SAFER SEX 3.0

Condoms, PrEP & Protection by therapy

Safer sex prevents HIV

Each of the following three methods protects against HIV when used properly:

  • Condoms prevent HIV entering the body or mucous membranes during sex.

  • PrEP (Pre-Exposure Prophylaxis): HIV-negative persons take HIV medication that protects them from becoming infected during sex.

  • Protection by therapy: HIV drugs suppress the proliferation of viruses in the body, HIV cannot be transmitted during sex.

More information about the three methods can be found below.

Which safer sex method (currently) suits you, is your decision. You do not have to commit yourself once and for all, but can decide depending on the situation and phase of life. You can also use several methods simultaneously.

OUR TIP: Of course you can get advice on the individual topics from us: by phone on 0681 - 19 4 11 or in a personal conversation. You can find the telephone consultation times here. You can make an appointment for a personal consultation by phone or e-mail.

Especially for gay men, the German Aidshilfe offers a live chat. There, gay consultants answer your questions. Our street worker Achim is also part of the consultant team. You can reach the live chat at www.health-support.de.

Alternatively, you can call number 0180 33 19411 (9 cents per minute for calls from a German landline phone, a maximum of 42 cents per minute from the German mobile networks) to use the nationwide counselling offer of Aidshilfe centres: Monday to Friday from 9 AM to 9 PM and on Saturdays and Sundays from 12 PM to 2 PM. You can reach the free online counselling of Aidshilfe at www.hiv-counselling.org

(Note: The texts are essentially from the flyer "SAFER SEX 3.0 - More protection from HIV .You decide" of the campaign "ICH WEISS WAS ICH TU” (I KNOW WHAT I’M DOING) of Deutsche Aidshilfe e.V. and was supplemented by us, amonst ither things, with tips and regional information.)

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Condom

Condoms protect from HIV transmission. It is probably the best known safer sex method.

Watch out for:

  • quality: e.g. the condom should have a CE mark.

  • undamaged wrapping and the date of expiry.

  • proper storage: protect condoms from heat (such as direct sun) and pressure - therefore do not keep in a wallet or in your pocket for longer periods of time.

Furthermore:

  • Always use plenty of lubricant (water-soluble or silicone-based) to keep the condom from tearing. Greases and oils such as Vaseline or massage oil damage the rubber.

  • First pull the rubber over the hard cock, and then distribute the lube on the outside of the condom.

  • Use a new condom for each sexual partner.

  • Periodically check that the rubber is still in place. During long, vehement sex change condom.

  • After fucking pull out your cock while it is still hard, holding on to the condom.

OUR TIP: When used properly, condoms protect reliably from HIV. But they do not provide complete protection against other venereal diseases such as gonorrhea or syphilis. Therefore, have yourself checked regularly for other venereal diseases. You can find information about our test offer here.

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PrEP

PrEP (for pre-exposure prophylaxis) means "pre-risk precaution". In a PrEP, you take HIV medications to protect you from HIV infection. More information can be found at www.iwwit.de/prep.

Since September 1, 2019, people with a substantial HIV risk have been entitled to the drugs and necessary examinations for the HIV prophylaxis PrEP, provided that they have statutory health insurance and are at least 16 years old.

OUR TIP: You have questions about PrEP? We offer an open PrEP consultation once a month. The dates are published on the introductory page (link). You can also arrange consultation appointments with us outside the open consultation hours (0681 - 19 4 11 or info(at)gudd-druff.de).

Important for the effectiveness of PrEP is the correct application:

  • A negative HIV test is required before the start and four weeks after starting because if you are infected with HIV, the PrEP tablets are not sufficient for treatment and you may develop resistance.

  • Your kidney function and your hepatitis B status must also be checked. If you have kidney problems, you cannot use the PrEP.

  • During the PrEP, you must have an HIV test every three months and have your kidney levels ​​checked regularly.

  • Moreover, regular tests are recommended for venereal diseases, especially syphilis, gonorrhea and chlamydia.

OUR TIP: You can take the required initial and check-up examinations with your PrEP doctor. Costs can be borne by your health insurance if you are insured (starting from September 2019). The necessary regular HIV tests and examinations for syphilis, chlamydia, gonococci and possibly hepatitis B and C can be taken free of charge here at the Aids-Hilfe center every Tuesday from 6 - 8 PM. We can document the results in a "check book" issued by us. We do not offer the kidney function tests, you have to do these at the prescribing doctor’s office.

There are two alternatives for taking the PrEP:

1. Daily PrEP

  • "Loading phase" (before the first sex): 1 tablet per day for 4 days

  • Then continue 1 tablet daily

  • End or interruption of PrEP: After the last sex, one tablet a day for 2 days. Your doctor may also recommend a longer phasing-out period.

