FS Mag Upfront "We just don’t give a toss about our health when the right high is kicking in" OFF YOUR FACE with David Stuart @DavidaStuart QUICK LINK: Get to know: MDMA/ecstasy Sero-converting at the chill-out – even condoms won’t protect you The number of gay guys using chems who catch HIV daily (yes, daily) in London is certainly worrying, but what’s even more worrying is that we’re still misunderstanding the basics of how to avoid catching HIV when having sex. The truth remains, whether you have sex with one guy a year, and it’s sober, or whether you have sex with four guys a week on chems – if you’re safe every time, you more than likely won’t catch HIV. Lots of gay men are not safe every time. And chems, awesome as they are, can really impact our decisions; we just don’t give a toss about our health when the right high is kicking in. One of the most commonly-made mistakes is choosing to use condoms with the dude who tells you he’s HIV-positive, but thinking it’s less important to use condoms with the guy who tells you he’s HIV-negative. Not because he’s lying – I don’t believe there are many of us who’d lie about our status. We’re an awesome, loving community really. The first irony is that the guy who tells you he’s HIV-positive clearly knows his status, and is probably on HIV medicines, likely therefore to have an undetectable viral load, meaning he’s not highly infectious. If you went to a sexual health clinic for PEP after a condomless shag with an HIV-positive, undetectable guy, the doctors would assess the danger to be so low, they’d be unlikely to recommend PEP. Here’s the other irony. It’s an unhappy truth, that an HIV-negative guy who has multiple partners each week on chems, is more likely to have missed a couple of condom opportunities, and it’s possible he caught HIV in the previous six weeks or so. He’s not lying about his status; the HIV test he did last week showed he was HIV-negative, but it’s not accurate enough to show this recent infection. What’s worse, he’s very, very infectious in the first ten weeks or so after this infection; you could catch it from a blow-job, some pre-cum, from topping him even briefly; definitely from bottoming. Spending two or three days in a chemsex/chill-out environment with this guy, naked and intimate, exploring wet orifices, makes you highly-prone to infection as well, even if he uses a condom when he fucks you. Yet he said, quite honestly, that he’s HIV-negative. And let’s not demonise him; he’s just struggling with the complicated HIV facts and with normalised chemsex trends we all have to live with in London. Let’s hope that everyone this guy shags within the coming weeks, knows and remembers to use condoms with guys who say they’re HIV-negative. Because, at the chemsex party or chill-out next week, and the week after (and the week after), each mistake would mean another HIV infection, and another. It’s a snowball effect of HIV infections that we call a ‘cluster’, and it is contributing to the five gay men that are diagnosed HIV-positive in London, every day. Every day. If the above guy is you, or if you might have shagged him, get tested really frequently. Every one to three months if you’re regularly having unprotected sex. If you have caught HIV in the last few weeks, the symptoms you may get include a sore throat, fever and serious night-sweats. Other symptoms, that might just feel like a bad comedown, are lethargy, exhaustion, diarrhoea, a rash or swollen glands. If you think the above risks apply to you, and you’re having these symptoms, it could be that your body is responding to the new HIV in your system (it’s called ‘sero-conversion’), and as well as being very infectious to any shags you have in the coming weeks, it can be quite dangerous for you. Please do go along and report these symptoms to your sexual health clinic. It’s important the clinic know how you’re feeling so that they order the right tests. You’ll be prioritised, you won’t be judged, and there are some things your clinic can do to keep you safe, as well as things that can ensure better long-term health. It’s probably not your major concern in that moment, but it’s also better for your entire community. And that’s a good thing too. I’ve used a lot of terms above like ‘infectious’, and ‘risk’. Given the fear and stigma associated with HIV, sex and drugs, it is important to remember not to let morality, fear or ignorance transform into any demonisation of those of us who don’t make immaculate choices when it comes to our sex or party lives. HIV is much simpler and less drama than it was 20 years ago, but HIV prevention is actually more complicated. We’re looking for love, companionship, connection and community amid a climate of Grindr-sex, chill-outs, chems, poor relationship education in schools, imperfect gay equality and complicated HIV health messages. And often loneliness. Let’s remember our gay brotherhood amongst these challenges, and be kind. Be assured too, that there’ll be no demonisation or judgement when you talk to your healthcare team. They only want you and your community to be well. These chemsex clusters of new HIV infection are a new concern and put many of us using chems at greater risk. But we’ll get through it, as long as we stay well-informed, maintain an honest and regular relationship with our sexual health clinics, enjoy awesome, healthy sex/romantic lives, and remain caring members of our larger gay community. David Stuart is the Substance Use Lead/Health Advisor at 56 Dean Street. Chemsex support at 56 Dean Street: for gay men who use drugs for sex. Walk-in appointments Tuesday evenings, Thursday afternoons and two Saturday afternoons each month. For details visit www.chemsexsupport.com. To get more information on drugs, visit www.gmfa.org.uk/alcohol-and-drugs. THIS ARTICLE WAS TAKEN FROM FS ISSUE #148.