Tested Negative

_ TESTED NEGATIVE? _

This book can help you stay that way.

JUST FOUND OUT YOU’RE HIV-NEGATIVE? Just found out you’re HIV-negative? Where you go from here is up to you. Your next HIV test could also be negative, or it could be positive. But you can be in control of that. You can stay negative.

You might not think this book is for you, but lots of people who have HIV didn’t think it would happen to them. Sometimes guys take risks without realising. Sometimes we know we’re taking risks and need help to make changes. This book can help you with both of those things.

Even though you have a negative test result now, this might not be the case in the future if you put yourself at risk. By reading this book and trying out That’s why it’s important to develop strategies to help keep you HIV-negative. some exercises you’re making a commitment to keep your negative We’ve written this book to help you. HIV status forever. What have you got to lose? There’s information you can read and exercises you can fill in. You don’t have to do it all though; look at the contents page to see what’s right for you.

CoNTENTS HIV TESTS

MAKING CHANGES

Everything you need to know about different types of HIV test.

Recognise the signs and symptoms of early HIV infection.

Find out when you should take your next HIV test.

How a negative HIV test might make you feel and how this could affect the sex you have.

Staying Safe 20

The importance of staying safe.

Time for you to think about what safer sex can do for you.

HIV and Risk These chapters are on risk; whether it’s risks you know you are taking, or risks you might not realise are there.

How to reduce risks if you fuck without condoms.

This page is helpful if you’ve been guessing someone’s HIV status. When a guy tells you he’s HIV negative, can you know for sure?

Information on different kinds of sex and their different levels of risk when it comes to HIV.

The second half of this book is designed to be as unique as you are. To get the most out of it, there are spaces for you to fill in. Try them out. It gives you a chance to really think about you, the sex you have and your future. Ultimately, it can help make sure the sex you have is as safe as you want it to be. You don’t have to fill all of the exercises in and even if you don’t do any of them, there’s still useful information and experiences from other guys.

Get to grips with the way you think about sex and change the unhelpful thoughts that can pop into your head.

Take control to get the sex you want.

Find your warning signs so you know when you might need extra help.

How risky is your sex? Identify your personal risks.

Make a plan to keep yourself healthy by setting goals.

Spot the differences between safer and unsafe sex. See the little differences that could affect the type of sex you have.

Find out what could be around the corner by looking ahead at your future sex life.

what if it goes wrong? 52

How to get back on track if things go wrong.

Information about PEP for those recently at risk of HIV infection.

Has this book helped you? Tell us what you think.

HELP AND SUPPORT 54

Various options for ongoing help and support after you have had a negative HIV test result.

CoNTENTS HIV TESTS

MAKING CHANGES

Everything you need to know about different types of HIV test.

Recognise the signs and symptoms of early HIV infection.

Find out when you should take your next HIV test.

How a negative HIV test might make you feel and how this could affect the sex you have.

Staying Safe 20

The importance of staying safe.

Time for you to think about what safer sex can do for you.

HIV and Risk These chapters are on risk; whether it’s risks you know you are taking, or risks you might not realise are there.

How to reduce risks if you fuck without condoms.

This page is helpful if you’ve been guessing someone’s HIV status. When a guy tells you he’s HIV negative, can you know for sure?

Information on different kinds of sex and their different levels of risk when it comes to HIV.

Get to grips with the way you think about sex and change the unhelpful thoughts that can pop into your head.

Take control to get the sex you want.

Find your warning signs so you know when you might need extra help.

How risky is your sex? Identify your personal risks.

Make a plan to keep yourself healthy by setting goals.

Spot the differences between safer and unsafe sex. See the little differences that could affect the type of sex you have.

Find out what could be around the corner by looking ahead at your future sex life.

what if it goes wrong? 52

How to get back on track if things go wrong.

Information about PEP for those recently at risk of HIV infection.

Has this book helped you? Tell us what you think.

HELP AND SUPPORT 54

Various options for ongoing help and support after you have had a negative HIV test result.

THE HIV TEST

wHICH TEST

So you’ve recently had an HIV test? This section will help you understand the type of test you had.

If you go for a sexual health checkup, most clinics now include an HIV test on an “opt out” basis - they tell you they’re doing an HIV test and you have an option to decline - rather than you asking for one yourself.

HIV does not show up in your blood right away, so if you’ve been at risk of getting HIV you have to wait a while before taking the test. The length of time you have to wait will depend on the type of test you take. During this “window period” the test would not be accurate. So which test did you have? It can depend on when you were last at risk of HIV; although you may have been tested as part of a check-up, even if you didn’t think you had risky sex.

Some clinics have more than one type of HIV test available, but not all clinics offer all types of test. To use the right test, the clinic needs to know how long it’s been since you were last at risk of getting HIV:

ANTIBODY TEST You may have also had the following options when you tested: • Didn’t give blood: see non-blood tests on page 10 for information on finger prick tests, swabs from the mouth and tests on samples of piss. • Had the results the same day as the test: see rapid tests on page 10. • Took the test at home: see home sampling on page 10. Details of how to find HIV testing near you can be found in the ‘Help and Support’ section at the back of this book.

Most HIV tests are antibody tests. Rather than testing for HIV itself, they test for antibodies to HIV - your body’s natural response to the virus. While these antibodies can often be detected within 2-8 weeks, it can take longer. That’s why it’s recommended that you wait until at least 3 months after the last time you were at risk of getting HIV before you take the test. If you get tested before 3 months have passed, you could get a negative test result even if you have HIV as antibodies may not have developed.

• 3 months or more: you may have had an antibody test (see page 7). • 1 month: you may have had a combined antigen/antibody test (see page 8). See page 24 for information on HIV risks. • 3-4 weeks ago: you may have had a p24 antigen test (see page 8). • Less than 3 weeks: if you went to a private clinic, you may have had a test for HIV’s genetic material (see page 8). This is not usually available for normal HIV testing. • Less than 72 hours (3 days): turn to page 53 for information on PEP.

THE HIV TEST

wHICH TEST

So you’ve recently had an HIV test? This section will help you understand the type of test you had.

ANTIGEN TEST Another type of HIV test is the p24 antigen test. The p24 antigen is a part of HIV. In the first few weeks after someone is infected with HIV, lots of p24 is produced and it can be detected in the blood. It usually takes about 3-4 weeks after someone is infected with HIV before there is enough of the antigen to be detectable, but it can take longer. You may have had a p24 antigen test 3-4 weeks after any risk of HIV infection. If you had a p24 antigen test you usually have to get an antibody test after 3 months too, to make sure it was accurate.

COMBINED ANTIGEN/ ANTIBODY TEST

TESTS FOR HIVâ&#x20AC;&#x2122;S GENETIC MATERIAL

The p24 antigen test is rarely used by itself but by combining it with an antibody test HIV can be diagnosed earlier than if antibody testing is used alone. This is important because if someone has HIV, they can be highly infectious before they develop antibodies to the virus. Many clinics now offer combined antigen/antibody tests (also known as fourth generation tests) which make earlier HIV diagnosis, within the 3-month window period, more likely. They can usually detect HIV after 1 month of being infected.

Some private clinics offer HIV tests which can detect HIVâ&#x20AC;&#x2122;s genetic material (the building blocks that make up the virus) around 9-12 days after being infected. These tests are very expensive and so are not routinely used. Usually, samples have to be sent away to a lab before you can get the results.

