Men, Sex & Sexuality

Sex is an important part of our life. A responsible and protected sex is by making the right choices for ourselves and our partners. It’s based on mutual respect, open communication, honesty, caring for our health and the health of our sexual partners.

Sexual orientation differs from one man to another, while some men have sex with women only (heterosexuals), some have sex with both men and women (bisexual), and others are attracted exclusively to men (some of the identify themselves as homosexual/gay). Also, some men do not want to define their sexual orientation and attraction, which is why we use the term men who have sex with men (MSM) to identify it, regardless of the sexual orientation or identity of the person. Attraction or orientation is not something we can decide. A sexual relationship should be between two adults by mutual consent and with the complete agreement of both of them. However, any relationship between an adult and a minor is an offense, and any relationship without the clear and explicit consent of the partner is a crime of rape, and in both cases it is punishable by law in all countries.

Human Immunodeficiency Virus – HIV: Transmission, Testing, & treatment

  1. Definition

HIV is a virus that affects the body’s immune system and works on weakening it.

HIV testing shows the presence of the virus’s antibodies in the blood. It is an easy and accurate test, and we only need a small drop of blood (finger prick) to get the result in few minutes. It should be noted that the HIV rapid test needs three weeks to three month (depending on the type of test) after the last sexual exposure to give us accurate results–this is known as the window period.

If the test result is negative it means that the person is not carrying the virus, and that the must keep on having safe practices. If the result is positive, you can access counseling, health services and psychological support, which guarantees you a long and healthy life.

If you feel anxious or suspicious that you might have been exposed to the virus from another person through sperm, blood or anal fluids. Testing will give you an answer, but it must be done weeks or months (depending on the test) after the exposure that you are doubting and you must have protected sex until you get tested to get accurate results.

HIV does not have any specific and obvious symptoms. Therefore, it is not necessary to wait for the symptoms or illness to appear to get tested. The sooner the virus is detected, the easier it will be to treat it. All sexually active people must get HIV test every six months.

  1. Transmission

HIV is transmitted through the bodily fluids of someone who is living with HIV who has detectable viral loads. Two things are required for the transmission to happen: the bodily fluids of the person living with the virus and the entry point into the bloodstream

The entry points into the bloodstream Body Fluids with High Viral Loads
The virus cannot enter the body through healthy (non-injured) skin. The places/scenarios which can make the virus enter the bloodstream are:

– Anus and vagina

– Skin cuts, ulcers, or infections.

– A wound or inflammation in or around the mouth.

– The eyes.

– Sharing a syringe with another person.

– Sharing razors or blades.

– Unprotected anal sex (without a condom and lubricant made of water or silicone) exposes a person to a greater possibility of catching the virus, as it travels directly from the anus to the bloodstream.

 

Not all body fluids contain the same amount (density) of the virus.

Body fluids that are considered to be the highest risk for transmitting the virus are:

– Blood

– Semen

 

Other fluids such as urine, sweating, tears, and saliva do not transmit the virus.

 

As for the pre-cum fluid, the transmission of the virus is still there but it’s less risky.

 

 

  1. Prevention & Limitation of Risky Behaviors

Unprotected sexual practices expose sexual partners to HIV infection if one of them is living with the virus. So, here are a few tips to reduce the risk of transmission:

  1. A) Use a condom with a water or silicon based lubricant during anal sex. If you are the receiving partner (Bottom), make sure that your giver sexual partner (Top) uses the condom for the entire duration of the penetration.
  2. B) Refrain from using lubricant made of oils and the use of actual oils because it could break the condom—always use lubricants made of water or silicone.
  3. C) If you or any of your partners have any symptoms of sexually transmitted infections (STIs) such as sores, blisters or rashes on or around the penis/anus; also if there’s discharge from the penis or anus, you should immediately contact a specialist for treatment.
  4. D) We recommend carrying a condom when going to parties or any other occasion where sexual intercourse is possible.

The risk of the virus transmission for the giver or receiver (top or bottom) is the same if the condom is not used.

For relationships that are exclusively with one partner (Monogamous), we recommend that you keep checking and speaking openly with the partner on all matters, especially sexual health and prevention matters.

  1. Preventive Methods

Male condoms are the best way to prevent the risk of HIV transmission and some other STIs. The condom is effective because it stops the exchange of bodily fluids that may contain the virus: semen and blood. People living with HIV should also use a condom to limit the spread of the virus and not to be exposed to other STIs. The condom and lubricant should always be used together.

How to use a condom:

– Check the expiry date

– Do not open the condom with a knife, scissors or teeth, pay attention when you or your partner are wearing it so your nails won’t break it

– Press the top of the condom and push it down the penis while it’s hard to fully cover it

– Apply the water or silicon based lubricant on the condom and on the anus

– When you ejaculate the condom should be removed from the penis, make sure that it does not leak the liquid, tie it from the top in the form of a knot, and throw it in the trash.

