Let me introduce myself. I’m a primary care physician and HIV specialist. I have been in practice for 10 years and in that time a lot has changed in the field of HIV prevention and treatment. I work at Ochsner and am a staunch advocate for innovation to address health inequities experienced by the LGBTQ+ community. It’s my goal, in this and future articles, to share inspiring examples of health care providers and community advocates alike who are at the cutting edge of promoting sexual health and wellness in the Gulf South. In this article I’ll talk about how we’re playing our part at Ochsner in empowering patients to have fulfilling sex lives and finding ways to access medical services that can keep them healthy.
Preventing HIV and STIs (Sexually Transmitted Infections) Promoting sexual health nowadays is about reviewing the full scope of options and seeing what works best for you. You can have an active sex life and protect your sexual health. There’s no one-size-fits-all approach. Below are some important examples of medical services you might consider.
PrEP – a Revolution in HIV Prevention PrEP stands for “pre-exposure prophylaxis.” If you are not living with HIV, there’s a once-a-day pill to prevent HIV infection that is transmitted in semen, vaginal fluids, blood and breast milk. When taken daily, PrEP reduces the risk of getting HIV by over 90%. Approved in 2012 by the FDA, PrEP has helped to dramatically reduce the spread of HIV.
Who Should Use PrEP? Anyone 18 years or older who is sexually active might consider PrEP. Teens age 12 to 17 may also benefit from PrEP but it may be more complex to get. An important first step is to ask a knowledgeable medical provider about PrEP. Together you can determine if PrEP is right for you and help you overcome barriers to getting on PrEP
Post-Exposure Prophylaxis (PEP) This is different than PrEP. In most cases, maximum protection from HIV requires taking PrEP medicines daily for 5-7 days. If you are recently exposed to HIV and are not already on PrEP, then seeking PEP medications within 72hrs of the exposure can dramatically reduce your chances of acquiring HIV. PEP medications are more potent than PrEP and have been shown to be a better solution for protecting against HIV when the exposure was very recent (72 hrs or less).
Accessing PEP in New Orleans has become easier and ER visits are often unnecessary. During daytime hours Mon-Fri, calling the Ochsner PEP/PrEP Hotline is a good start (855-241-9347). CrescentCare offers evening and weekend coverage (504-457-2711), making it possible to avoid that crowded ER.
Undetectable = Untransmittable (U=U) If you are living with HIV, you can now live a long and healthy lifespan. Getting and staying on treatment and becoming undetectable not only provides immediate health benefits to you but also to current or future partners. Twenty years of science shows that people living with HIV who take their medicines until they have an undetectable viral load have no risk of spreading the virus to sexual partners.
Know Your Options. Play Smart You can have an active sex life and protect yourself from HIV and other STDs. Having a candid discussion with a health care provider about your sex life is a step toward promoting better sexual health and finding out what prevention strategies work best for you including how often you should check in for STI screening.
Should You Get Tested for HIV/STIs More Frequently? Well, it all depends. Your health care provider will ask about different kinds of sexual practices you enjoy and help determine what tests should be done and how often. Oral sex allows for STI transmissions of syphilis, gonorrhea, and chlamydia but very low risk for HIV. Vaginal sex without a condom is higher risk for most STIs. Anal sex without a condom, especially if you are the receptive partner “or bottom” is the highest risk for most STIs.
Discuss HIV Having frank conversations with your partners is key. Whether someone is living with HIV or not, talk about HIV in an honest way. Support someone through HIV treatment so they can become undetectable and cannot pass it on. Know how and where to begin PrEP so everyone plays a role when it comes to HIV. If your partner is struggling to stay on meds, support them in getting back into care and soon they too will have an undetectable viral load.
Expanding Your Options Sex can often be spontaneous, and at Ochsner, we can help you make choices that are right for you and provide tools to avoid STIs and HIV. With or without condoms, it may not be possible to plan ahead and condoms are not for everyone. Condoms and other barriers such as dental dams are a great way not only to prevent HIV but also other STIs as well. PrEP could be a good fit and provide added protection.
Be Empowered Sometimes it’s hard to have an open discussion about STIs and HIV with new partners. But keep practicing, it gets easier! Even if you don’t know much about the sexual health of a partner there are steps you can take to promote sexual health. Advocating for condom use offers a high degree of protection from most STIs. If consistent condom use is hard to put into action, PrEP is a great option because unlike condoms, you don’t need to negotiate with a partner about whether you should take PrEP. The choice is yours.
Promoting Sexual Health – Mind and Body Pleasure and intimacy are integral parts of sexual health but sometimes things can get in the way of attaining these goals. Past traumas, anxiety, depression, or struggles with drugs can lead to sexual difficulties. Opening up to your provider about these issues can help you start on the path to overcoming these challenges.
I hope you found this article useful and thought-provoking. I welcome your questions and feedback, in addition to requests for future topics – DrG.HIVWarrior@gmail.com