COMBINED ANTIGEN/ ANTIBODY TEST

TESTS FOR HIVâ&#x20AC;&#x2122;S GENETIC MATERIAL

RAPID TESTS

HOME SAMPLING

TESTING NEGATIVE

The length of time it takes to get your results depends on the type of test you have. Some clinics have tests that can take a few days or weeks to get the results. However, rapid tests are available in some clinics that can give you results in under an hour. The advantage of a rapid test is that you do not have to return to the clinic to get your result. You get them the same day.

It is generally recommended that HIV tests are done with medical supervision. However, home sampling kits are available. You take a sample (usually from inside your mouth with a swab) at home which you send to a laboratory for analysis. Your results are then given to you by a doctor.

A negative HIV test result can mean:

Rapid tests usually use small samples of blood taken with a syringe or a small prick in the end of your finder.

NON-BLOOD TESTS You can’t get HIV from saliva or piss but both contain antibodies. HIV tests are available in some clinics which detect antibodies to HIV in your piss, or in fluids in your mouth. These can be collected with a swab. This can be useful if you don’t like needles.

You can get these tests at: www.thtbypost.org.uk There are tests which you can take and get the results at home – similar to a pregnancy test – but these are currently unregulated in the UK and illegal to sell. Because of this, you have no guarantee that the result will be accurate.

• That you’ve avoided HIV infection up to that point. A negative HIV test result does not mean: • That you will never be infected with HIV. • That you are immune to HIV. • That the sex you are having is always safer sex. • That the people you’ve had sex with are all HIV negative. • That none of the people you’ve had sex with are HIV positive. Your negative HIV test is just the start of staying negative. Keeping your HIVnegative status is down to you, the kind of sex you have and the help you get from services that can support you.

RAPID TESTS

HOME SAMPLING

TESTING NEGATIVE

A negative HIV test result can mean:

Rapid tests usually use small samples of blood taken with a syringe or a small prick in the end of your finder.

wHEN SHOULD I TEST AGAIN?

SYMPTOMS OF EARLY HIV INFECTION

There are over 8,000 gay men in the UK who have HIV and do not yet know. That’s around a quarter of all the gay men living with HIV.

If you’ve tested negative in the past, it doesn’t mean you can never get HIV. If you have risky sex, you will need to test again to know if you have been infected.

Knowing your HIV status for sure, whether it’s positive or negative, can be empowering and puts you in control. It means the end of uncertainty, and an opportunity to make positive decisions about your lifestyle, health and relationships.

See page 24 for information on HIV risks. Not every unprotected fuck automatically gives you HIV. If you have sex with a guy who has HIV and don’t use condoms, you could still test negative. However, that’s no guarantee that you won’t get infected if you do the same thing again. Some people get infected with HIV the first time they fuck without condoms and some people get HIV only after having lots of unprotected fucks.

That’s why it’s recommended that you take an HIV test at least once a year if you’re having sex. This may vary depending on the type of sex you have. If you only have one partner who you know is HIV-negative, then testing regularly To be sure of staying negative, may be less important to you. If you are you need to avoid taking risks. having sex with lots of different partners, you may want to test more frequently.

Taking an HIV test is also recommended if you experience any symptoms linked to the early stage of HIV infection (often called primary infection or acute infection). Early HIV infection can have a variety of different symptoms. Some doctors believe that rash and fevers are most commonly linked with early HIV infection, especially if you have both together or with other symptoms.

These symptoms can be linked to many other illnesses too, like the flu, but it’s worth getting it checked out if you think it could be HIV. The longer you leave any health problems, the worse they can become. Earlier diagnosis and treatment means you’re more likely to have a healthy future.

Possible symptoms of early HIV infection: • Fever • Rash • Mouth ulcers • Joint pain • Sore throat • Loss of appetite • Weight loss • Muscle pain • Feeling overly tired • Feeling sick Most people (up to 90 percent) who get HIV will have at least one of these symptoms, but they may not realise it. Some people experience severe symptoms and some people experience very mild symptoms. They usually appear 1-4 weeks after becoming infected.

wHEN SHOULD I TEST AGAIN?

SYMPTOMS OF EARLY HIV INFECTION

There are over 8,000 gay men in the UK who have HIV and do not yet know. That’s around a quarter of all the gay men living with HIV.

If you’ve tested negative in the past, it doesn’t mean you can never get HIV. If you have risky sex, you will need to test again to know if you have been infected.

HOw A NEGATIVE HIV TEST MIGHT MAkE YOU FEEL Knowing that you are definitely HIVnegative gives you a chance to look back at the sex you’ve had and make some decisions about the future. But you need to know the facts to make the right choices for you. By talking to men who have tested negative in the last two years, researchers discovered that some men who thought that were being safe enough were actually putting themselves at risk of getting HIV. They put these men into four groups, based on their reasons for testing: • Men who thought they were safe enough • Men who slipped up • Men choosing high risk sex • Men who take regular risks

SAFE ENOUGH? Some men take an HIV test even when they think they are being safe. They don’t believe they are at risk of getting HIV. Sometimes that’s true - lots of guys do always have safer sex. But it’s not always that easy. We can falsely convince ourselves that taking risks once in a while won’t lead to HIV. You might think the sex you’re having isn’t risky because you wrongly believe HIV only happens to other people.

“Some guys have unsafe sex all the time. I don’t. I don’t sleep around as much as other guys and I fuck safer most of the time. I tested negative so I can’t have been that risky.” – Manny, 30 If you keep testing negative after taking risks you might think you will never get HIV. The truth is, HIV can happen to anyone who has unsafe sex. The more times you have unsafe sex, the more times you are putting yourself at risk. However, you could still get HIV after one unsafe fuck.

SLIPPING UP

CHOOSING HIGH RISk SEX

REGULAR RISk

You might be the type of guy who takes an HIV test because you know that you have been at risk of HIV infection. Fucking without condoms may not happen a lot. You know it’s risky but it was a “slip up” from your usual safer sex.

Some guys have risky sex even if they know that they could get HIV. This might be because they don’t fully understand the consequences of being infected, or because they don’t believe they will get HIV. After testing negative, they can start to feel that the risk of getting HIV isn’t that great, because they always get a negative result.

You might be one of the men who finds themselves taking risks regularly. This can be for a variety of reasons, like feeling down, getting drunk or taking drugs. When they get an HIV test, some of these men are very anxious as they know that it could be positive. If the result is negative it can be an opportunity to change.

Some people slip up in the heat of the moment, or because they’ve slept with a guy a few times and so don’t think condoms are as important. Others say it was because they thought it would be more intimate. If you slip up and then test HIV-negative it can give you a false sense of security. You might think you got away with it and so slipping up again will be OK too. This leads to some guys taking more risks.

“If you test negative, it can make you think what you’re doing is OK. You try different things out; just fucking for a little while without condoms or just being a top. You think it’s like, yes, I’m still OK, so you fuck without condoms more. It’s not until you test positive that you realise you could have got HIV any of those times.” – Grant, 26

“I was just happy that it was all clear, that I hadn’t picked anything up or passed anything on. It made me think that I’ve been doing a balancing act but that things are going happily.” – Josh, 49 Testing negative can reduce anxiety about HIV at first, but it doesn’t offer protection against HIV. Continuing to take risks led to some of these men becoming HIVpositive soon after their negative result.

“It makes you feel, right, fresh start. No infections, no nothing, and stay like that.” – Deepak, 24 For others, it can make unsafe sex seem less risky. Some men wrongly believe that they have something about them that means they can’t get HIV.