 How to improve condom use:

  • Some believe that the condom reduces pleasure during intercourse. Therefore, it is important to make sure that the type and size of condom suit us because it does not reduce pleasure, it’s just a common idea.
  • The use of more than one condom during a single intercourse does not work, as it could tear it.
  • In group relationships (orgies), a different condom should be used with each new partner.
  • Do not keep condoms in places with high temperature because it reduces its shelf life.

Lubricants come in form of a gel that could be used for medical purposes or during sexual intercourse. Using the right lubricant makes the relationship safer by preventing condoms from tearing, and makes sexual intercourse more comfortable and pleasurable.

Lubricants are essential for sexual intercourse because the penis is dry and can damage the inner layer of the anus, which increases the risk of transmission of HIV and other STI’s

You should only use a lubricant that is made of water or silicone with a condom. The use of any substance that contain oils such as baby oil, hands and body lotion, butter or ghee, petroleum jelly, cooking oils or any other similar products could break the condom during intercourse.

Some people may use saliva during intercourse, but it may not be as efficient as a lubricant and it poses a risk of transmission of some STIs

Always use a lot of lubricant on the anus before proceeding with the intercourse. Keep on applying lubricant if the sessions lasts for a long time, or if you start feeling that the intercourse has become dry or sticky. Also, use lubricants to protect the condom from tearing and to prevent dehydration and ulceration of the inner layer of the skin.

PreExposure Prophylaxis (PREP)

This treatment is a pill taken daily that greatly reduces the risk of HIV transmission. Currently, it’s difficult to get PREP in our countries but it is important to mention it and to know what it is, because we might meet people from other countries who take it. PREP is an expensive drug, those who wish to buy it they should pay for it at their own expense as health ministries rarely provide it for free. If someone wants to start this treatment, it is advisable to discuss it with a doctor beforehand and to do regular check-ups.

If someone says that they’re taking PREP, we should always keep in mind that condoms should be used during sexual intercourse, as they remain best preventive method against HIV and some other sexually transmitted infections.

Studies have shown that a person living with HIV who is committed to the treatment and have undetectable viral load, cannot transmit the virus. However, it does not protect them against the rest of the sexually transmitted infections, so condoms remains the best preventive measure

If you were exposed to the virus in any way, you can get a treatment called Post-Exposure Prophylaxis (PEP).

If you were exposed to the virus, you can ask for this treatment from your doctor. If you’re committed to it for a month, it can stop the transmission of the virus. However, you should start this treatment immediately within 72 hours (3 days) after the exposure. Please check with a doctor who is specialist in infectious diseases before starting any treatment. Also, the accessibility to this drug changes from one country to another.

LIVING WITH HIV

If the HIV test result is positive, people often feel overwhelmed and frightened. It is important to remember that HIV is a very controllable infection with antiretroviral therapy but it is not completely curable.

Knowing your HIV status (positive or negative) allows a person to make better decisions regarding their health. If the result is positive, a person must have a lot of questions which is why they should be asked to someone reliable who can give an accurate answer.

Living with HIV does not mean that the person has AIDS. People living with HIV who are committed to the treatment can live a regular healthy life since they have a good immune system. As for those who are not committed to treatment, they may experience many health complications that lead to AIDS and become susceptible to any infection because the immune system is weakened.

When starting HIV treatment, some people may experience some side effects of the medicine such as drowsiness, insomnia, vivid dreams, diarrhea, headache, nausea, stomach pain, problems in the digestive system, skin rashes, or sexual dysfunction, and they may not feel any side effects. However, after a period of two weeks to a month all these effects disappear. In case any of these effects remain after that period, they should immediately consult their doctor to review their specific treatment.

After several months of treatment, HIV viral load  becomes undetectable in the blood. The center for disease control and prevention (CDC) in 2017 confirmed that people living with HIV, who are committed to treatment and have an undetectable viral loads do not transmit the virus to others

People living with HIV who keep on getting treated properly can have a normal and healthy life. Special examinations prescribed by the doctor, can monitor the health condition of the person living with HIV through measuring viral loads and the immunity count.

Your doctor can also recommend a test called Viral Load, which detects the ratio of HIV in the blood but this examination is not always available. However, it allows you and your doctor to know how is your body responding to the treatment.

The risk of transmission of other sexually transmitted infections such as syphilis, Hepatitis B can be higher for people living with HIV. Therefore, it is very important to learn as much as possible about HIV and other STIs and sexual health in general.

