Health Sex and sexual health Safe sex More to safer sex: are we having happier and healthier sex lives? We all know that there is more to safer sex than just one HIV and STI prevention method, but what methods are we actually using? Are we using PrEP, condoms, regular testing, or PEP in an emergency, educating ourselves about HIV and STIs, or even looking after our mental health to make better choices about our sexual health? Or are we using a combination? We surveyed 203 people and asked them how they are having safer sex and what they think of the methods that are on offer. PrEP PrEP is heralded by many as a game changer in HIV prevention. By taking one pill a day, someone can protect themselves from HIV. So, is everyone taking it? WE ASKED: Do you take PrEP? Yes - 21% Yes, occasionally - 9% No, but I would – 35% No – 35% Of the 30% who take PrEP, we asked why they take it. “I take PrEP to take control of my own sexual health,” says Carl, 29. “I had encounters where partners weren’t using condoms when they said they would, and I’d only realise after. PrEP gave me the confidence to take charge of my own sexual health and I felt liberated. I still use condoms occasionally but prefer sex without. I feel so much more freedom having sex than I ever have before and a huge amount of fear has been taken away.” Chris, 24 told us, “I take it for peace of mind. I wasn’t having much sex in general before taking it, even with condoms. I’m also part of the kink community, so I wanted to be good with my health.” Alan, 45, said, “It’s a no-brainer. I understand that it only protects against HIV, but I still don’t feel the need to use condoms, as most other STIs can be transmitted through things like rimming and oral sex.” “When we opened our relationship,” explains Nathan, 35, “my boyfriend didn’t want to use condoms, so I figured I might as well do the same.” Ben, 26, says PrEP gives him peace of mind. “Just in case a condom fails or is non-consensually removed. It also prevents anxiety caused by unprotected oral, even though the risk is low.” Despite being scientifically proven to work, some respondents told us that they have been shamed for taking PrEP. Carl, 29, tell us: “I’ve had people shame me on Grindr, especially when I first started taking it at thebeginning of the Impact Trial. They usually called me irresponsible or a slut. I have however notice this decrease as its use has become more prevalent.” “A guy online asked me about it,” says Nathan, 35, “and when I told him he sent me a load of abusive messages about how people like me were the problem and we were breeding infections and causing the next epidemic.” Andy, 60, says, “People frown upon it and as I’m older they can’t understand why I take it. I’ve seen older guys shame younger guys who protect themselves as sluts.” Ben, 26, explains: “I haven’t been shamed but I keep the fact I’m on it quiet to prevent shaming orresponses saying “you’re on prep so we don’t need to use condoms”.” PrEP has transformed the way people have sex and the way people navigate their sex life. WE ASKED: Has PrEP changed the way you have sex? Yes, for the better – 52% Yes, but it might’ve increased my risk of STIs – 24% No – 21% I don’t know – 3% Carl, 29, goes into detail about how it has impacted his sex life: “I no longer feel fear when having sex. I can still take precautions where I feel sex is particularly risky, but I can now have condomless sex with all my regular partners with less fear. I get tested every three months for all STIs to ensure things can be cleared up if necessary. It also means a ‘slip up’ is potentially less harmful to me.” Ben, 26, says, “I still use condoms and I use PrEP purely as a second line of defence against HIV.” Ed, 28, explains: “I started taking more control over my sexuality, getting more educated on risks besides HIV, testing more regularly, and I became more confident to be sexual again. As a trans person it enabled me to feel in control despite the near silence about trans gay men.” Nathan, 35, says, “It removes an awful lot of anxiety around my HIV status. I was brought up in a real climate of fear around HIV and I used to panic every time I had sex with someone new, even if we used condoms, until I could get tested again. Now I finally feel like I can enjoy sex without feeling ashamed and guilty.” Some people don’t take PrEP. It could be to do with lack of access, that they are in monogamous relationships, or even a lack of faith in the science. 