“I thought it’s bound to be positive this time, with the amount of drug fucks I’d had. And it wasn’t. I was like, OK, I’ve done lots of risky things and I seem to not be getting it.” – Dale, 51 But even if the HIV test result is negative at that point, if they don’t make changes to the type of sex they have they could get HIV in the future.

There are lots of guys who now have HIV because they slipped up. Calling an unsafe fuck a ‘slip-up’ makes it sound like you have no control but if you want to stay HIV-negative, you can be in control. It’s not always easy but this book can help you with that. 16

SLIPPING UP

CHOOSING HIGH RISk SEX

REGULAR RISk

STAYING SAFE Sometimes there can be little information given to us when we get a negative HIV test so we’re left to draw our own conclusions about what the result means. Taking an HIV test might give you a sense of relief, but it doesn’t tell you the sex you have carries no risks. Some guys make decisions about the sex they have in the future because of their HIV test result.

“The first time I had a test I was utterly, you know, nerve racked by the whole thing. But subsequently, you know, if you do it twice yearly for some years, or even more regularly, and it’s negative, negative, you begin to get, I wouldn’t say complacent, but you think, well, this is fine, you know, I’m never going to get this.” – Rob, 46 If you choose to take more risks then you can’t guarantee you’ll stay negative. HIV could be on the cards for you in the future. But a negative test result can be the starting point to staying negative forever. You can choose to make some changes. The rest of this book can help you avoid HIV for good by giving you the facts, helping you to always practise safer sex and showing you where to get support when you need it.

REMEMBER... • HIV is very serious but avoidable. • It’s easy to say ‘just this once’ but one unprotected fuck could lead to HIV. • If you slip up and have risky sex, you can still go back to safer sex. • You can be in control of the sex you have and in control of your health. • We can all change our behaviour if we equip ourselves to make that change. • You are able to protect yourself from HIV and stay negative. • We all need a little help from time to time. • This book can help you to make your sex safer.

SAFER SEX AND YOUR HEALTH Safer sex is any sex that prevents one guy’s cum, blood or anal mucus (the stuff that lines the inside of the arse) getting into someone else’s body. These fluids can carry infections. Condoms used for fucking, with waterbased or silicone-based lube, are the surest way to protect you or your partner against HIV infection - and most other sexually transmitted infections too.

While HIV has become easier to live with, it still has a major impact on your life, health and relationships. HIV and other sexually transmitted infections have also been linked to serious illnesses in later life, ranging from heart disease to cancer. They can stay in your body for many years if they aren’t treated. This can cause damage to your heart, brain, bones and other parts of your body.

For information on how to use condoms correctly, and how to reduce the chance of them breaking, go to www.gmfa.org.uk/condoms or see ‘Help and Support’ at the back of this book.

Protecting yourself and your partners isn’t just about health; it also makes it easier to keep having great sex. Getting any STI can put you out of action while you get it sorted out. What’s more, one study found that around a third of people with HIV had found sex difficult in the last month, most often due to treatment side effects or the psychological impact of HIV.

It makes sense to stick to safer sex. We all want to avoid illness, so reducing your chances of getting sexually transmitted infections can only be a good thing. The immediate health benefits aren’t the only reason for safer sex. It can protect your future health too.

Safer sex can help you avoid all that and it means you don’t have to worry about what you might have picked up.

“I used to slip up every now and then, especially if I’d slept with a guy a few times. I’d worry about it for weeks afterwards and eventually get a check-up. One day I realised that it just wasn’t worth the worry. It’s just easier to stay safe.” – Alan, 29 There’s more information about HIV and STIs at www.gmfa.org.uk/sex or see ‘Help and Support’ at the back of this book.

For information on how to use condoms correctly, and how to reduce the chance of them breaking, go to www.gmfa.org.uk/condoms or see ‘Help and Support’ at the back of this book.

Safer sex can help you avoid all that and it means you don’t have to worry about what you might have picked up.

SAFER SEX AND YOU It can also help to write down what could happen if you have unsafe sex. Think about some of the things you want to avoid.

I want to avoid…

Reason 2.

“Illness and life-long medication.” – Deepak, 24

Reason 3.

“Worry, stress and anxiety.” – Grant, 26

If you’ve taken risks in the past, making changes can be empowering, giving you control over your life, relationships and health.

I want to have safer sex because…

We’ve given you some of the reasons why we think safer sex is important but if you want to stay HIV-negative, it can help to think about your own reasons for staying negative. Writing down your reasons helps you to remember why they are important to you. They might sound obvious at first but writing them down gives you something to look back on.

Reason 1.

“Added difficulties with my relationships.” – Rob, 46

Here’s what other gay men said:

“I like sex. In fact I love it. Using a condom lets me enjoy fucking without worrying about the risks.” – Grant, 26 “I have a partner and I want to protect us both from HIV.” – Rob, 46 “I don’t want to take HIV medication.” – Deepak, 24 “I try my best to stay healthy. Safer sex is part of that.” – Manny, 30

SAFER SEX AND YOU It can also help to write down what could happen if you have unsafe sex. Think about some of the things you want to avoid.

I want to avoid…

Reason 2.

“Illness and life-long medication.” – Deepak, 24

Reason 3.

“Worry, stress and anxiety.” – Grant, 26

If you’ve taken risks in the past, making changes can be empowering, giving you control over your life, relationships and health.

I want to have safer sex because…

Reason 1.

“Added difficulties with my relationships.” – Rob, 46

Here’s what other gay men said:

LOw RISk OR NO RISk In order to stay HIV- negative, you need to know about sex. Different types of sex carry different levels of risk when it comes to HIV. Using condoms and lube for fucking is low risk when it comes to HIV. There are lots of other ways to have safer sex too. You might want to try some really horny, really low risk things which don’t involve fucking. No one has ever caught HIV from kissing, wanking, nipple play, rimming (licking arse) or getting pissed on. That doesn’t mean that there’s no risk of other infections from these things though. Only you can decide what risks are right for you. Information about other STIs and condoms can be found at www.gmfa.org.uk/sex or see ‘Help and Support’ at the back of this book.

The risks involved with some types of sex, like fisting or using sex toys, can vary. Fisting is safest if you use latex gloves as any tiny cuts on your or his hand could provide a route for HIV to get from one person to another. If more than one person is being fisted, HIV could be passed from one of the guys getting fisted to another, via anal mucus or blood carried on the fist. That’s also why sex toys shouldn’t be shared unless they’ve been washed thoroughly or used with a different condom for each person.

Highest Risk

Risk of HIV

Using a condom and water-based or silicon-based lube for fucking will help you avoid HIV. It could be risky if the condom breaks, but that can usually be avoided if they are used correctly. For information on how to use condoms correctly, and how to reduce the chance of them breaking, go to www.gmfa.org.uk/condoms or see ‘Help and Support’ at the back of this book.

