STIs

Infections a top can get during “bareback sex”:

  • Chlamydia and/or Gonorrhoea which will present with a penile discharge. Treated with antibiotics
  • Syphilis is possible – treated with Penicillin injections
  • Hepatitis B
  • Hepatitis C
  • HPV-the virus that causes warts. Only the symptoms can be treated if you become symptomatic..remember some people are asymptomatic (do not show any symptoms).
  • Herpes Simplex Virus – causes cold sores and also genital herpes. We can only treat the symptoms
  • HIV – Even though the risk is much lower for a top

You can go to any private lab or alternatively go through to a Health4Men competent clinic. Here is a list of common STIs and how they are tested:

  • HIV – a rapid HIV test can be done at any Health4Men clinic
  • Syphilis- we can do a rapid syphilis test at our clinics
  • Herpes-the best test is to take a swab and send it to the lab of the actual fluid in the blister
  • HPV-the virus that causes warts. Unfortunately there is no test available in for men
  • Chlamydia and Gonorrhoea- this will most most likely present as a penile discharge, which we screen symptomatically at Health4Men and most private labs will either do a urine test or request a swab. Gay men or men who have sex with men have a slightly different scenario as it is possible to have this in your throat, your anus or your penis.
  • Hepatitis A, B and C – blood tests can be done at any lab and selected ones at Health4Men.

This can be very daunting and suggest that you phone one of the doctors at Health4Men to discuss your specific case.

To find a clinic please click here: http://www.health4men.co.za/map/

It is always important to treat partners if they may have been at risk of infection. Gay men can have asymptomatic STIs – this means that they don’t have any symptoms even though they are infected.

HIV

If you believe you are HIV negative and may have been infected, make contact with your healthcare provider 
as soon as possible, but make sure it is always within 72 hours of when the risk took place.

Your healthcare provider will screen you by verifying if you are at risk and if you are HIV negative and more than likely put you onto a course of PEP (Post Exposure Prophylaxis). The sooner you start PEP the better it works!

Just remember: PEP can only be used by negative people to prevent infection.

If you are negative they will talk about the risk you had and tell you more about PEP. They will tell you how to use it correctly and about potential side effects.

After you have received PEP you will be reminded to come to the clinic after one month, and again after three months, to make sure that the PEP worked and that you are still HIV negative.

For HIV to be transmitted the following is needed:

Enough HIV ( what this means is if someone is on ARVs with an undetectable viral load there actually is not enough virus) in a high risk fluid (blood or semen) that gets an entry point into the body (this means the inside of the anus, under the foreskin, the head of the penis, into the pee tube an open cut or even your eyes).

If you are not sure if his cum actually went into your pee tube (or any other entry point), then the risk is still there; The best thing would be to go for an HIV test and then again after 4-6 weeks to exclude the window period.

The time you are infected or exposed to the HIV virus to developing antibodies of HIV is 3 months but we know that you can still start seeing HIV antibodies in 6 weeks.

The test is done at 3 months because we want to get an accurate HIV test result. Remember, this is a life decision moment and giving accurate results is very important. The 3 month period after the window period is the right time to get accurate results.

You may be worried and concerned about clinical symptoms that you are experiencing but may not even be related to your HIV status. It could just be stress leading to low immunity and in turn makes you vulnerable to flu viruses or other viruses like herpes which cause mouth ulcers.

If you are still concerned then there are tests that can be done, especially in private:

  • 10 Day HIV DNA PCR Test (for exposures that occurred more than 10 days ago)
  • 28 Day HIV DUO Test (for exposures that occurred more than 28 days ago), a fourth generation HIV test
  • 90 Day HIV Antibody Test (for exposures that occurred more than 3 months ago), a third generation HIV test

You can ask your private GP if he or she can assist you to organise the test for you.

For further assistance don’’t hesitate to contact a Health4Men clinical expert/doctor in our Health4Men clinics listed on our website.

People who are HIV positive often find it hard to gain muscle mass. This is especially so if they are older or have been HIV positive for a long time. Sometimes this can be due to low testosterone hormone.

If you are HIV positive and struggling to gain muscle weight, I suggest you discuss this with your doctor or nurse. In some cases, they can do a blood test to check your testosterone level.

Many guys use steroids and other hormones during training to build muscle. Most of these products are not properly tested and could have negative effects. Their interaction with HIV or with treatment is also unknown and potentially harmful.

There are many guys who are positive who feel exactly the same way as you do.

We recommend getting in contact with Positively Alive (http://www.positively-alive.com/) which is a discrete, online support network.

This is a very common question we get when discordant couples/partners(1 HIV positive and the other HIV negative) have unprotected sexual intercourse.

If your partner, who is a Bottom, is HIV positive and has an undetectable viral load (due to being on ARVs) then his chances of infecting you as a Top is very small. We ideally would recommend a situation where a Top is HIV negative and Bottom HIV positive (called sero-positioning) this reduces the risk of transmitting the HIV virus to the other partner.

However, we can’t stress enough that the safest way to have sex is to use a condom and lube and even consider going on PrEP as an extra precaution.