70% of respondents said that they don’t take PrEP, with 35% said of thatpercentage saying they don’t but they would. Neil, 37, tells us: “I only have one sexual partner. We are both monogamous and we both know our status so don’t need PrEP.” Bart, 35, simply says: “I don’t trust that it works.” Nicholas, 38, had trouble accessing PrEP: “It seems that despite it being available on the NHS, I am still finding it hard to access PrEP.” A sentiment supported by David, 49. “I asked at the clinic before it was available, and I wasn’t having sex when it started to become available. By the time I had sex again, the trial was full. Sex is sporadic for me. I’m not in a sexual relationship with my husband. The last time I had sex I took PEP after, which I got from a clinic.” And by Ell, 27, “There were no spaces left on the trial at my local clinic. I found out about the trial too late, which I think was the reason why. However, now PrEP is on the NHS in England, I do plan on enquiring about using it.” Ariel, 25, tells us: “I think HIV maybe isn’t discussed enough among straight people and people who don’t or haven’t yet engaged in sex with members of the opposite sex. I’ve heard my gay friends discuss HIV, but my straight friends worry more about things likechlamydia or getting pregnant. This is one reason why I might not have heard of PrEP. It’s bad though and I should be more educated.” Even though some people may not take PrEP, would that put them off having sex or relationships with people who do? WE ASKED: Would you have sex with someone who uses PrEP? Yes – 56% Yes, but I’d use condoms – 39% No – 1% I’m not sure – 4% Neil, 37, says, “Not everyone is truthful. Also, PrEP doesn’t protect against other STIs such as chlamydia, gonorrhoea or syphilis.” Danny, 41, tells us, “Although it doesn’t protect against everything, it at least lets me know that the guy I’m with is thinking about safe sex and looking after himself. I have had bareback sex and also used condoms with guys who were also on PrEP.” Ell, 27, says, “I trust in the science and I also believe those who use PrEP are more inclined to care and look after their sexual health.” Ian Howley, Chief Executive of LGBT HERO told us why PrEP is an important tool for gay and bisexual men, he said: “I think we can all agree that PrEP has been a gamechanger. The statistics over the last several years have shown a huge drop in the number of mencontracting HIV. PrEP has been a key part of this success. However, we must not solely rely on it. PrEP is great, but it’s not for everyone and we shouldn’t be encouraging those who are not keen on PrEP to use it. There’s more to safer sex and PrEP is just one option – a pretty damn good one though. “As some of the men have already stated, it does not prevent STIs and that’s why PrEP as a standalone strategy doesn’t really work. We recommend either PrEP and condoms or PrEP and regular testing so if you pick up STIs it can be caught early and treated.” CONDOMS Condoms have been touted as the main form of HIV and STI prevention for decades, but with the advent of PrEP, are people still using them? WE ASKED: Do you use condoms? Yes – 38% Yes occasionally – 30% No but I would – 13% No – 19% Of the respondents who told us they do you use condoms, we asked in detail about why they use them. WE ASKED: Why do you use condoms? To prevent STIs – 83% It makes me feel safer – 74% It’s the sensible thing to do – 69% To prevent HIV – 68% Peace of mind – 55% It makes me feel cleaner – 40% It helps me last longer – 1% I prefer the sensation – 0% Brandon, 39, explained to us why he used them: “PrEP is fantastic for preventing the spread of HIV but there are other, increasingly drug resistant STIs out there which could be inconvenient and painful. The difference in sensation and pleasure as a penetrative partner wearing a condom is minimal and not worth the potential risks. Also, most receptive partners aren’t ever as clean as they think they are and I’d rather poop on a condom than on my penis.” Ell, 27 says, “At the moment I do prefer to use condoms for casual sex, this is mainly because I’m not on PrEP. If I were I’d be more inclined to have sex without one, with my partner’s consent.” Trent, 29, gave a simple response: “They are easy to use and make me feel safer.” Ariel, 25, tell us: “I hate condoms. I have PTSD and mild OCD along with a bunch of other mental illnesses and one of the symptoms is being particularly sensitive to certain textures. Latex is a texture that really freaks me out. I should use them more though. If it was a friend or someone who’s sexual history I was familiar with, I’d be less likely to use a condom, and just get an STI test after. I always get an STI test in between new sexual partners. But if it was a total stranger, I would use a condom. I’m aware this really isn’t great sexual health practice. When the pandemic ends and I start hooking up with people properly again, I’ll be better.” As simple and as readily available as condoms are, they are not without their issues. WE ASKED: