are your partners? Do they know their status? How do you have sex? What can you do to make sex safer? Once you understand the risk factors, you can start implementing prevention strategies, such as:
Wear a condom.
This is the simplest and safest safer sex strategy and should be used in addition to any other risk-reduction strategies, including PrEP and PEP.
Get tested and know your status.
Sometimes, prevention strategies might unknowingly fail. We regularly see patients who did not use a condom during oral sex because they considered it low risk, resulting in an unexpected case of gonorrhea in their throat.
Disclose your status to your partner and ask about theirs.
Keeping your status a secret only puts you at increased risk. If you know your status, and your partner’s status, you can consider all your options.
Consider choosing PrEP.
If you are HIV negative and may have sex with someone who is HIV positive, you can consider Pre-Exposure Prophylaxis, or PrEP, in addition to condoms. PrEP is a once a day pill that when used consistently, according to the Centers for Disease Control (CDC), has been shown to greatly reduce the risk of HIV infection. The key word is “reduce” because PrEP does not eliminate all risk of HIV infection, especially if it is not taken every day as prescribed. It’s a good step in the right direction – so long as you don’t count on it as a pre-party weekend savior.
Ask your provider about PEP.
Post-Exposure Prophylaxis (PEP) might be an option if you have unprotected sex, are not on PrEP and are exposed to HIV. PEP allows someone to take anti-HIV medications after they may have been exposed to HIV to reduce their chances of contracting the disease. However, to be effective, PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in your body. PEP consists of antiretroviral medication and should be taken for 28 days. If you are interested in PrEP or PEP, you should have an honest conversation with your health care provider to determine if they are right for you, and if they are a covered benefit under your insurance plan.
When it comes to HIV and STD prevention, there are no black and white answers, or a cure-all pill, it’s a highly complex topic that is in your hands. Understand your life, understand your risk factors and talk to your provider about your sexual health and what HIV and STD prevention techniques they recommend. After that, it’s up to you. fhcsd.org