Getting fucked without condoms and getting his cum in your arse

Sharing needles for injecting drugs

Getting fucked without condoms but not getting his cum in your arse

Fucking a guy’s arse without using condoms

Sucking a guy’s cock and getting his cum in your mouth Fisting (without using new latex gloves for each partner)

Sharing sex toys (without using a new condom on them for each partner)

Sucking a guy’s cock but not getting his cum in your mouth Lowest Risk

Getting fucked by a guy using condoms and lube

Fucking a guy using condoms and lube

Fisting (using new latex gloves for each partner) Sharing sex toys (if a new condom is used with each partner)

No one has caught HIV from:

Nipple play Pissing on a guy or getting pissed on

Wanking Rimming Kissing

Highest Risk

Risk of HIV

Getting fucked without condoms and getting his cum in your arse

Sharing needles for injecting drugs

Getting fucked without condoms but not getting his cum in your arse

Fucking a guy’s arse without using condoms

Sucking a guy’s cock and getting his cum in your mouth Fisting (without using new latex gloves for each partner)

Sharing sex toys (without using a new condom on them for each partner)

Sucking a guy’s cock but not getting his cum in your mouth Lowest Risk

Getting fucked by a guy using condoms and lube

Fucking a guy using condoms and lube

Fisting (using new latex gloves for each partner) Sharing sex toys (if a new condom is used with each partner)

No one has caught HIV from:

Nipple play Pissing on a guy or getting pissed on

Wanking Rimming Kissing

RISk REDUCTION

BEING A TOP

VIRAL LOAD

POPPERS

While there are ways of reducing the risk of HIV infection if you fuck without condoms, they do not ensure that you will stay HIV-negative. They may help you reduce your chances of getting HIV, but there is no guarantee that you won’t get infected. They are not as safe as always using condoms.

Gay men are more likely to catch HIV from being fucked (being bottom) than from fucking (being top). Although there is less risk of catching HIV if you’re a top, many men are still infected this way.

Viral load is the term used to describe the amount of HIV a person has in their bodily fluids, like blood and cum. The lower the viral load of an HIV-positive person, the less infectious they will be. Modern HIV treatments mean that people with HIV can have a very low, or even undetectable, viral load.

Poppers (amyl nitrite) can increase the chances of HIV transmission when an HIV-negative guy uses them whilst being fucked by a positive guy. Some researchers think that this is because it can cause the blood vessels in your arse to dilate. This gives the virus a better chance of entering the bloodstream. However, if you don’t use poppers and fuck without condoms you could still get HIV, and using poppers doesn’t automatically mean you will get HIV.

SERO SORTING For HIV to be transmitted through sex, one of the guys must be HIV-positive. Sero-sorting means selecting partners with the same HIV status as you (i.e. HIV-positive men only sleep with other HIVpositive men, HIV-negative men only sleep with other HIV-negative men). If everyone only had sex with people who had the same HIV status then there would be no increase in the number of people with HIV. The challenge is to know someone’s HIV status for sure. Between one in eight and one in ten gay men in London have HIV. While you may be able to tell that some of these men have HIV, in most cases you won’t. Around a quarter of the guys infected with HIV in the UK don’t even know themselves. 26

There is HIV in the anal mucus (the stuff that lines the arse) of an HIVpositive man. This can enter the body of the guy doing the fucking through the end of his cock. Research tells us that you are more likely to get HIV from fucking a guy without condoms than you are from giving him a blow job - even if you get his cum in your mouth.

wITHDRAwAL Pulling out before cumming may reduce the chances of getting HIV for the guy who’s getting fucked because there’s more HIV in cum than there is in precum. It’s still possible to get infected if you get pre-cum in your arse that contains HIV. It’s extremely unlikely that HIV will be transmitted from sucking cock if you don’t get cum in your mouth.

Unfortunately it is very difficult to know exactly what level the viral load is at. Even if someone is taking HIV treatment, their viral load can alter dramatically in a short period (especially if they pick up any other infections, including the flu). What’s more, doctors only usually measure the viral load in someone’s blood. This isn’t the same as it is in his cum, pre-cum or anal mucus - all of which can transmit HIV.

HAVING LESS SEX If you have less sex, or sex with fewer men, you may reduce the likelihood that you’ll have sex that passes on HIV. You don’t eliminate the risk altogether; men have been infected with HIV after one unsafe fuck.

RISk REDUCTION

BEING A TOP

VIRAL LOAD

POPPERS

kNOwING HE’S NEGATIVE Even when you know the risks, sometimes the guy you are with can make sex feel safer. If you’re having sex and you think you’re both HIVnegative, then using condoms might not seem important. But if you want to have sex without condoms and stay negative, you have to be sure you are both HIV-free. That’s the tricky part. Guys are more likely to fuck without condoms if they both have the same HIV status. However, researchers discovered that around 40 percent of HIV-negative men who say they ‘know’ their partner’s HIV status are in fact guessing. Even if a guy tells you he’s negative, he may not know for sure. Around a quarter of the guys infected with HIV in the UK don’t know yet, because they haven’t tested. Anonymous surveys and blood tests have confirmed that some men who are HIV-positive think they are negative. You can make up all sorts of reasons why you think someone’s HIV-negative – how he looks or behaves, where he goes out, the fact that you’ve already fucked a few times and know him quite well. The truth is, you won’t know for sure.

TESTING TOGETHER And there’s no guarantee that someone who knows they are HIV-positive will tell you. He might find it difficult because there’s so much stigma or rejection. Maybe he thinks you’re positive too because you haven’t mentioned condoms. Or maybe he just doesn’t feel like telling you.

If you’ve had sex with someone a few times, or you’re starting a relationship, you might find it harder to keep having safer sex. If you want to have sex without condoms it’s important to get an HIV test together. Even if you both think you are negative, you need to be absolutely certain to avoid HIV for sure.

Three quarters of the UK’s gay men expect a guy with HIV to tell them before sex, but that doesn’t mean it will happen. Only 20 percent of diagnosed positive men always disclose their HIV status.

Lots of guys have got HIV because they stopped using condoms with a guy who they thought was negative. It’s difficult to know the exact fuck that led to someone getting HIV but studies have asked recently infected HIV-positive men when they thought it happened. Roughly a third thought it was from fucking with a regular partner.

Hoping someone will tell you, or knows, their own HIV status puts your safety in their hands. Taking responsibility for the sex you have puts you in control.

If you want to stop using condoms with a partner, taking a test together helps you make an informed decision and avoid the guesswork. If you both test negative, you can decide if you want to rely on the trust and security of a

relationship to stay HIV-negative. Many gay guys use this safer sex strategy with a long-term partner and, if you both test negative and don’t fuck without condoms outside the relationship, it can work. Remember to tell the clinic about any recent risky sex, so that you get an accurate HIV test result. See page 6 for more details of HIV tests. If you and your partner are both happy having sex outside your relationship, you can have an agreement that any sex outside that relationship is safer sex. It can help to discuss what you would do if one of you did slip up. Having rules and being honest can help you to keep each other safe and avoid bringing HIV into your relationship.

Three quarters of the UK’s gay men expect a guy with HIV to tell them before sex, but that doesn’t mean it will happen. Only 20 percent of diagnosed positive men always disclose their HIV status.

Hoping someone will tell you, or knows, their own HIV status puts your safety in their hands. Taking responsibility for the sex you have puts you in control.

HOw RISkY IS YOUR SEX? What kind of sex have you had that Recognising any risks that you take with was risky? What was risky about it? sex, and why you take them, is a huge step towards staying HIV-negative. If you Write it in the space below. know why you’ve had risky sex, you can make the changes that you want to make. 1. Some people think that taking risks is just about slipping up, but lots of factors can play a part. Alcohol and drugs can affect your decisions, or you might want to stop using condoms with a guy you really like, or you might believe a guy is negative without knowing for sure. There are lots of reasons but you can be in control. You don’t have to slip up or take risks that you’re not happy with. Using what you’ve read, or know, about safer sex, think about times when you’ve had sex that wasn’t as safe as you wanted it to be. You don’t need to think about the reasons why yet, just the type of sex you’ve had.

2. 3.

