Stay Safe

Step 1: When your penis is hard, take the condom out of the wrapper carefully using your fingers (not your teeth). Squeeze the air out of the teat on the tip of the condom (if there’s one) and put it over the end of your penis. Don’t stretch it and then pull it over your penis as this’ll make it more likely to break.

Step 2: Roll it down the length of your penis – the further down it goes the less likely it’s to slip off. Put some water-based lubricant over your condom-covered penis. Put plenty of lube around his arse too. Don't put any lube on your penis before you put the condom on, as this can make it slip off.

Step 3: Check the condom occasionally while fucking to ensure it hasn't come off or split. If you fuck for a long time you’ll need to keep applying more lube. When you pull out, hold on to the condom and your penis at the base, so that you don’t leave it behind. Pull out before your dick goes soft.

Reasons why condoms may fail include:

• Not knowing how to put on a condom
• Unrolling the condom before putting it on your penis
• Using oil-based lube including some creams, body lotions or shampoo
• Using lube in the wrong places (i.e., on your penis before putting on the condom or not putting lube up and around his arse)
• Having a long session using the same condom
• Using an expired condom (always check the expiry date on the package)
• Using the wrong size of condoms

Most testing clinics will provide condoms when you go for an HIV test. You can also purchase condoms at any supermarket, chemist or convenience store.

STIs are infections that can be passed on when you have condomless sex, or other close sexual contact with another person.

Many people with STIs don’t have symptoms, so it’s worth getting tested if you think you have put yourself at risk. For a guy, signs and symptoms may include:

1. discharge or pus from the tip of the penis or anus;
2. pain or a burning feeling when passing urine;
3. itchiness, soreness or redness around the penis or under the foreskin;
4. blisters, ulcers or warts around the genital area.

But remember, in most cases STIs have no symptoms, so it’s good to get tested regularly just to be on the safe side.

It’s important to get tested if you think you have put yourself at risk. Many people with STIs don’t have symptoms, so it’s worth getting tested even if you feel healthy. If you think you have an infection, you shouldn’t have sex until you’ve had a check-up. 

Most STIs are easy to treat. Treatment for each infection is different. It’s often as simple as taking tablets, applying lotions or perhaps a small injection. It’s important to complete the course of treatment. You should follow any advice given by the doctor about not having sex during treatment. This is to prevent re-infection of the same STI or passing it on to other people.

There are lots of ways to reduce your risk of getting any STI. The most common way to protect yourself is by using condoms and water-based lubricant. Find out more about staying safe here.

‘PrEP’ stands for ‘Pre-Exposure Prophylaxis’, an anti-HIV medication that is highly effective preventing people from getting infected with HIV if they are exposed to the virus . The main HIV drug currently being used as PrEP is called Truvada. Researches show high effectiveness in practicing PrEP in men who have sex with men (MSM) including transsexual and bisexual contents. For effectiveness please see the page, How can PrEP be used.

Crucial steps for PrEP:

Before starting PrEP – TEST if you are suitable for PrEP

• You must take an HIV test and be sure that you do not have HIV to avoid developing drug resistance to anti-HIV medication.
• You also need to test for kidney and liver function.
• Understand your method for PrEP – daily or on-demand.

During PrEP – MONITOR your body status

• Get tested every 3 months for HIV and other STIs.
• Have your kidney and liver functions regularly monitored.

Stopping PrEP – REVIEW your protective strategies

• Knowing when to stop according to your date of last sex and PrEP intake method.
• Make use of alternatives protective strategies

Restarting PrEP – CHECK if you are suitable for PrEP

• Calculate the date of last unprotected sex
• Check HIV test to ensure HIV negative
• You also need to test for kidney and liver function

Good adherence is crucial as the protective effect is greatly reduced if PrEP is not used according to the medical guidelines.

There are different ways to use PrEP:

Daily PrEP

The easiest method for all genders is to take PrEP daily – take one pill of Truvada each day at the same time of day. It takes different time for different body parts to build up the drug concentration to prevent HIV. If you are having receptive anal sex (bottom) it takes 7 days of daily PrEP before you are protected from HIV. Estimated HIV prevention level is 99% (Anderson et al., 2012).

If you are having insertive anal sex (top) or vaginal sex it takes 20 days of daily PrEP before you are protected. [Illustration]

On demand PrEP

Some people are taking PrEP before and after sex. This method only works for men having anal sex with men, not for people having vaginal sex. MSM can take two pills 2-24 hours before sex, one pill 24 hours after sex and another 48 hours after sex. This is called 2-1-1 dosing. [Illustration]

If you have sex again after the first sex with PrEP, make sure you repeat the 2-1-1 dosing. Estimated HIV Prevention Level is 86% (Molina et al., 2015).  [Illustration]

4 pills per week

This method only works for men having anal sex with men, not for people having vaginal sex. This method requires exceptionally high adherence to the dosing regimen. It is highly recommended to start from daily dosing for 7 days before dropping down to 4 pills per week. You can take the pills on the days of week you prefer, as long as you take it up to 4 days per week. If you forget a dose, then you are likely not protected from HIV. Estimated HIV prevention level is 95%.( iPrEx,2014)

Consult your doctor before deciding which method is suitable to you.

Important note: PrEP may not be suitable for people with kidney and liver functioning abnormalities, such as Hepatitis B.

PrEP is not the right fit for everyone but can be useful for many people who are at risk for HIV infection and comfortable with the idea of taking a daily pill to prevent HIV.

If you answer yes to any of the questions below, then PrEP may be one HIV prevention strategy to consider.

