HIV AND YOU A useful guide for guys living with HIV who want to know more about how alcohol and drugs can affect their medication and quality of life.
What is SX Scotland?
What is this booklet?
SX is about improving the sex, health and wellbeing of gay and bisexual men, and all men who have sex with men, living in Scotland.
For many men who have sex with men, drinking alcohol or taking drugs can be a big part of our culture.
We’re here to improve the physical, mental and sexual health of all men who have sex with men, however you define yourself. By listening to the people in our community, and empowering them to have their voices heard, we provide support to those we work with, encouraging them to have consensual and pleasurable sex with the least harm. SX is provided by Waverley Care. Waverley Care is positive about HIV, hepatitis C and sexual health in Scotland. By being part of Waverley Care we have benefited from over 30 years of learning and expertise working to reduce new infections, increasing access to testing and challenging the stigma experienced by our communities.
Heading out for a drink offers the chance to socialise, meet up with friends, and potentially hook up with guys for sex. Alcohol lowers our inhibitions and makes us feel more relaxed. An increasing number of men have started using certain street drugs, known collectively as ‘chems’, alongside alcohol, to enhance the sex they have. This is often referred to as ‘chemsex’. Chems can make you feel less inhibited and more aroused during sex, and can help you last longer. If you’re living with HIV, it’s important to know that both alcohol and chems can affect how your medication works, creating unwanted and potentially dangerous side effects. In this booklet you’ll find information on the effects of alcohol and chems on your health, and how they can affect HIV medication. You’ll also find details of where to get support if you want to discuss, cut down or stop your drinking or drug taking.
HIV Living with HIV
HIV carries around a lot of stigma, and the devastating impact it had in the ‘80s and early ‘90s continues to influence what people think now. Fortunately, the truth in Scotland today is quite different. With effective treatments and early diagnosis, people with HIV can expect to live long and healthy lives. Despite all of the progress, men who have sex with men continue to be more affected by HIV than other groups in society. Whether you are newly diagnosed or have been living with HIV for some time, it can be a lot to deal with. In this section, you’ll find more information about living with HIV, from support with a new diagnosis and treatment, to telling other people and preventing new infections. If you’re living with, or affected by HIV, and looking for support, you can get in touch with us by email or through the chat app on our website. Email: info@s-x.scot Website: s-x.scot
Recently Diagnosed
An HIV diagnosis can bring a whole range of emotions. You might feel shocked, overwhelmed, or angry. You might struggle to take it all in, or have lots of questions about what it means for your health, your relationships and your sex life. All of these responses are totally normal and valid. Whatever your situation, the most important thing is don’t panic. Well-established HIV treatments are really effective and can allow you to live a long and healthy life. We can help with things like counselling or one-to-one, peer and group support – giving you a safe place to talk. We can also help you access specialist HIV support through Waverley Care. If you’ve recently been diagnosed with HIV, and are looking for support, get in touch to chat about how we can help.
HIV Telling other people
Whether it’s a partner, friends and family, or people you work with, telling people that you’re living with HIV is a daunting prospect. Knowing what to say, when, where and how – or even whether to say anything at all – can be confusing. You might be worried about how someone will react, how it’ll affect your relationships and whether your privacy will be respected. The important thing to remember is that the decision to tell people or not is yours alone, and that there are many good reasons for both choices. When it comes to talking to sexual partners about your status, the guidance under Scottish law is that you are not obliged to tell them if you take ‘reasonable precautions’. This includes things like using condoms, avoiding high risk acts like anal sex without a condom, and sticking to sex that has low risk of transmission, such as kissing or oral sex. In addition, if you’re receiving effective HIV treatment and your HIV consultant has informed you that you’re ‘undetectable’ then this
is also a ‘reasonable precaution’ to prevent the transmission of HIV to your sexual partners (find out more in the U=U section). If you are wanting to tell a sexual partner, maybe think about why and how you want to do it. Sometimes it can be more comfortable telling people about your status away from having sex. Perhaps on a date, once you get to know the person better. However, some people like to mention their status early on in conversation, that way, if there’s an issue, you can get it out the way and move on. Some guys decide on telling their partner about their HIV status
based on the sex they want to have. If there is no possibility of transmission then some guys choose not to tell their partner about their status. However, some guys will always tell their partners so they can make an informed decision. An advantage of talking to your partners about your HIV status is that they can then find out more about HIV prevention, including PrEP, PEP and U=U.