Have you ever had an issue with a condom? It was too small – 46% It broke during sex – 40% It slipped off during sex – 32% It was too thick and reduced the sensation – 30% It was too big – 6% Trent, 29, tell us, “I was the penetrative partner and I noticed the sensation got better. I looked down and saw the condom had broken. So we stopped and I put another one on.” Paul, 38, says, “Sometimes they are too small and tight, so it cuts off circulation enough that there’s no sensation. I had to find bigger ones.” Ariel, 25, says, “Some guys with erections that fluctuate during sex can equal problems with it slipping off and being too big. Condoms can also be too small for them. It’s uncomfortable for them, so they just take it off.” Brandon, 39, explains: “I’m not “hung” by any stretch of the imagination but my penis is larger than average and a regular size condom can get too tight, pinch and feel really odd. Like a vacuum.” Ell, 27, says: “I think he was going too fast during sex once to be honest, and the friction caused the condom to split.” Some people don’t or won’t use condoms. In fact, 32% of respondents said they don’t use them. WE ASKED: Why don’t you use condoms? I don’t like them – 39% They stop me getting hard – 28% I take PrEP so feel like I don’t need to use them – 25% It doesn’t feel as good – 22% They reduce my sensation – 14% My partner prefers I don’t use them – 6% I can’t find condoms that fit – 3% An overwhelming 99% of the respondents who don’t use condoms told us that they would have sex with someone who did use them. Charlie, 26, says, “I understand why they would want to use a condom, and I respect that they want to practice safer sex.” Andrew, 38, stated, “Why not? If they want to I’m not going to disrespect them and say no.” Ian Howley of LGBT HERO commented; “There’s a common misconception that gay and bi men have stopped using condoms. We know this is not the case. Yes, as people have moved to PrEP their condom use may have dropped but there’s still a large proportion of men for whom condoms are the choice for protection. And this is a great method. Condoms pervert HIV and STIs if used correctly but we also know that condoms fail about 6% of the time because people don’t use enough lube or not the correct lube. But let’s be honest here, we also know that the vast majority of men do not use condoms for oral sex and some STIs can be transmitted even if you use condoms. If you are someone who thinks they don’t need to test because you are using condoms, think again. You should be testing for HIV and STIs at least twice a year. Know the symptoms, get tested and get treated.” PEP PEP is an emergency medication you take after sex that can stop you from becoming HIV-positive if you believe you’ve been exposed to HIV. How many people have accessed PEP and does everyone know what it is and where it’s available? WE ASKED: Have you ever taken PEP? Yes – 13% No – 86% I’m not sure – 1% For those who had never taken PEP before, we asked: Do you know what PEP is or does? Yes – 78% No – 12% I’m not sure – 10% Some of the respondents who had used PEP before told us the circumstances around them accessing the medication. Alex, 29, told us: “Someone told me that he was positive, after we has unprotected sex.” Topher, 31, revealed, “I had a broken condom once and I was sexually assaulted once.” “A guy I was seeing,” Brandon, 39, explains, “started bleeding from his mouth a lot and I was worried about blood being inside my mouth.” Ian Howley of LGBT HERO told us: “PEP is probably one of the least known methods to prevent HIV. It does have some stigma attached to is because people are embarrassed to ask for it. There are also some myths that it makes you feel crap for a while. This used to be the case but the medication has little or no side effects nowadays. It’s great that we have a method of prevention where if you think you’ve put yourself at risk you can go to a clinic and get medication to stop you from becoming HIV-positive. However, it’s only an emergency method and it relies on getting to the clinic as soon as possible, as the medication won’t work after 72 hours. So yes, if you have put yourself at risk then get yourself on PEP by visiting a clinic or your nearest A&E but consider PrEP moving forward if you think you’ll put yourself at risk in the future.” TESTING FOR HIV AND STIS Testing regularly for HIV and STIs is a vital part of a safer sex strategy, but how many of us are adhering to regular check-ups? Or are we relying on other prevention methods without testing? WE ASKED: How often do you test for HIV? Every three months – 29% Every six months – 23% As and when I feel I need to – 23% Once a year – 15% I don’t test for HIV – 10% Every two years – 1% “I test for HIV because