Partner Notification and Disclosing HIV Status

According to the World Health Organization (WHO), partner notification services are a voluntary process in which a person diagnosed with HIV is encouraged to voluntarily notify their partner(s). The WHO recommends to notify sexual partners confidentially and provide voluntary services for HIV testing, prevention, treatment and care

Here are some recommendations on HIV partner notification:

– Personal referral – when the person living with HIV is encouraged to voluntarily disclose his status to his partner(s) and encourages them to get tested.

– Contract Referral – when the person living with HIV is encouraged to voluntarily disclose his status to his partner(s) and encourage them to get tested; if the partner(s) does not undergo the test within a specified period, a healthcare provider will directly contact them in a confidential manner.

– Dual referral – when the person living with HIV and the healthcare provider inform the partner(s) together and encourage them to get tested (with the permission and consent of the person living with HIV).

– Provider referral – when a healthcare provider notifies the partner(s) on his own and encourages them to take get tested (with the permission and consent of the person living with HIV).

(Center for Infectious Diseases Control))

As for informing casual sexual partners, this is up to the person living with HIV because each case must be evaluated separately. Many people do not have enough information about HIV which may lead to a difficult reactions from some while others might be more accepting. We recommend that you always use a condom with all partners. It is preferable to encourage them to get tested and to guide them to a reliable center

As for family or friends, it is not possible to be certain about this subject. Some people living with HIV have found great support from people around them while others have faced a lot of ostracism, discrimination and stigmatization. We recommend studying each case separately and getting help from service providers before disclosing your status. Sometimes you might find yourself able to disclose your status but at other times you may decide not to say anything. In all cases, this is your health and the choice is totally yours.

As for the medical staff, there are different opinions about informing the doctor or physician about your status. If the person wants to inform the medical staff, we recommend that you consult a doctor who is a specialist in HIV treatment beforehand. Similar to sexual partners, family and friends, there are doctor who are professional and there are others who discriminate, stigmatize or even refuse to provide treatment to people living with HIV. For more information on safe places (healthcare settings, organizations, etc…) which provide HIV treatment and care free of stigma and discrimination, consult centers that are specialized in services for people living with HIV. Remember, the lack of knowledge about the virus might be the underlying cause of the stigma that you might face.

HIV Treatment & Antiretroviral

HIV treatment is a combination of antivirals to keep a person healthy–this medicine is called antiretroviral.

Antiretroviral therapy helps control the virus and prevents from reproducing. This allows the immune system to recover and protect the body from other infections, such as tuberculosis and others.

We do not recommend any rupture of the treatment because the virus can develop resistance against the medicine which is very harmful. The treatment should be taken according to the prescription to be efficient, which means taking it daily at the same. In case the person can’t commit to the treatment correctly as prescribed, it is very important for them to consult the doctor to help them find way to commit to the treatment in a consistent manner \ because the medicine might not be as effective after a while. Some men worry about the side effects of the medicine, keep in mind that the current treatment has minimal side effects that can be expected and managed easily.

We recommend that you start getting treated as soon as you get a positive test result, which is also strongly recommended by doctors

You should consult a local hospital, clinic, center, organization or institution working this field (e.g. infectious diseases or sexual health) about the access to HIV treatment free of charge by the ministry of health in the country of residence

– HIV treatment prevents the virus from multiplying

– HIV Treatment suppresses the virus, prevents infections, improve the overall health of those living with the virus and increases their life expectancy

– The current treatment is appropriate, causes minimal side effects and improves the quality of life.

Finally, we recommend that you eat healthy, get enough sleep and exercise. It’s very important to eat a balanced diet that is rich fruits and vegetables that are high in vitamins, and to avoid uncooked meat and fish. If you drink alcohol, have it only in moderation, as it could harm your liver. Your body needs all possible care to support itself, so avoid things that increase stress.

Sexually Transmitted infections

It is very important to prevent all types of STIs, and to try talking about these issues to your sexual partner.

Syphilis

Description

This infection causes painful sores on the lips, mouth, penis, or the anus (it’s also possible inside it) in a window period that could extends up to a month since the transmission. If it’s not treated, these ulcers can heal but the infection remains–other symptoms that can show up later including a rash on the skin or inside the mouth. However, if the infection is not treated for a long time, it causes problems in the heart, eyes and other parts of the body which could also lead to blindness and even death at a later stage.

A doctor will prescribe a specific antibiotic treatment which will cure syphilis and prevent further complications

Transmission

Syphilis can be transmitted during unprotected anal or oral sex (without a condom), and with the direct contact with an ulcer like rubbing the penis or any infected area, and exchanging sex toys. Sometimes, syphilis ulcers can be inside the mouth or anus, so you can’t know if your sexual partner has it.

You can still get Syphilis even if you’re using a condom because it is transmitted by touch or skin to skin contact.

How can you know if you have it?