We can help you talk things through if you’re worried about telling other people about your HIV status, and we can also help you access specialist support and advice through Waverley Care. Just get in touch. Email: info@s-x.scot Website: s-x.scot
HIV U=U
U=U is a powerful, fact-based challenge to HIV stigma that is helping to reduce new infections around the world. U=U stands for Undetectable=Untransmittable, and its simple message is this - a person living with HIV, who is taking treatment as directed by their clinician and maintains an undetectable viral load CANNOT pass on the virus through sex. What does ‘undetectable’ mean? HIV treatments work by reducing the levels of HIV in a person’s body. When this level (or viral load) gets below a certain point, HIV becomes undetectable. If someone is living with HIV, their clinician will be able to confirm if they are undetectable with a simple blood test. This is usually part of routine HIV appointments. There are a couple of important points to remember about being undetectable: - You must have an undetectable viral load for a period of six months from your first undetectable reading to be undetectable.
- A person can only stay undetectable if they continue to take treatment as directed by a clinician. HIV treatment is a life-long commitment, but support is available from Waverley Care for people who are struggling. What does ‘untransmittable’ mean? U=U is based on clear scientific evidence, backed by HIV specialists around the world. A person who is living with HIV, on treatment, and who has achieved and maintains an undetectable viral load CANNOT pass HIV on through sex. So Undetectable=Untransmittable. Again, there are a couple of important points to remember: - U=U only prevents HIV being passed on through sex - it doesn’t prevent transmission by other routes such as sharing drug injecting equipment. - You won’t transmit HIV provided that you have had an undetectable viral load for 6 months. - U=U is only about HIV and does not prevent the transmission of other STIs - correct use of
condoms and lube remains the best protection against a range of STIs. - It is important to keep in contact with your clinician through regular HIV appointments and to follow their guidance. Why is U=U important? Many guys who are living with HIV experience significant stigma in relation to the sex they have. Guys can often encounter this when they disclose their HIV status on apps. U=U is a powerful challenge to this stigma. It highlights that not only
can treatment help people living with HIV to live healthy lives, but also that treatment can play a role, alongside condoms, regular testing and PrEP, in stopping the spread of HIV. The first step to U=U is to encourage men to know their HIV status by accessing regular testing. If you want to know more about U=U and the science behind it, visit the Prevention Access Campaign website: https://www. preventionaccess.org/consensus
Alcohol What is it?
Alcohol is a legal drug generally sold as beer, wine or spirits. By law, the strength of alcoholic drinks is stated on the packaging as a percentage, and can range from around 5% in beer to 55%+ in spirits.
Official Guidance
Guidance issued by the UK Chief Medical Officers suggests that men, and women, should not drink more than 14 units of alcohol a week. However, it’s also suggested that your alcohol intake is spread over the week and not taken in a single sitting (binge drinking). No more that 3 to 4 units should be consumed in one sitting, which is approximately 3 shots of spirits or two pints of regular lager or two average size glasses of wine. It’s also recommended to have a break for a few days between drinking sessions.
The effects
A few drinks may help reduce inhibitions and feelings of anxiety, making you feel sociable, chatty and confident. But there are downsides. With lower inhibitions you’re more likely to take risks, such as
unprotected sex, or to be taken advantage of by others. On a night out, too much alcohol can cause black-outs, accidental injury and unconsciousness. The morning after, you’ll have to deal with a hangover - including nausea, headaches and sweats. In the most serious cases excessive drinking can lead to coma and even death. Alcohol is addictive and, over the longer term, excessive drinking can cause sexual dysfunction (brewer’s droop), liver damage, high blood pressure, strokes and cancer.
The Law
Alcohol can be consumed legally by people over the age of 18.
