When we think of STI and HIV prevention, our minds immediately go to condoms. That’s great. Condoms are easy-to-use, accessible, and an effective way to reduce your risk of STI’s and HIV! It’s important to have condoms and know how to use them to stay safe during sex. But did you know there are other ways to prevent STI’s and HIV as well? They vary in accessibility, ease of use, and efficacy. Knowing about as many risk reduction methods as possible allows you to protect yourself and to educate others.
PrEP (pre-exposure prophylaxis) is a daily pill that greatly reduces your likelihood of getting HIV during sex, as well as through sharing needles during intravenous drug use. About a year ago, it also became available in the US in the form of a bimonthly injection administered by a doctor. When taken as directed, PrEP is more than 99 percent effective in preventing HIV transmission during sex.
There are a few disadvantages to PrEP, however. First, it doesn’t prevent other STI’s. It only works for HIV, so using condoms is still strongly recommended to prevent infections like chlamydia, syphilis, and gonorrhea. It’s also only available by prescription, which requires access to a doctor or other prescriber. You also have to get regular HIV tests to continue your PrEP regimen, because if you do get HIV, continuing PrEP can make HIV treatment more complicated. Overall, however, it’s a safe medication that does a great job in preventing HIV.
One concern that’s often cited about PrEP is that it increases risky sexual behavior that can lead to other STI’s. While the research on this is mixed, prescribers of PrEP largely feel that the protective benefits of PrEP outweigh the potential increase in risky behavior.
On a similar note, HIV positive individuals can prevent transmission of HIV by taking their medications correctly and consistently. For most people, this will make your viral load low enough that transmission is very unlikely. This is commonly known as “treatment as prevention,” or “Undetectable = Untransmittable.” Again, this method only prevents HIV, not other STI’s, so condom use is still recommended for the best protection.
Another option is to engage in lower-risk sex. Anal, vaginal, and oral sex are higher risk sexual activities when it comes to STI transmission, but they are not the only kinds of sex! Manual stimulation (for example, hand jobs and fingering) are lower risk, as is using sex toys like dildos and vibrators. Masturbating together and dirty talk are two activities that carry no risk of STI transmission.
Recommending withdrawal (pulling out) can be controversial, because it is a much less effective way to prevent STI transmission, but if no other options are available to you, and you are still planning to have sex, it does reduce your risk of infection. It’s not the best option, but this is about risk reduction, not elimination. If you are having condomless sex, it’s better than nothing.
Abstinence is an unpopular option, but I’d be remiss not to mention it. Not having sex is 100 percent effective in STI prevention, and it is right for some people. If you choose to remain abstinent, this is a totally valid choice, and no one should shame you for it.
Getting tested is an important part of being a sexually active person. Getting regular STI/HIV testing can bring you peace of mind, and if it does turn out you have an STI or HIV, can get you the treatment you need as quickly as possible. This way, you can stay healthy and avoid transmitting an STI or HIV to others.
Since we are on the topic of sexual risk reduction, it’s worth mentioning pregnancy prevention as well. Often overlooked when it comes to LGBTQ+ folks, it is applicable to many. For example, a cis woman in a relationship with a trans woman might choose to use birth control. Many bisexual folks also use it. If you are a person at risk of pregnancy and do not want to become pregnant, talk to a healthcare provider or sexual health educator to find out what options are available and decide which method you’d like to use.
Rather than being a drag on spontaneity, appropriate care makes sex more enjoyable! Knowing you’re being safe can reduce your inhibitions and allow you to enjoy sex fully, without worrying as much about risk. Talking honestly with your partner about STI/HIV status, prevention, and safety shows your partner you care about them and want to help them stay healthy.
When it comes down to it, it’s up to you to keep yourself safe and to select the prevention method that works best for you. Some folks use more than one method at the same time, and some try a variety of methods before they land on the one that works for them. Don’t be afraid to try something new if what you’re doing isn’t working for you. That’s part of the magic of sex!