PrEP vs PEP vs Condom

	PrEP		PEP		Condom
Preventing HIV	Yes		Yes		Yes
Preventing STIs	No		No		Yes
Accessibility	Thai Red Cross (Generic) Private clinics Legitimate online suppliers*		Public hospital** HK Private clinics / hospital		Convenient Stores, Supermarkets, Pharmacy stores and NGOs

 *Price: PrEP

Medication fee, excluding consultation and testing fee:

Thailand:Generic: ~120-275HKD a month, Branded: ~5640 HKD a month

HK: Branded: ~8000-10000HKD a month

PEP:

Thailand:Private Clinic: ~816-5020HKD;Thai Red Cross: ~222HKD

HK:Private Clinic: ~13,000HKD Public hospital: ~180HKD (just the first week dosage, but the program requires 28 days)

Condom:~45-250HKD per package

You are advised to observe the relevant Import and Export Ordinance if you do so. For more information, please visit AIDS Concern website at [updated QR code, re-organize website pages]

**According to the guideline from the Centre for Health Protection, any use of PEP for non-occupational exposure (nPEP) would be ‘exceptional and should be considered only in the event of high-risk exposure to a source known to be HIV positive’ within 72 hours of exposure. Doctors in public hospital would determine the need for PEP prescription on a case by case basis.

 

We’re not here to be the condom police and dictate your sex life. Condoms have been and continue to be an effective strategy to reduce HIV risk, but we know that many people are already not using condoms every time they have sex. PrEP is an additional tool to consider for HIV prevention.

Note that PrEP doesn’t protect againstSTIs, like gonorrhea, chlamydia, or syphilis. Condoms still remain the best strategy to protect people from HIV and STIs.

No. Many people go in and out of “seasons of risk,” where there are certain times it makes sense to take PrEP and then other times where it doesn’t.

It takes time for PrEP to build up levels in your body that are considered protective. The exact length of time isstill being investigated. However, for gay men protective levels should be reached in your anal tissue after seven days of consistently taking your daily PrEP without missing any doses.

It’s challenging to remember to take medication every day, but once you get into a routine, it’s easier. If you happen to forget a dose, don’t freak out. You can take the missed dose when you remember it, as long as it’s the same day. If you routinely take PrEP at night and forget, you can take the pill next day morning with your breakfast. However, it’s important tostick with the same time try to do your best next time when you missed it. You can also talk to your prescriber / doctor or other PrEP users; they may have some helpful tips for you.

Depending on the time you take your dose, people suggest different ideas to help remember. For instance, if you decide to take your dose in the morning or evening perhaps leave your PrEP next to you toothbrush so you remember to take it at the same time as you brush your teeth. Another way people remember is to set a repeated alarm in their phone, reminding them it’s time to take their dose.

If you don’t take it, it won’t work so do whatever you think is best to help you remember It’ll get easier over time. If you’re struggling to regularly remember, talk to your prescriber / doctor or other PrEP users; they may have some helpful tips for you.

Before you start using PrEP, it’s essential to make sure you’re HIV negative; you run a risk of developing HIV drug resistance if you’re already infected with HIV when you start PrEP. HIV drug resistance means certain medications will no longer keep the virus in check if you’re HIV-positive. For this reason, it’s really important to confirm your HIV-negative status before you start using PrEP.

When you’re using PrEP, you should get tested for HIV every three months to make sure PrEP is the right prevention strategy for you.

For the first few weeks of starting the medication used for PrEP, some people complain about nausea, vomiting, fatigue, and dizziness, with these minor symptoms eventually resolving themselves over time. This is often referred to as ‘start-up syndrome”.

Some people in clinical trials had elevations in blood tests that looked at kidney function. With this particular side effect, there were no physical symptoms, so it’s important to remember that if you take PrEP, you need to get routinely checked by your doctor to make sure your kidneys are working properly.

Some people in studies had a decrease in bone mineral density within the first month. However, but these changes were small, didn’t progress over time, and didn’t increase risk for fracture. Once the medication was stopped, it’s likely the bone mineral density returned to normal.

PrEP is not yet available in the public health system in Hong Kong. Some private doctors are prescribing but the cost is quite high, which is priced at approximately $8000 to $10000 a month. If you want to get PrEP privately please contact AIDS Concern by telephoning 2898 4411 so that we can advise you on possible clinics. There are a number of providers in Thailand offering PrEP at a few hundred HK dollars per month. One reputable centre is the Thai Red Cross Research Centre which has a Prep-30 project. Another centre which provides PrEP is Sathorn International Clinic. These centres do not require you to go to Bangkok.

Please see the links here if you would like to learn more:
http://www.adamslove.org/en-d.php?id=429
http://www.sathornclinic.com/hiv-std/prep/

It should be noted that the importation of pharmaceutical products and medicine are controlled under the Import and Export Ordinance (Cap. 60), thus must be covered by a license issued by Department of Health under delegated authority of the Director-General of Trade and Industry Department. Pharmaceutical products and medicines imported in the personal baggage of a person entering Hong Kong and which are accompanied by him and in a reasonable quantity for his personal use may be exempted from licensing requirement. People who are going overseas to get access to PrEP are therefore strongly advised to keep a medical certificate provided by the prescribing doctor on them when they have to bring PrEP to Hong Kong for personal use. You may call the Drug Office of Department of Health (Tel.: 2319 8460) for enquiries relating to import/export of pharmaceutical products and medicine or Customs and Excise Department (Tel.: 2815 7711) for general enquiry on Customs clearance.