Here’s what some other guys said:

“I got fucked by a guy without using condoms. He told me he was negative, but I didn’t know for sure. If he was positive I could have got HIV.” – Alon, 37 “I got fucked by a guy who was HIV positive. We didn’t use condoms and he said he wouldn’t cum inside me. I know it was still risky though.” – Josh, 49

An HIV risk is something that can put you at risk of getting HIV. That doesn’t mean that you will definitely get HIV if it happens, but there is a possibility that you could get HIV. The more times it happens, the more times you risk getting infected with HIV. But it could happen the first time.

“I sometimes don’t use condoms if I’m a top. It’s risky because I could still get HIV.” – Clive, 23 “I got fucked without condoms by this guy after we got a bit drunk. We’d been together a few weeks. It just happened.” - Philippe, 19

If you’re still not sure try looking at page 24 for information on sex that’s ‘Low Risk or No Risk’.

2. 3.

Here’s what some other guys said:

If you’re still not sure try looking at page 24 for information on sex that’s ‘Low Risk or No Risk’.

SEX SPOT THE DIFFERENCE If you want to change something, it helps to know why it happens. By looking at the times you’ve had safer sex and the times you’ve had unsafe sex, you can start to see differences. This can help you to understand the choices you make, so that you can make sex as safe as you want to. 1. This exercise can help. Draw a line down the middle of a piece of paper so it’s in two columns. Start by thinking about a time you had sex that wasn’t as safe as you wanted it to be. Write down answers to the following questions in the left hand column. There are some examples to help. It’s important to be honest with yourself when you look back at the sex you’ve had. You don’t have to show this to anyone else; you’re doing it for you.

YOU

HIM

What were you thinking about that could have affected the sex you had? “I was on my own, looking for a fuck.”

Was there something about the sex or the guy/guys that made the sex less safe? “He looked fit and healthy so I didn’t even think about HIV.”

How were you feeling? Did your feelings affect your decisions about sex? “Bit low, crap week and no boyfriend.” What alcohol or drugs had you taken? How much? When? “Had a few drinks and a bit of charlie.” What were you thinking and feeling just before you knew you were about to have an unsafe fuck? “I didn’t want it to happen but I didn’t want him to stop fucking me either.” Was there something you said or didn’t say that made the sex less safe? “I didn’t really say anything. I didn’t mention condoms.”

Did he do something to make you feel safe even though the sex was risky? “He didn’t mention condoms or HIV so I assumed he was negative too.” Was there something you wanted from him or to give him? “Sex, I suppose, that feeling of someone inside me. Being with someone.”

THE PLACE What was the day and time of day? “Late at night.” Where were you when you met the guy? What had you been doing before and were you with anyone? “I met him at a bar.”

SITUATION Had anything happened earlier that was affecting the situation? “Had a bad week at work so wanted to let my hair down.” What happened when you had sex? What was it about the sex that was not as safe as you wanted? How did it make you feel? “I felt nervous. We didn’t talk much, it was just happening. I didn’t want him to stop fucking but I wanted him to use a condom.” What did you do to be in control of the situation? Was he in control? “I didn’t, I left it to him to make the decisions” What else played a part? Who else was there? Was there something about the sex or the guy? “I really wanted him to like me.”

YOU

HIM

What were you thinking about that could have affected the sex you had? “I was on my own, looking for a fuck.”

Was there something about the sex or the guy/guys that made the sex less safe? “He looked fit and healthy so I didn’t even think about HIV.”

THE PLACE What was the day and time of day? “Late at night.” Where were you when you met the guy? What had you been doing before and were you with anyone? “I met him at a bar.”

SEX SPOT THE DIFFERENCE 2. Now think about the last time you had sex that was as safe as you wanted it to be. In the right hand column, write down as honestly as you can exactly what happened.

YOU

HIM

SITUATION

What were you thinking about that could have affected the sex you had? “Had the weekend to myself, looking to hook up with someone.”

Was there something about the type of sex or the guy/guys that made you have safer sex? “He was online looking for sex so it wasn’t like he was a virgin! I just thought it was best to be safe.”

Had anything happened earlier that was effecting the situation? “Was feeling good, had a good week at work and was feeling confident.”

How were you feeling? Did your feelings affect your decisions about sex? “Good, relaxed. It was the start of the weekend.” What alcohol or drugs had you taken? How much? When? “Glass of wine.” What were you thinking and feeling just before you knew you were about to have sex? “Good, relaxed. We’d chatted. He’d been round for a bit before we fucked. We’d had a laugh.” Was there something you said or didn’t say that made the sex safer? “We talked about condoms online. He asked if I had them and I said I did, that I wasn’t into bareback.”

Did he do something that made you have safer sex? “Talked about condoms so I knew we would use them.” Was there something you wanted from him or to give him? “Mostly just his arse.”

THE PLACE

What happened when you had sex? What was it about the sex that made it as safe as you wanted? How did it make you feel? “I felt relaxed. I wasn’t worried. We were both into each other and both asking for what we wanted.” What did you do to be in control of the situation? Was he in control? “Talked about what sex we wanted.” What else played a part? Who else was there? Was there something about the sex or the guy? I was feeling relaxed with him so could talk easily.

What was the day and time of day? “I met him in the evening at my house.” Where were you when you met the guy? What had you been doing before and were you with anyone? “Chatting online.”

SEX SPOT THE DIFFERENCE 2. Now think about the last time you had sex that was as safe as you wanted it to be. In the right hand column, write down as honestly as you can exactly what happened.

YOU

HIM

SITUATION

What were you thinking about that could have affected the sex you had? “Had the weekend to myself, looking to hook up with someone.”

Was there something about the type of sex or the guy/guys that made you have safer sex? “He was online looking for sex so it wasn’t like he was a virgin! I just thought it was best to be safe.”

Had anything happened earlier that was effecting the situation? “Was feeling good, had a good week at work and was feeling confident.”

Did he do something that made you have safer sex? “Talked about condoms so I knew we would use them.” Was there something you wanted from him or to give him? “Mostly just his arse.”

THE PLACE

What was the day and time of day? “I met him in the evening at my house.” Where were you when you met the guy? What had you been doing before and were you with anyone? “Chatting online.”

SEX SPOT THE DIFFERENCE Think about the sex you have that is as safe as you want it to be and the sex you have that isn’t. Look back at your answers from pages 32-35 to help you. What did you do differently? Try writing a few things in the space below. Don’t just focus on the down side and the things you didn’t do, think about the positive things you did to make sex safer too.

Here’s some of the things that other guys said:

“If a guy tells me he’s HIV-negative, I’m more likely to fuck without condoms. I don’t really know his HIV status though.” – Philippe, 19 “I have more unsafe sex if I’ve had a drink or taken drugs.” – Josh, 49 “If it’s a one-off shag I use condoms but if I’ve met a guy a few times, sometimes you just get carried away and don’t use them.” – Deepak, 24 “If I talk about the sex I want, it’s easier to mention condoms.” – Manny, 30 “If I carry condoms with me, I’m more likely to use them.” – Clive, 23 “If I’m feeling confident, I feel in control of the sex I have.” – Dale, 51 “If a guy doesn’t tell me he’s positive, I just assume he’s negative.” – Steve, 32 “I sometimes guess a guy’s status, to see if I should use condoms. If they say something, or look a certain way.” – Alon, 37

Here’s some of the things that other guys said:

UNHELPFUL THOUGHTS The way we think and feel can be a powerful thing and it can affect our decisions about safer sex. ‘Unhelpful’ thoughts and feelings can change the way we behave which can make unsafe sex more likely.