It’s important to know my status,” says Paul, 35, “for my own health and to keep anyone I’m sleeping with safe.” Martin, 61, tells us, “I test for the certainty of my status, so as not to inadvertently infect someone else, and to address treatment if tested positive.” Nick, 37, says, “I do it for general safety and if I’ve had a lot of anonymous partners in a short period of time.” There are now a multitude of ways to access HIV testing, so it’s easier than ever to know your status. WE ASKED: For your most recent HIV check-up, where did you get tested? At home with a home testing kit – 45% In a sexual health clinic – 43% Via my GP – 6% At a hospital – 2% No respondents tested in a bar or club or sauna or sex venue setting but this could be due to COVID-19 and lack of on-site testing. Paul, 35, told us why he tests at home: “It’s moreconvenient and less waiting around. In the past I’ve also been tested in a bar, as it was available.” “I tested in May 2020 at home because of the pandemic,” Peter, 28, tell us, “But normally I would visit a sexual health clinic.” Charlie, 26, says, “It’s easier and convenient to test from home. I feel like my risk is low enough to not always go to a clinic." Although home testing isn’t for everyone, as Paul, 38, explains: “I tried home testing for the first time but I’d prefer to go to a clinic as I found it difficult.” WE ASKED: How often do you test for STIs? Every three months – 30% Every six months – 23% As and when I feel I need to – 20% I don’t test for STIs – 14% Once a year – 11% Every two years – 2% When I have symptoms – 0% 46% of respondents said they had been diagnosed with an STI. WE ASKED: What STIs have you been diagnosed with? Gonorrhoea – 27% Chlamydia – 26% Crabs – 16% Genital warts – 14% Syphilis – 7% Herpes – 4% HPV – 3% Shigella - 2% Hepatitis B – 2% #Hepatitis A – 1% “I got my STI from a former partner who was cheating,” says Simon, 34. “I found out when I got my regular screening as he hadn’t told me.” “I had no symptoms,” Leo, 30, tells us. “It was a routine test and I was told by the clinic. Upon arriving I saw on their computer screen that the only positive was from a test which (according to the screen) wasn’t conclusive for Chlamydia, but I took the medication anyway to be safe and my next test was negative. My partner at the time was with me when I got the phone call.” Danny, 41, explains, “I got gonorrhoea from a regular partner and so he told me to get tested. My syphilis diagnosis actually came about because I was showing some symptoms and my GP wasn’t able to tell what it was. I went to sexual health clinic just in case to see if there could be anything else causing symptoms. I found out I had syphilis, got treatment and the symptoms went away. I spoke to previous partners that I has syphilis, but I didn’t know when it was, so I spoke to people going back about six months through apps.” Ian Howley of LGBT HERO commented: “I think we’re all aware that STIs have skyrocketed in the last couple of years. People’s methods have changed as more options have become available and this is a result of that. I think the biggest issue here is getting people to care about STIs. On one hand we are saying get tested and if you have something it’s easily treated. No worries. And then on the other hand we’re complaining that STIs are on the rise. It’s two directions of the same conversation. This allows some to be confused and think it’s not a big deal if they pick up an STI or two. Personally, I’d rather someone picked up syphilis than HIV but we should be trying to prevent the spread of all STIs. There is no failsafe way not to pick up an STI. Every sexual act carries risk, even condoms can’t prevent everything. The best thing we can do as a community is to use condoms, PrEP and test regularly. Know the symptoms of STI and get treated as quickly as possible so you don’t pass it on to anyone else. If we all do our bit then we can get these stats down.” EDUCATION ABOUT HIV Many of those know the tools to prevent HIV – condoms, PrEP etc – but how many of us actually know the facts about HIV? WE ASKED: Do you know what the term HIV-undetectable or U=U means? Yes – 91% No – 8% I’m not sure – 2% The majority of respondents confirmed that they know if someone living with HIV is on effective medication can’t pass it on through sex. But despite their knowledge, would it affect their decisions around having sex a dating someone living with HIV? WE ASKED: Would you date someone living with HIV? Yes – 79% No – 6% I’m not sure – 15% Would you have sex with someone living with HIV? Yes – 80% No – 8% I’m not sure – 12% James, 22, explained his feelings about why he wouldn’t date or have sex with someone living with HIV: “It seems like a big risk to take, I