You can definitely get circumcised even though you are HIV positive!

Many people get confused about this because circumcision is a way of reducing the risk of becoming positive if you are a negative guy.

However, there are many other reasons (including traditional and medical) why a guy may choose to get circumcised, which has nothing to do with his HIV status.

If you do choose to get circumcised, it would be a good idea to be on ARVs first to improve your immune system and ensure the healing process runs smoothly.

Is it normal?

This is a common condition and is known as premature ejaculation. It is especially common in younger guys and mostly goes away without any treatment. There are a few things that can help slow down your ejaculation. Applying firm pressure at the joint between the head (glans) and shaft of the penis before you get close to ejaculation may help delay things. There is some medication which can delay ejaculation but it’s not usually necessary. We suggest you discuss this with your doctor or nurse so they can advise you.

YOUR ARSE

The anus is surrounded by muscles which are able to relax and expand as well as contract. If you find that you are too tight to enjoy anal sex, there are a few things you can do to help.

Firstly, you should aim to try relax and expand the anal muscles before sex. This can be done during foreplay where the anus can slowly be stretched and relaxed by using fingers and toys (e.g. dildos) before sex.

Taking things slowly in a comfortable, relaxed environment with a sex partner that you trust will help. You might also want to try do this on your own a few times until you are used to it.

I suggest using lots of lubricant to help avoid pain during sex. Another tip is to choose a sexual position where you can control the speed and depth of penetration by your partner.

Ongoing pain during sex is not normal so if your problem persists and you are unable to enjoy the types of sex you want, you should discuss this further with your health provider.

Your Rights

Employers are not allowed to request employees and applicants for employment to go for an HIV test unless an employer can prove that testing is a necessary requirement of the job for example in the case of nurses or doctors.

No HIV-positive employee has to disclose his/her HIV status to his/her employer.

Employers are not allowed to dismiss (demote or transfer) HIV-infected employees on the basis of their HIV status alone provided that they are otherwise qualified to do the job and provided that they are able to work.

PrEP

PrEP is available at any retail pharmacy in the country. It requires a script from a GP and you will need a kidney function test first. Patients accessing healthcare in the private sector should therefore access PrEP from an educated GP. The retail cost for PrEP is R600pm for the original drug (Truvada) or R250pm for a generic version. Some medical aids will fund this.

PrEP is currently not available in the state sector outside of demonstration projects such at the Ivan Toms Centre for Men’s Health in Cape Town and soon Health4Men at Yeoville clinic in Gauteng. Sex workers can access PrEP from the Wits Reproductive Health & HIV Institute (WRHI) clinic in Hillbrow. The Department of Health is working towards providing PrEP for sex workers and MSM in the future.

72 hours & PEP

If you think you are HIV negative and may have been infected, make contact with your healthcare provider 
as soon as possible, always within 72 hours after the risk took place. The sooner you start PEP the better it works. The healthcare provider will check to see whether you are already HIV positive – PEP can only be used by negative people to prevent infection.

Condoms

Health4Men condoms are normally available at all the Health4Men competent clinics (which you can find by visiting www.health4men.co.za/map/. They’re also available at events where We The Brave and Health4Men are attending.

Clinics

It’s really simple to find one of the Health4Men competent clinics that are gay friendly. Visit www.health4men.co.za/map/ and you’ll be able to search for the closest clinic.

Your Dick

There are many supplements and tablets that you can use to improve your weak erection but first you need to see a doctor and assess if you have erectile dysfunction. We suggest you see a doctor or urologist to also make sure you do not have Diabetes, Hypertension or any prostate related problems first before using these substances.

ARVs

You can get ARVS from a public health institution or funded NGO for free.

You can also go to a private doctor experienced in HIV treatment but you would have to pay for the consultation, blood monitoring and ARVS.

Check out the Health4Men website and see the services that they provide for free!

If you’re looking for a gay-friendly competent clinic or healthcare provider go through to Health4men.co.za/map/.

This is something that happens often to many people who take ARVs. As you know, correct pill taking is needed to get the maximum benefit from HIV treatment and missed doses can lead to the virus escaping treatment and becoming resistant.

If you usually get your ARVs from a state clinic, you are able to attend ANY government clinic in the area you are travelling and they should be able to provide an emergency supply until you return home, or refer you to a nearby clinic that has ARVs. It is often useful for you to carry your clinic card if you travel so that the government clinic can contact your home clinic for any treatment details they need.

If you get your ARVs from a private GP, you can call your doctor and he should be able to fax or email a script to a pharmacy in the area you are travelling in. They can then provide ARVs as per the script but you may need to pay cash for them.

Warts

Anal warts are caused by a sexually transmitted virus called HPV (human papilloma virus). Health providers are able to treat these warts in a number of different ways e.g freezing them (called cryotherapy), using creams or lotions or sometime surgical removal. We are not able to remove the HPV from the body once someone has been exposed.

There is vaccine available to prevent HPV. Usually this is given to young guys or girls before they start having sex and get exposed to HPV. There might however still be benefit for you to have this vaccine so this should also be discussed with your healthcare provider.