Rather than acting on ‘unhelpful’ thoughts and feelings, ‘helpful’ thoughts can steer us in the direction that we want. They can remind us why we want to stay safe. Here are some ‘unhelpful’ thoughts that other gay guys have had and the ‘helpful’ thoughts that kept them safe.

Then jot down some opposing powerful thoughts about safer sex. Writing them down will make them easier to remember when you need them.

If I have this unhelpful thought…

I remember this…

If I have this unhelpful thought…

I’ll remember…

“I want his naked cock in my arse so we can feel more intimate.”

“I want to be intimate not infected. If we care about each other we want to protect each other.” – Manny, 30

“It looks hot when guys fuck without condoms in porn films.”

“What I see on screen isn’t the real world. Guys who do porn have to take HIV tests all the time and they’re still putting themselves at risk.” – Rob, 46

“If I get HIV now, I’ll still be healthy until I’m 50 or 60.”

“HIV can still make people ill and the side effects of medications can cause short- and long-term problems.” – Alon, 37

“I want to try sex without condoms.”

“If I get HIV and then meet someone who’s negative, we’d always have to use condoms. I want to have the option one day when I know it’s safe.” – Deepak, 24

“It’s just one time.”

“Some people get HIV after just one unprotected fuck.” – Philippe, 19

Now it’s your turn. Your thoughts are as unique as you are, so think about the thoughts you’ve had when you’ve have unsafe sex and write them down.

Helpful thoughts shouldn’t be downbeat. There are many positive reasons for staying safe.

Then jot down some opposing powerful thoughts about safer sex. Writing them down will make them easier to remember when you need them.

If I have this unhelpful thought…

I remember this…

If I have this unhelpful thought…

I’ll remember…

“I want his naked cock in my arse so we can feel more intimate.”

“I want to be intimate not infected. If we care about each other we want to protect each other.” – Manny, 30

“It looks hot when guys fuck without condoms in porn films.”

“What I see on screen isn’t the real world. Guys who do porn have to take HIV tests all the time and they’re still putting themselves at risk.” – Rob, 46

“If I get HIV now, I’ll still be healthy until I’m 50 or 60.”

“HIV can still make people ill and the side effects of medications can cause short- and long-term problems.” – Alon, 37

“I want to try sex without condoms.”

“If I get HIV and then meet someone who’s negative, we’d always have to use condoms. I want to have the option one day when I know it’s safe.” – Deepak, 24

“It’s just one time.”

“Some people get HIV after just one unprotected fuck.” – Philippe, 19

Now it’s your turn. Your thoughts are as unique as you are, so think about the thoughts you’ve had when you’ve have unsafe sex and write them down.

Helpful thoughts shouldn’t be downbeat. There are many positive reasons for staying safe.

TAkE CONTROL Being in control of the sex you have is about making choices and feeling confident in sticking to those choices. It’s about feeling able to say no to the things you don’t want and yes to the things that you do.

Assertiveness isn’t about making demands or being aggressive, it just means being direct and clear about what you want. When people talk about the things they want, they can behave in different ways:

If a guy wants you to try something you’re not into, or something that’s too risky for you, being assertive allows you to stick to your choices.

Here’s why being assertive puts you in control while being passive or aggressive can lead to problems: PASSIVE communication

ASSERTIVE communication

People who use passive communication often avoid telling people their opinions or feelings, letting others make choices for them. This can allow others to manipulate them and what they do.

Being assertive means stating your opinions and feelings clearly, appropriately, and respectfully. People who have learnt to be assertive often have a sense of high self-esteem. They are very respectful of the rights of others and often feel in control of situations.

“I don’t mind. Do what you want.” Passive Apologetic Dependent Indecisive Anxious Nervous

Passive Aggressive

Aggressive

Indirect Helpless Deceitful Defensive Blaming Manipulative

Overbearing Arrogant Hurtful Bullying Controlling

Assertive

AGGRESSIVE communication

Direct Honest Forgiving Effective Independent

Aggressive communicators can be verbally and/or physically abusive. They express their feelings and opinions in a way that violates the rights of others. They can be loud, demanding, and overbearing. They blame others instead of owning their issues.

“This is what I would like but I respect your choices too.” Assertiveness allows us to take care of ourselves, and can be good for your mental health, life and relationships.

“Do it!” PASSIVE-AGGRESSIVE communication Appearing passive on the surface but acting out anger in a subtle, indirect, or behind-the-scenes way is known as being passive-aggressive. It usually comes from feeling powerless, and incapable of dealing directly with an issue. There may be difficulty acknowledging feelings.

“OK, I’ll do whatever you say. You asked for it.” 40

If a guy wants you to try something you’re not into, or something that’s too risky for you, being assertive allows you to stick to your choices.

Here’s why being assertive puts you in control while being passive or aggressive can lead to problems: PASSIVE communication

ASSERTIVE communication

People who use passive communication often avoid telling people their opinions or feelings, letting others make choices for them. This can allow others to manipulate them and what they do.

“I don’t mind. Do what you want.” Passive Apologetic Dependent Indecisive Anxious Nervous

Passive Aggressive

Aggressive

Indirect Helpless Deceitful Defensive Blaming Manipulative

Overbearing Arrogant Hurtful Bullying Controlling

Assertive

AGGRESSIVE communication

Direct Honest Forgiving Effective Independent

“This is what I would like but I respect your choices too.” Assertiveness allows us to take care of ourselves, and can be good for your mental health, life and relationships.

“OK, I’ll do whatever you say. You asked for it.” 40

ASkING FOR SEX Imagine a situation where you would want to ask a guy to have safer sex. 1. Describe the situation.

“About to have sex and no one’s mentioned condoms.”

REFUSING A REQUEST 6. Think of what you want to achieve in this situation and write down a request that that is clear and direct.

Imagine a situation where you would want to refuse a guy’s request for unsafe sex.

“You’re really hot, I really want to fuck. Do you have condoms? If not I’ll get some.”

“A cute guy asks me to bareback and says he’s HIV negative.”

1. Describe the situation.

2. How would you currently behave?

“I would rely on him to get them.”

“Might do it, if I believed him.”

3. How does this make you feel in control?

“It doesn’t, I just assume I’ll get away with it.”

“No, it puts him in control and I’d worry about it for ages after.”

4. How could you be more assertive?

“I could mention condoms earlier, and only have safer sex.”

“Tell him I don’t have unsafe sex so it’s clear.”

5. Are your rights, and the rights of the guy you’re with, being respected? Would either of you feel out of control? Why?

6. Think of what you want to achieve in this situation and write down a request that that is clear and direct.

“I really want to fuck but I don’t do bareback.”

“I think we’d both feel a bit out of control.” “I don’t think he’s thinking about what I want.” 42

ASkING FOR SEX Imagine a situation where you would want to ask a guy to have safer sex. 1. Describe the situation.

“About to have sex and no one’s mentioned condoms.”

REFUSING A REQUEST 6. Think of what you want to achieve in this situation and write down a request that that is clear and direct.

Imagine a situation where you would want to refuse a guy’s request for unsafe sex.

“You’re really hot, I really want to fuck. Do you have condoms? If not I’ll get some.”

“A cute guy asks me to bareback and says he’s HIV negative.”

1. Describe the situation.

2. How would you currently behave?

“I would rely on him to get them.”

“Might do it, if I believed him.”

3. How does this make you feel in control?

“It doesn’t, I just assume I’ll get away with it.”

“No, it puts him in control and I’d worry about it for ages after.”