Mixing alcohol with HIV medication
Although there aren’t significant issues with mixing alcohol and current HIV medications, there are things for guys who’re living with HIV to be aware of. Drinking too much can make you throw up – either on the night or the morning after. If this happens within an hour of taking your HIV medication then you should retake
the dose as soon as you can. Drinking can also make you forget things, like taking your medication. It may be worth taking medication at a time when you’re less likely to be out, and setting a regular reminder on your phone, or watch, to make sure you take it correctly. There is some evidence that alcohol can be more harmful for guys who have HIV than guys who don’t – even if they drink the same amount. Studies have shown that guys who are living with HIV record higher blood alcohol levels than those who don’t have HIV. The levels increase more for guys who aren’t on effective HIV treatment. Therefore, it’s particularly important for people with HIV to stick to the recommended alcohol guidelines. Alcohol can also damage the liver
regardless of how little you drink and this is something that guys living with HIV need to be aware of. That’s because the liver plays a role in processing HIV medications, so a damaged liver can result in unwanted side effects. Although alcohol doesn’t cause significant issues with the effectiveness of HIV treatments, it can interact with other medicines you might be taking, including some antibiotics, tuberculosis drugs, antidepressants and sedatives, such as Valium. You can talk to us, or your clinician if you’re worried about how any medications you’re taking may be affected by alcohol. Email: info@s-x.scot Website: s-x.scot
Chems and Chemsex Chemsex
An increasing number of guys have started using certain street drugs, known collectively as ‘chems’, alongside alcohol, to enhance the sex they have. This is often referred to as ‘chemsex’. Like alcohol, chems can make you feel less inhibited and more aroused during sex, and can help you last longer. We know that chems can have unwanted or dangerous side effects and, if you’re living with HIV, they can also interact with your medication to create further unwanted issues. The Law In the UK drugs are split into three categories: Category A Cocaine, MDMA, Heroin, LSD, Methamphetamine Category B GHB/GBL, Cannabis, Mephedrone, Ketamine Category C Steroids, Benzodiazepines
Category A drugs are considered the most dangerous. Possession of them carries a sentence of up to seven years in prison, while being caught supplying can lead to a life sentence. For Category B drugs, you can be sentenced for up to five years for possession, increasing to 14 for supplying. Category C drugs carry a maximum sentence of two years for possession and, like Category B, up to 14 years for supplying. New drugs appear on the street all the time and can be more dangerous than drugs we already know about. This is because little is known about the side effects and interactions they may cause. Drug interactions When different medications or drugs are taken at the same time, they can ‘interact’ in your system. This can have an impact on how effective a medication is. This is the case for both prescribed medications and drugs bought on the street. Although the interactions of prescribed medications are tested, allowing suitable combinations to
be prescribed, less research has been done with street drugs. Added to this mix, it can also be difficult to determine the purity of any street drug or to know what it has been cut with, which can also affect how it interacts with other drugs. What we do know is that HIV medication and some street drugs are processed by the body in the same way, which can alter the effects of medication and street drugs. Why is this important? Some HIV medication contains ‘boosting agents’, which slow down their release from the liver. This allows the medication to stay in the body for longer, or at increased levels. Without the boosting agent the HIV medication may not be as effective. The boosting agent may also affect the street drugs you’ve taken, processing them more slowly or storing them in the body for longer or in greater concentrations. This can lead to serious side effects or cause an overdose. Chemsex drugs to be concerned about Although not an exhaustive list, dangerous interactions with HIV medication is possible with the
Street Drugs Chems and Chemsex following chems: Major concern, significant interactions: Ketamine and Viagra Medium concern, some interactions: Cocaine, GHB, Methamphetamine, MDMA and Mephedrone What can happen when drugs interact? Interaction with HIV medication may increase the intensity of the chems, sometimes to unwanted or dangerous levels. There’s also been a handful of documented cases of deaths and serious side effects in people taking HIV medication with crystal meth, MDMA and ketamine. Ketamine can also lead to damage of the liver if used frequently. Taking too much erectile dysfunction medication (such as Viagra) can be dangerous for the heart. Poppers can also interact with erectile dysfunction medication, causing blood pressure to drop making you pass out. Although there are limited studies about the interaction of G (GHB/ GBL) with HIV medication, studies have reported that HIV medication can increase levels of G in the body.
This issue is the same with cocaine where HIV medication can result in higher levels of cocaine being stored in the body. Like alcohol, chems can interfere with your sleep and your routines which means you could mix up, or miss, doses of your HIV medication. Chems also lower your inhibitions, which can lead to risk taking, such as unprotected sex, being taken advantage of, or being hurt, by others. You could also put yourself at risk of hepatitis C or other STIs.
Recently diagnosed with HIV?
Within the first month of taking new HIV medication, when you’re still getting used to the medication, your body is most likely to have unwanted interactions with chems. An interaction may happen immediately or take some time to take effect. Talk candidly with your HIV consultant, or HIV pharmacist, if you are considering taking chems so they can inform you of the risks based on the medication you’re actually taking. It may mean switching to an alternate HIV medication with less interactions or side effects. If you’d like to talk to us about being recently diagnosed or about chems and sex, then send us an email or visit our website and use the chat app.
Email: info@s-x.scot Website: s-x.scot
Sex Consent
If you were to have sex (including oral sex or mutual masturbation) with someone aged 16-17 where you were in a position of trust, then it would be an offence and may be punished with a prison sentence.
We believe that sex should be pleasurable for all partners, free from coercion and harm. If you and your partner(s) consent to having a specific type of sex, it ensures that everyone involved wants to engage in those activities, freely and willingly.
Giving consent When you consent to have sex with your partner(s), you are doing so throughout the sexual encounter, and consent can always be retracted. That means that you can withdraw consent at any point.
Consent is something we all need to talk more about because it’s an important element of our sex lives. Consent is about partners agreeing to the sex that they want..
