HIV & STI Prevention
It can be hard to find accurate, up-to-date, and culturally sensitive sexual health information for queer and trans folks. At QTHC, we’re trying to make it easier for you.
Before Sex
HIV and STI prevention options that can be used before sex include vaccines, PrEP (Pre-Exposure Prophylaxis), testing and treatment, U=U, making a plan and having a conversation with your partner(s).
Vaccines
A number of sexually transmitted infections (STIs) are preventable by vaccine. Most STIs do not have their own vaccine, but there are vaccines available for Hepatitis A and B, as well as HPV. If you don’t know whether or not you’ve had these vaccinations, as some are administered at a young age, you can reference your health records, health care provider or public health authority.
While HPV vaccinations may be less effective for adults who are already sexually active, increasing evidence suggests potential benefits of vaccination for adults of all ages — especially for trans women and men who have sex with men.
Vaccination appointments can take time to arrange, and some vaccines can require multiple doses, months apart from one another. If you plan to use vaccinations as a part of your prevention strategy, consider planning well in advance. In Alberta, some people can access the Hepatitis A and B and HPV vaccines for free. You can assess that criteria at immunizealberta.ca.
PrEP (Pre-Exposure Prophylaxis)
PrEP (Pre-Exposure Prophylaxis) is an HIV medication used by someone who is HIV negative in advance of possible exposure to HIV to prevent transmission. PrEP acts like a chemical shield which stops HIV from making more copies of itself, ultimately preventing someone from becoming HIV positive even if they were exposed to the virus. PrEP does not provide protection against other STIs.
The medication is most often taken daily, though some people take it on-demand. When taken at least four times per week, PrEP reduces the risk of HIV infection by 99% as per the CDC. PrEP can be a safe and effective HIV prevention option for many different people who are at a higher risk of HIV transmission, regardless of race, ethnicity, sexual orientation or gender identity.
Talk to your health care provider if you feel that PrEP might be beneficial for you. The process of finding a prescriber and completing the necessary screening required can often take several weeks. If you plan to use PrEP as part of your prevention strategy, consider planning in advance. People living in Alberta who have an Alberta Health Care Card may be able to access PrEP free of charge. For more information on PrEP access, visit prepalberta.ca.
Testing & Treatment
One of the most effective ways to prevent HIV and STI transmission is through regular testing and treatment. If you’re sexually active, best practice is to get tested after every new sex partner (or annually if you only have one sex partner). If you are engaged in any of the following activities, it is recommended that you get tested at least once every three to six months:
Sex with multiple partners
Inconsistent use of condoms or other barriers
Group sex
Intravenous drug use/needle sharing
Drug use during sex
Sex work
HIV treatment or PrEP
You should also be tested anytime you experience symptoms. These might include one or more of the following:
Burning when you pee
Discharge from the genitals
Abnormal bleeding, cramping or pelvic pain
Sores, bumps, or warts on the genitals
Sore throat
Regular testing can reduce the risk of passing HIV or STIs to others and allows you to take early action for your own health if you do receive a positive result. Early action can include treatment, adjusting sexual activities and informing previous partners to benefit their health and the health of their partners. Many STIs can be cured with treatment, eliminating the chance of transmission. Other STIs have no cure but can often be managed with treatment to reduce the likelihood of transmission. In Alberta you can get tested and treated for STIs through your family doctor or nurse practitioner, your local STI clinic, sexual health centre or walk-in clinic.
U=U (Undetectable = Unstransmittable)
HIV treatment is a great example of how treatment can be an effective form of prevention. When someone living with HIV accesses treatment regularly as prescribed by their health care practitioner, they can achieve an undetectable viral load. This means that the amount of the virus in their body is so low that it is not detected by common HIV testing.
When someone has an undetectable viral load, they cannot transmit HIV to their sexual partners. In other words, Undetectable = Untransmittable. However, it is important to note that an individual’s undetectable status may fluctuate due to gaps in treatment or other factors. If you’d like to learn more about U=U, you can check in with your health care provider, local sexual health centre or an HIV/AIDS organization.
Making a Plan
It’s hard to stick to a plan if you don’t have one — don’t leave your HIV and STI prevention options to the last minute. Consider your best prevention options and make a plan for how you will use them. For example, if you plan to use barrier methods like condoms or dental dams, make sure you have them on hand prior to a situation where you might need them. If you are on PrEP or HIV treatment and plan to use drugs or alcohol, set reminders on your phone so you don’t accidentally miss a dose.
There is no one right way to make a plan. Prevention plans can look as different as the variety of tools and options that are available. Having an attainable plan in place is the main priority.Don’t be too hard on yourself if things don’t turn out exactly as you plan. Like anything else, finding prevention strategies that work for you can be a learning process.
Some prevention options require long-term planning. If you are relying on PrEP, HIV treatment or vaccines as part of your prevention strategy, you may want to start planning weeks or even months in advance to make sure you have access to what you need when you need it.
Having a Conversation with Your Partner(s)
Open communication is one of the most effective prevention strategies. Having a conversation with your partner(s) before having sex is a great way to discuss a number of important things such as:
When you were last tested for HIV and STIs
Your current STI and HIV statuses and whether you’re on treatment to reduce or eliminate risk of transmission
And if you are currently living with HIV and/or STIs:
Which sexual activities you are most comfortable with consenting to and which boundaries you’d like to set
Which prevention strategies you are already using (i.e. PrEP, HIV treatment) and/or would like to use during sex (i.e. condoms, dental dams)
Initiating these conversations before engaging in any type of physical activity enhances the effectiveness of open communication as a prevention technique. This way, all parties involved have the agency to assess the level of risk they are comfortable with. Remember that people living with HIV and/or STIs have likely experienced some form of discrimination due to their status, so try to approach these conversations with kindness and empathy. You can set firm boundaries and expectations without belittling others’ experiences and preferences.