4. How could you be more assertive?

“I could mention condoms earlier, and only have safer sex.”

“Tell him I don’t have unsafe sex so it’s clear.”

5. Are your rights, and the rights of the guy you’re with, being respected? Would either of you feel out of control? Why?

6. Think of what you want to achieve in this situation and write down a request that that is clear and direct.

“I really want to fuck but I don’t do bareback.”

“I think we’d both feel a bit out of control.” “I don’t think he’s thinking about what I want.” 42

wARNING SIGNS Sometimes, certain situations can make taking risks more likely.

This is what sometimes happens and can lead to unsafe sex:

If you know what things are likely to increase the chances of you having unsafe sex, you can take control and change those situations.

Try to list at least 3 specific things which might lead to you having unsafe sex.

Once you’ve written down a few ideas, you can look back over them and find the ones that are most likely to work.

Write down anything that comes into your head at first.

Answer these questions for each of your ideas. Then pick ones that have more good consequences than bad.

1. Is there something about you that you could do differently? Something you could say?

1. How would you be able to make that change? What would you need?

If you’re having trouble identifying warning signs, think about the differences between the times you’ve had safer and unsafe sex

Here are some examples from other guys:

The ‘Sex Spot the Difference’ exercise on page 32 may help.

“Going on a huge bender and doing loads of drugs.” – Manny, 30

“Not having condoms.” – Steve, 32

“If he tells me he’s HIV negative and I believe him without really knowing.” – Grant, 26 “If I’m feeling a bit down and want to be with someone.” – Josh, 49

Now use the spaces below to jot down some possible ways of either changing those situations or making sure you can still have sex that’s as safe as you want it to be.

2. Is there something about the situation you could change?

2. What good things would happen if you did it?

3. How could you feel in control? 3. What bad things would happen if you did it? 4. Was there something about your state of mind that you could change or get help to change?

See ‘Help and Support’ at the back of this booklet for the kind of support that’s available to help you make these changes.

wARNING SIGNS Sometimes, certain situations can make taking risks more likely.

This is what sometimes happens and can lead to unsafe sex:

If you know what things are likely to increase the chances of you having unsafe sex, you can take control and change those situations.

Try to list at least 3 specific things which might lead to you having unsafe sex.

Once you’ve written down a few ideas, you can look back over them and find the ones that are most likely to work.

Write down anything that comes into your head at first.

Answer these questions for each of your ideas. Then pick ones that have more good consequences than bad.

1. Is there something about you that you could do differently? Something you could say?

1. How would you be able to make that change? What would you need?

If you’re having trouble identifying warning signs, think about the differences between the times you’ve had safer and unsafe sex

Here are some examples from other guys:

The ‘Sex Spot the Difference’ exercise on page 32 may help.

“Going on a huge bender and doing loads of drugs.” – Manny, 30

“Not having condoms.” – Steve, 32

“If he tells me he’s HIV negative and I believe him without really knowing.” – Grant, 26 “If I’m feeling a bit down and want to be with someone.” – Josh, 49

Now use the spaces below to jot down some possible ways of either changing those situations or making sure you can still have sex that’s as safe as you want it to be.

2. Is there something about the situation you could change?

2. What good things would happen if you did it?

3. How could you feel in control? 3. What bad things would happen if you did it? 4. Was there something about your state of mind that you could change or get help to change?

See ‘Help and Support’ at the back of this booklet for the kind of support that’s available to help you make these changes.

SETTING GOALS Making changes can seem a bit overwhelming unless you have clear steps ahead. Setting goals can help you focus on a particular thing you want to change. It can help you to see where you want to be in the future and motivates you to make it happen. When it comes to making the sex you have safer, setting goals will help you to protect yourself even when you’re in the throes of passion. That’s because setting goals is like drawing yourself a map to achieve success. If you know the route, you can get there easily. Even just the act of writing your goals down can set the process in motion.

Look at the things you do differently when you have unsafe sex and think about what you’d like to change in the future.

Write down some things that you’d like to change or do from now on that could make sure sex is always as safe as you want it to be.

Use the ‘Sex Spot the Difference’ exercises on page 32 if you need some help.

The ‘warning signs’ exercise on page 44 may also give you some clues.

“Always carry condoms with me when I go out.” – Deepak, 24 “Get an HIV test with my partner before I stop using condoms.” – Alan, 29

Next, write down some important reasons why you want to make those changes. What will you gain? You can look back at ‘Safer Sex and You’ on page 22 for help.

“So I have more control over the sex I have.” – Deepak, 24 “Because I value my health.” – Dale, 51

1. 2. 3.

Some big changes can be daunting, but you can make them easier. The next page shows you how. 46

Look at the things you do differently when you have unsafe sex and think about what you’d like to change in the future.

Write down some things that you’d like to change or do from now on that could make sure sex is always as safe as you want it to be.

Use the ‘Sex Spot the Difference’ exercises on page 32 if you need some help.

The ‘warning signs’ exercise on page 44 may also give you some clues.

“Always carry condoms with me when I go out.” – Deepak, 24 “Get an HIV test with my partner before I stop using condoms.” – Alan, 29

Next, write down some important reasons why you want to make those changes. What will you gain? You can look back at ‘Safer Sex and You’ on page 22 for help.

“So I have more control over the sex I have.” – Deepak, 24 “Because I value my health.” – Dale, 51

1. 2. 3.

Some big changes can be daunting, but you can make them easier. The next page shows you how. 46

SMALL STEPS Major changes might seem too big to take on but you can usually break them down into smaller steps. You don’t have to do everything at once.

Write down any small steps that could help you with the goals you’ve set on the previous page.

First Big Change

Second Big Change

Third Big Change

“Always carry condoms when I go out.” – Deepak, 24

“Drink less when I go out.” – Alon, 37

“Always insist on safer sex.” – Dale, 51

Small Steps

Small Steps:

“Buy condoms.” 2.

“Only drink half pints.” 2.

“Put safer sex on my online profile.” 2.

“Keep a condom in my wallet.” 3.

“Ask friends to look out for me.” 3.

“Talk about condoms before I have sex.” 3.

“Remember to always take them with me.”

“Alternate alcohol with soft drinks.”

“Leave condoms and lube by my bed.”

You don’t have to make changes alone. Think about some ways you could get help making these changes. The ‘Help and Support’ section at the back of this book has a list of organisations offering support.

SMALL STEPS Major changes might seem too big to take on but you can usually break them down into smaller steps. You don’t have to do everything at once.

Write down any small steps that could help you with the goals you’ve set on the previous page.

First Big Change

Second Big Change

Third Big Change

“Always carry condoms when I go out.” – Deepak, 24

“Drink less when I go out.” – Alon, 37

“Always insist on safer sex.” – Dale, 51

Small Steps

Small Steps:

“Buy condoms.” 2.

“Only drink half pints.” 2.

“Put safer sex on my online profile.” 2.

“Keep a condom in my wallet.” 3.

“Ask friends to look out for me.” 3.

“Talk about condoms before I have sex.” 3.

“Remember to always take them with me.”

“Alternate alcohol with soft drinks.”

“Leave condoms and lube by my bed.”

LOOkING TO THE FUTURE If you find yourself in a situation you’re not prepared for, it can be difficult to know how to react. We’ve all been there - someone does something we weren’t expecting and it takes a while for your brain to kick in with a response. The same sort of thing can happen with sex. Sometimes, in the heat of the moment, things happen that we weren’t expecting. But if you’ve already thought about that situation, you’ll have a better chance of knowing how to respond.