Symptoms to pay attention for:

– Painful ulcers

– General skin rashes, especially on the hand or abdomen

– Ulcers inside the mouth or anus

As for the advanced stages:

– Feeling sick for a long time

– Feeling of tingling in your hands and feet

– Joint pain

– Skin infection

– Anesthesia and weakness in the limbs

– Eye problems

– Confusion and delirium

Note that the time frame for the appearance of these sign varies from a person to another.

Gonorrhea and Chlamydia

Description

They’re caused by bacteria and they both have similar symptoms including white, green, or yellow discharge from the penis, or an infection in the anus or mouth. These signs may appear within 1 to 10 days after exposure to the bacteria. Some people may have these infections but have no symptoms (Asymptomatic).

These infections can be treated with antibiotics prescribed by your doctor

Transmission

These infections are transmitted through unprotected sexual contacts (oral or anal sex including riming). You can get it even if you are not exposed to your partner’s semen or blood, but simply by touching or physical contact with the infection.

A condom does not totally protect against these infections. Therefore, if you see any secretions in your partner, it is best to abstain from any practice until you consult a doctor

How can you know if you have it?

Symptoms to pay attention for:

– Pain or burning feeling when you urinate

– Unusual secretions from the penis

– Pain or swelling in the testicles

– Persistent sore throat that does not heal with regular antibiotic treatments

– Redness or swelling of the tongue

– Redness, pain, infection around the anus or discharge from it

Genital Herpes

Description

There are many types of herpes that are not limited to affecting genital areas of the body. The sexually transmitted herpes infection causes blisters on the lips, penis including the foreskin, or around the anus. These blisters contain a fluid which become painful ulcers when they burst. You cannot always see herpes, and symptoms can appear within 2 to 20 days after the exposure. Herpes can be treated, but it cannot be fully cured. It can reappear when the person is sick, under stress, or when the immunity weakens (for example due to HIV)

Transmission

Herpes is transmitted in oral or anal sex (including riming) and with the direct contact with pimples or ulcers as they are very infectious. Be careful, it’s a self-contagious infection as it is transmitted by touch and kissing (from the mouth to the sexual organs and vice versa)

A condom does not fully protect from it.

How can you know if you have it?

Symptoms to pay attention for in the first stage (rarely cause ulcers in the sexual organs):

– Skin rash on the lips or around the mouth

Symptoms to watch out for in the second stage (usually causing ulcers on the genitals)

– Burning skin rash, and painful sores

– itching or tingling in the genitals (penis or testicles) or in the anus

– The persistent need to urinate

Warts

Description

It is one of the most common sexually transmitted infections, which causes a small, painful (s some cases) bump that appears on the penis, testicles, anus, and on the opening or inside of the vagina. They’re hard blisters that grow on the skin, if not treated it can spread to other parts of the body and cause penile or anal cancer. It takes 1 to 3 months after the exposure for the symptoms to appear. There is no cure for this infection but these pimples can be removed with burning, freezing with liquid nitrogen, or a small surgery (for example if they are inside the anus). However, they can reappear so treatment must be repeated. Also, some types of ointments for the skin can help treat these small warts

Transmission

These warts are transmitted through unprotected sexual contact when having sex with a man or woman alike (oral or anal sex) and direct contact with pimples. This infection can be contagious even if warts are not visible on the skin, and it can be transmitted from man to woman or vice versa, from man to man or a woman to woman

The condom does not fully protect from it

How can you know if you have it?

Symptoms to pay attention for:

Warts on the penis, testicles, around or inside the anus and around the mouth. Depending on the area of the infection, they could be painful, itchy, burning, discomforting and they may bleed

These warts can spread to other parts of the body and it’s also self-contagious

Hepatitis

Description

Hepatitis is virus that has several types A, B, and C, and can be transmitted through sexual relations and cause liver problems, yellow eyes, dizziness, abdominal pain and vomiting.

Hepatitis A

This virus can be transmitted if a person doesn’t wash/clean their hands well after using the toilet (defection). The transmission of hepatitis A is risky among people who pratice anal sex especially riming. The risk of transmission is from the consumption of feces which contains the virus. This virus can be prevented with a vaccine. The infection can lead to a difficult medical condition, but you can recover from it without any having long-term symptoms.

Hepatitis B

It is the most common hepatitis virus among adults. It’s transmitted through unprotected sex (without protective use) even without the direct exposure to blood or semen. It stays in your body for a long time which could lead to liver damage and increase the risk of developing cancer. It can be prevented by a vaccine. It’s difficult to treat, but it can be controlled with some new treatments. The condom protects you from it.

Hepatitis C

It’s usually transmitted through sharing injection needles between drug users or during unprotected anal sex (without using a condom). This virus stays in the body and could lead to liver damage for a very long time. It can be cured after treatment. There is no vaccine for hepatitis C and a condom protects you from it.

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