During Sex
Get to know prevention options that can be used during sex, including barrier methods and activities with a lower risk of transmission.
Barrier Methods
Whereas some prevention options like PrEP or PEP (post-exposure prophylaxis) only prevent transmission of HIV and not other STIs, barrier methods can be effective tools to prevent both. There are a range of barrier methods that you and your partner(s) can use, depending on the body parts and activities you use during sex. These include:
Internal or external condoms for use during penetrative anal or vaginal/frontal sex, including penetrative sex with shared sex toys; external condoms can also be used during oral sex
Dental dams for use during oral sex
Gloves for use while fisting
While not a barrier method, to prevent damage to your body and to the barrier methods that you’re using, use lots of lube
There are many kinds of lube to prevent genital tearing, which can help prevent STI transmission. Be sure to check which lube works best for your needs, whether it’s for sex toys or barrier methods (i.e. condoms or dental dams). Most barrier methods are one-time-use only and should not be reused. Anything that is reusable (i.e. sex toys) should be cleaned as per manufacturer instructions before being reused or shared with other partners. Barrier methods can be found in pharmacies, grocery stores, sex toy stores and some convenience stores. Free barrier methods can be found at community-based organizations and some schools, universities, doctor’s offices, family resource centres and Public Health offices.
Activities with Lower Chance of Transmission
Some sexual activities have a higher chance of HIV or STI transmission compared to others. For example:
Mutual masturbation typically carries a lower chance of transmission than oral sex
Oral sex carries a lower chance of transmission than penetrative anal or vaginal/frontal sex
Only having sex with one partner generally carries a lower chance of transmission than you and your partner(s) having sex with multiple partners
Topping (being the insertive partner) typically carries a lower chance of infection than bottoming (being the receptive partner)
Ensuring that each partner only uses their own sex toy, and that condoms are used for each new toy use, carries a lower chance of transmission than if sex toys are shared between partners
Please note that the chance of transmission for different types of sexual activity can change if you are using other HIV and STI prevention options like PrEP, HIV treatment or barrier methods
By choosing sexual activities that carry a lower chance of HIV and STI transmission, you can help reduce or eliminate transmission between you and your partners, especially if you are not using other prevention strategies. Your health care provider or local sexual health centre can help you make choices about what activities are safer for you. Remember that most if not all sexual activities carry a certain level of risk to you and your partner(s). It is up to you to decide your level of comfort and which sexual activities to engage in while respecting the decisions of others to engage/abstain.
After Sex
Get to know prevention options that can be used after sex, including PEP (post-exposure prophylaxis), testing and treatment.
Testing & Treatment
Testing (and treatment if you receive a positive result) should be repeated frequently. If you’re sexually active, best practice is to get tested after every new sex partner (or annually if you only have one sex partner). If you participate in riskier sexual activities or are taking HIV treatment or PrEP, you should get tested at least once every three to six months. You should also be tested anytime you experience symptoms. These include:
Burning when you pee
Discharge from the penis or vagina/front hole or anus
Abnormal bleeding, cramping or pelvic pain
Sores, bumps, or warts on the genitals
Sore throat
Many STIs can be cured with treatment, eliminating the chance of passing them on to another person. Other STIs have no cure but can often be managed through treatment, reducing the likelihood of passing them onto others.
HIV treatment is a great example of how treatment can be an effective form of prevention. When someone has an undetectable viral load due to their HIV treatment, they cannot transmit HIV to their sexual partners. In other words, Undetectable = Untransmittable.
In Alberta you can get tested and treated for STIs through your family doctor or nurse practitioner, the STI Clinic Centre, certain community-based organizations and walk-in clinics.
Pep (Post-Exposure Prophylaxis)
PEP (post-exposure prophylaxis) is the use of HIV medication by someone who is HIV negative after a potential exposure to HIV to prevent HIV infection. PEP is usually reserved for emergency situations, such as after a needle prick injury, non-consensual sex, etc. PEP should be started as soon as possible (and no later than 72 hours) after a potential exposure to HIV. Once started, PEP is taken daily for 28 days. When taken as prescribed, PEP is very effective at preventing HIV infection from occurring.
To get PEP treatment, visit an emergency room or STI clinic as soon as possible after exposure. A family doctor or walk-in clinic may not prescribe you PEP. In both cases, you will be assessed to determine your risk of getting HIV. The health care provider determines if PEP is necessary. You may be offered a five-day “starter pack” of pills to start taking PEP right away and be given a prescription for the remainder of the full 28-day course.
The cost for PEP is usually covered by Alberta Health. Otherwise it may be covered by some private insurance plans. Without insurance, a month-long course of PEP can be costly. It is important to keep in mind that PEP isn’t as accessible as PrEP and isn’t offered as widely. You can check Alberta’s PEP guidelines to see if you’re eligible for PEP by clicking here.
This information was developed in consultation with queer, trans, and two spirit community members, community-based organizations, health care providers, and public health professionals. Information is based on the best guidance available and was informed by the Public Health Agency of Canada, Alberta Health, Alberta Health Services, the BC Centre for Disease Control, the Centre of Disease Control (US), and Planned Parenthood (US). Information has been adapted for succinct, accessible delivery to community and is not intended to be exhaustive or be used for clinical guidance.
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