absolutely hate being that way I guess I just need to know more about it but as it stands I would be fearful of contracting it.” Ralf, 39, also said fear rules his decision making: “I’m probably still brainwashed from school and the negative press about HIV and AIDS. I fear catching it, even though I have friends who are positive but manage it with drugs.” Tom is concerned that someone might not adhere to taking medication: “I’m fearful that if they forget to take their meds that they will become detectable.” However, the majority of respondents don’t feel this way. Paul, 39, says, “If they are undetectable then there’s less risk than having a Grindr hook-up where you don’t know their status.” “I don’t believe that a person’s HIV status should define them or their relationships,” states Bijou, 23. “If they are undetectable then there is no risk of it being transmitted to me. If they weren’t, PrEP is accessible.” Jamie, 55, says, “If they are undetectable then they can’t pass it on, if not I’m on PrEP so my risk is negligible. In the unlikely event I became positive I would switch from PrEP to treatment.” Ian Howley of LGBT HERO said, “Over the last few years we have seen a huge education push among the U=U / HIV-undetectable movement and and it’s paying off. More people today know that someone who is living with HIV, on effective medication and is HIV-undetectable can’t pass on the virus through sex, than they did 5 years ago. Knowing this will break down the stigma attached to the virus and will help people feel less apprehensive about testing. But it’s likely the stats we are seeing are not an overall representation of society, even within the LGBTQ+ community. There is still a long way to go and we must still increase people’s knowledge of how HIV is transmitted, U=U and the damage stigma inflicts.” MENTAL HEALTH There’s another way to protect your sexual health, and that’s looking after your mental health. It’s a prevention method not often considered but could be key to a happy and healthy sex life. WE ASKED: Do you think your mental health impact your sexual health? Yes – 78% No – 15% I’m not sure – 5% Tyler, 21, admits, “I have more casual sex to make up for something missing in my life.” “When depressed my libido either dives, or I use sex as a way to feel better about myself,” says Ki, 24. Bijou, 23, tells us, “Poor mental health is likely to amount to poor and more wreckless decision making. Therefore, you are more likely to put yourself at risk.” “I have very poor mental health often drink a lot or sometimes take drugs that make me take risks. I often sleep with people I’m not attracted to out of awkwardness or fear,” admits Paul, 35. WE ASKED: Have you ever used sex as a way to increase your self-esteem or self-worth? Yes – 59% No – 29% I’m not sure – 12% Paul, 39, explains how he has used sex to boost his esteem: “A few weeks after getting dumped I went to a sauna and got fucked by two guys. I just wanted to feel like someone wanted sex from me and not feel like I was completely repulsive.” “When I was young and immature, I thought it was the only way to feel good about myself, to feel attractive. But I was young and naïve,” says Andrew, 38. Charlie, 26, tells us, “My confidence is fairly low, so I would likely only have sex with people I feel I trusted or knew well enough, for fear of being rejected. So, in the conventional sense, no, but with a trusted partner I guess there have been times where it has improved my self-esteem.” Ian Howley of LGBT HERO says, “This is probably the method most people will be confused about. How do mental health and sexual health go together? They actually go together like milk and cookies, like bread and butter, like cheese and wine. Looking after your mental health will have a positive effect on your sexual health. Why? Think about it. If you don’t care about yourself, if you’re going through a though time, if you have low self-esteem or self-worth, do you think you’d care about HIV and STIs? Do you think you’d be able to make the best decisions when it comes to your sexual health? Probably not. A lot of people who are experiencing poor mental wellbeing tend not to make the best decisions regarding their health, this includes sexual health. This is why looking after your mental health and wellbeing will have a positive effect on all aspects of your life, including your sexual health. I recommend checking out www.OutLife.org.uk as a way to increase your knowledge on how better to look after your mental wellbeing.” With the multitude of HIV and STI prevention methods available, it’s important to find the one (or two, or three) that suits you. A combination approach is the best way of protecting your sexual health for a happier and healthier sex life.