Imagine a situation that could happen in the future where the sex is about to get riskier than you’d like. Try to imagine it in as much detail as possible: where you might be, who you might be with and why the sex is about to get more risky. Write a description in the space below.

Now, using what you’ve learned or already know, try to write down what you would do to change the situation, so that the sex is as safe as you want. 1. What could you do or say? 2. Is there anything you need to make it safer? 3. Are there any thoughts that you might have that you could challenge? 4. How have you been confident in making sex safer in the past?

REMEMBER SUCCESS Celebrating successes is a great way to remember the things you’ve done well. We’re not suggesting you throw a party every time you make sex safer, but if you do something you’re proud of, try writing it down. Making changes for a healthy, happy future is something to be proud of. Writing down how you did it means you’re more likely to remember in the future.

Try imagining different situations and do the exercise again.

wHAT IF IT GOES wRONG? It’s not always easy to be 100 percent safe all of the time and it can take time to make changes to the sex you have. However, if you don’t stick to your safer sex strategy, don’t beat yourself up. You can learn from it. It’s important to get an HIV test again so you know your HIV status for sure. Knowing your HIV status for sure means you can make positive decisions about your lifestyle, health and relationships. If it’s a positive result, the sooner you find out, the healthier your future can be. An early diagnosis is important so that you can get the support you need.

PEP

If it’s a negative result, remember why you want to stay safe and make that commitment next time. Go back over some of the exercises in this book again. Write down what happened, what went wrong and how you could change it. Most importantly, keep trying. We all make mistakes but the key is to learn from them so that we can make changes next time. That way you can achieve your goal of staying negative for good.

PEP is a course of HIV medication which you can take if you have been at risk of HIV infection. The course of HIV medication lasts about 28 days and, if taken within 72 hours of putting yourself at risk, may be able to prevent you from becoming infected with HIV. PEP stands for Post Exposure Prophylaxis. In other words, it is a form of protection (against HIV) that you can take after you have had risky sex or if a condom breaks. You can get PEP at a sexual health clinic or in the Accident and Emergency department of some hospitals. PEP may not be 100 percent effective but the sooner you start PEP within the 72 hour period after possible HIV risk, the more likely it is to work. More information on PEP can be found at www.gmfa.org.uk/pep

PEP

HELP AND SUPPORT

BOOkLETS

FACE TO FACE

GROUP wORk

There are many services in London that offer support to help you stay HIVnegative. They range from information and advice you can read to face-toface discussions with other gay men or trained healthcare professionals.

Booklets covering a range of important health related subjects for gay men can be picked up free from the health information racks in gay bars, saunas and clubs around London. They can also be downloaded at: www.gmfa.org.uk/booklets

There are lots of options for support after a negative HIV test result which can give you the opportunity to think about why you might take risks. Why we take risks in our sex lives can be related to all sorts of things. It can sometimes be helpful to sit with a counsellor or mentor, or within a group, to explore these reasons for taking risks.

MAGAZINE

MENTORING

You might be the sort of person who would prefer to talk about sex in a group setting with other gay guys, or even to take a short course which would give you information in a way that suits you. There are lots of different groups and courses in London offered by GMFA, PACE and THT. They are advertised regularly in the gay press or you can visit: www.gmfa.org.uk/gwk

FS (the fit and sexy gay man’s health magazine) is full of great articles about sex, relationships, drugs, HIV and loads more that’s important to gay lads. You can find it every other month in bars, clubs and sexual health centres.

Mentoring matches you with another gay man. You meet fortnightly over five months to work through a set of structured modules. They are there to support you and offer advice.

Some services may be offered at the centre where you had the test, or you can choose from the list below. It’s all available to help you and it’s free. A full list of services in London is available at: www.gmfa.org.uk/londonservices

wEB Information about HIV, sexually transmitted infections and safer sex can be found at: www.gmfa.org.uk/sex

PHONE THT Direct: 0845 12 21 200 London Lesbian and Gay Switchboard: 020 7837 7324

HELP AND SUPPORT

BOOkLETS

FACE TO FACE

GROUP wORk

MAGAZINE

MENTORING

Mentoring matches you with another gay man. You meet fortnightly over five months to work through a set of structured modules. They are there to support you and offer advice.

wEB Information about HIV, sexually transmitted infections and safer sex can be found at: www.gmfa.org.uk/sex

PHONE THT Direct: 0845 12 21 200 London Lesbian and Gay Switchboard: 020 7837 7324

COUNSELLING

NEED CONDOMS?

SEXUAL ASSUALT

MENTAL HEALTH

You can choose a short- or longterm approach to talking to a trained counsellor about any issues you have around sexual health. Some counsellors use cognitive behaviour therapy (CBT) to help you understand how your thoughts and feelings affect your behaviour (in a similar way to some of the exercises in this book).

You can get free condoms and lube in London from many bars, clubs and community or health organisations. They are also available at sexual health clinics. You can also buy very good value condoms and lube online from: www.freedoms-shop.nhs.uk

Survivors is an agency that provides counselling and support to victims of male rape. They have a helpline on Mondays, Tuesdays and Thursdays from 7pm-10pm on 0845 122 1201 or you can contact them at info@survivorsuk.org There website is www.survivorsuk.org

DRUGS

There are also three specialist centres in London with experienced professionals who offer medical help, counselling and practical and emotional support. You can contact these centres directly on the numbers below. You can find out more at www.thehavens.org.uk

PACE can help with many aspects of mental health and emotional wellbeing. The PACE helpline is available for family and relationship support. The helpline is open on Monday 9.30-12.30 and Thursday 3.30-6.30 on 0808 1807 223. Pace also offer structured Telephone Counselling, of up to 6 weekly 30 minute sessions. Or you can email pacehelpline@pace.dircon.co.uk

You can talk through various options and decide which type of counselling is best for you. Counselling and mentoring services are provided by the GMI Partnership (made up of Positive East, the Metro Centre and West London Gay Menâ&#x20AC;&#x2122;s Project). For further information or to book an appointment, call 020 8305 5002, email info@gmipartnership. org.uk or visit the website at www.gmipartnership.org.uk THT and PACE both offer counselling too. You can find out more at: www.gmfa.org.uk/counselling

Antidote offers information and support exclusively to lesbian, gay, bisexual or transgendered (LGBT) people around drugs and alcohol. Whether you want to cut down or stop using or drinking, or want information about keeping safe, Antidote can help. Telephone 020 7437 3523 or visit www.thehungerford.org/antidote.asp

Haven Camberwell: 020 3299 1599 Haven Paddington: 020 7886 1101 Haven Whitechapel: 020 7247 4787

COUNSELLING

NEED CONDOMS?

SEXUAL ASSUALT

MENTAL HEALTH

DRUGS

Haven Camberwell: 020 3299 1599 Haven Paddington: 020 7886 1101 Haven Whitechapel: 020 7247 4787

HAS THIS BOOk HELPED YOU? If this book has helped you, or if you think we could improve it, we’d love to hear from you. londonservices@gmfa.org.uk

GMFA projects are developed by positive and negative volunteers. To volunteer or donate call 020 7738 6872 or go to www.gmfa.org.uk/aboutgmfa

GMFA — the gay men’s health charity Charity number: 1076854 Company limited by guarantee: 2702133

The information in this booklet was accurate on 1 April 2009

Part of the Pan London HIV Prevention Partnership

Design and Illustration by Patrick Fry & Billy Woods Art Direction by Patrick Fry, Billy Woods & Sian Cook