2. Cause-related PrEP (for example, on the occasion of a sex party or a vacation)

  • "Fast Charge": Take 2 PrEP tablets ideally 24 hours, no later than 2 hours, before the first sex. (Taking them only 2 hours before sex is considered very short, as the drug first has to enter the mucous membranes from the stomach via the blood.)

  • Then 1 tablet daily

  • End or interruption of PrEP: After the last sex, one tablet a day for 2 days. Your doctor may also recommend a longer phasing-out period.

The effectiveness of PrEP has been scientifically proven. The daily PrEP is recommended in the European and German-Austrian guidelines of the medical societies; the event-related PrEP is also possible according to the guidelines, but takes place outside the approval ("off-label use"). It is therefore not mentioned in the agreement between licensed doctors and statutory health insurance.


And here are answers to some frequently asked questions:
 
Which HIV medications can I use to do a PrEP?

Currently, Truvada is the only HIV drug in the world that has been proven effective and approved for PrEP. Also effective are Truvada generic drugs with the same active ingredients. We strongly advise against a PrEP on your own with other HIV drugs.

 
How can I obtain PrEP tablets and how much do they cost?

Since September 1, 2019, people with a substantial HIV risk have been entitled to the drugs and necessary examinations for the HIV prophylaxis PrEP, provided that they have statutory health insurance and are at least 16 years old.

"Persons with a substantial risk" refers amongst others to Men who have sex with men or trans*persons who

  • have had anal sex without a condom during the last three to six months and / or

  • are expected to have anal sex without a condom in the coming months and / or

  • had a sexually transmitted disease in the 12 months prior to the PrEP prescribing consultation

OUR TIP: It is important to have good medical advice and support. Prescribing, monitoring and billing may only be done by specialist competent doctors. We therefore recommend that you have the PrEP prescribed by a medical surgery that is familiar with HIV therapy. You can find the addresses of the Saarland HIV-specialized medical offices and the HIV outpatient center (HIV-Ambulanz) of the University Clinic in Homburg here.


The cost of necessary examinations for the PrEP as well as the medicines is met by insurance.

By agreement, the PrEP provision includes

  • the medical consultation,

  • the PrEP medication (insured persons pay the statutory co-payment) and

  • the examinations required before and during the PrEP:

    • HIV test before starting the PrEP, four weeks after starting and then every three months (if you are HIV-infected and take only the PrEP medication, HIV can multiply)

    • check of kidney function before starting PrEP and then every 3 to 12 months (those who suffer from kidney disease should not do PrEP)

    • hepatitis B test before PrEP onset (if PrEP is discontinued while hepatitis B is present, this can aggravate hepatitis).

In addition, depending on the risk, studies may be carried out on the sexually transmitted diseases syphilis, gonorrhea and chlamydia, which are also mentioned in the PrEP guidelines.

In addition, the PrEP guidelines recommend regular screening for hepatitis C.

The drugs are available in blister pack for the price of 40 euros for 28 tablets and without blister pack for around 70 euros for a monthly supply.

NOTE: In Saarland, blister packed PrEP is only available in the ‘Stadtapotheke’ in Saarbrücken.

 

Does the PrEP have side effects?

Most people tolerate the active substances well. Some complain at times about nausea, diarrhea, headache, abdominal and joint pain as well as fatigue or sleep disorders. However, prolonged use of PrEP tablets may decrease kidney performance - so PrEP is not suitable for persons with kidney problems. The renal function must be checked regularly in a PrEP. Bone density can also be reduced by PrEP. However, as with renal function, it usually returns to normal when you discontinue PrEP. Interactions with hormonal therapy in trans *men have not been reported.

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Protection by therapy

An HIV therapy started early makes a good and long life possible. In addition, the therapy protects HIV-negative sexual partners from HIV, because the HIV drugs suppress the proliferation of HI-viruses in the body.

HIV can then no longer be transmitted during sex.

The prerequisite is that the medication is taken conscientiously and the therapy is effective. This is checked by a doctor every three months.

Not a single case is known in the world where HIV transmission occurred under these conditions.

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Check for other venereal diseases

Apart from HIV, there are other sexually transmitted diseases, such as gonorrhea, syphilis or chlamydia. Condoms reduce the risk of infection but do not provide complete protection.

Therefore, get checked at least once a year for other venereal diseases, no matter whether you choose to protect yourself by condom, PrEP, or protection by therapy.

OUR TIP: Use our free test offer "Test it!". You can check for syphilis, chlamydia, gonococci (gonorrhea) as well as hepatitis B and C with us. The test dates can be found here.

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