Consent must be gained every time for every sexual act. Having sex without the consent of your partner is illegal and is termed rape or sexual assault. In law, sexual consent is when we agree by choice, and have the freedom and capacity to make that choice. Age of consent The age of consent is the age at which a person is allowed to legally decide to have sex. The age of consent in the UK is 16. One exception to this is where one person is, or has been, in a position of trust over another – such as a teacher or carer. In these cases, the age of consent increases to 18.
Consent should be given willingly and enthusiastically, and is essential in sex. It’s not just a matter of saying yes, you can give consent both verbally and through body language. This lets your partner know that you are enjoying yourself, or if it’s not what you want. Equally, you can also withdraw consent verbally or with your body in the same way. It doesn’t matter who you’re having sex with, how far you’ve gone during the sex you’re having, or whether you’ve had sex with them or others in the past. If you decide you don’t want to continue, or want to stop what you’re doing, then it’s your right to do so. If you’re engaging in kink, then
consent follows the same principles, but in addition, you must be in a position to both consent and withdraw consent easily. Getting Consent Consent isn’t just what you’ve agreed to do with someone on an app, it’s a continuous conversation between you and your partner(s). The important thing in getting consent is to make sure that you talk about what you want to do and how you both feel during sex. You can do this easily by asking questions like: - Can I touch you there? - Is this okay? - Are you okay? - Do you like that? - Can I finger you? - Can I fuck you? Just because the person you’re having sex with is aroused, such as having a hard-on, doesn’t necessarily mean they’re consenting to what’s happening. Consent needs to be enthusiastic, willing and given freely. Sometimes this may mean pausing, or stopping altogether to talk about it, to ensure that what you are doing is consensual.
Other things to bear in mind regarding consent: - Being in a relationship doesn’t mean that you or your partner automatically consent. - Even if you’re in a sexualised environment, such as a sauna, it doesn’t mean you have the right to have sex with whoever you want. - If your partner hasn’t said no, that doesn’t mean they have consented – you can give or withhold consent through body language too. - If your partner is under the influence of alcohol or drugs, they may not be able to consent. - Even though you’ve talked about things on apps it doesn’t mean you’re consenting to it in real life. - If you’re having kinky sex, agree to safe words, and never put your partner in a position where they’re unable to give or withdraw consent.
Email: info@s-x.scot Website: s-x.scot
Sex Stealthing
Stealthing is when the person you’re having sex with removes the condom either from their own cock, or yours, without your explicit consent. When this happens, it means you’re having unprotected sex. If you’ve agreed to use a condom, but it’s removed during sex without your agreement, then the consent is over and it’s not consensual. Stealthing is illegal and a crime. It doesn’t matter if you continue to have sex and climax. If this has happened you should speak to your local sexual health service, who may be able to offer you PEPSE (Post Exposure Prophylaxis after Sexual Exposure), if they think you’ve been at risk of HIV. They can also support you in reporting this to the police.
Coercion
Coercion is when pressure is put on you to engage in any sexual activities that you don’t want to do. Being pressured and coerced to have sex is just as wrong as someone physically holding you down. Even if you haven’t said no, you still haven’t given consent freely and enthusiastically, therefore you’re not agreeing to what is happening.
Alcohol and drugs
Sober sex
To give consent you must have the capacity to be informed. In other words, you must be able to know and understand what you’re consenting to, freely and willingly, for consent to be valid. Having sex or engaging in any other sexual activities without consent, where you or your partner(s) are not able to freely give consent, is rape or sexual assault.
If you‘ve been using chems for a while, or usually drink heavily before sex, you might not know where to start. Sometimes it can be good to think back to a time when you had sex that you enjoyed without substances. Then think about what it was that you liked about it. This can help build a relationship with sex again without drink or drugs. If you’re scared or anxious about this then you can talk to us or your local sexual health service for advice and support.
If you, or your partner, have consumed alcohol or taken drugs, neither of you may be able to consent to having sex or engaging in any other sexual activities, including chemsex.
Sober sex is sex without the use of alcohol or chems. This means you’re not using substances to enhance the sex you have. Often, going back to sober sex can be a scary thought.
Email: info@s-x.scot Website: s-x.scot
Help and Support Alcohol
Alcohol unit calculator: drinkaware.co.uk/tools/unit-and-caloriecalculator Ways to reduce your drinking: issuu.com/home/published/control_booklet Alcohol and sex: s-x.scot/alcohol/alcohol-and-sex HIV and alcohol: aidsmap.com/about-hiv/alcohol
Chems
HIV medication and drugs: aidsmap.com/about-hiv/interactions-betweenhiv-treatment-and-recreational-drugs Drug A to Z: talktofrank.com
Sex
Self Help with Chems: s-x.scot/sex-drugs-chemsex/chemsex/chemsexself-help Rape Crisis Scotland: rapecrisisscotland.org.uk SX 1 to 1 Support: s-x.scot/sx-services/one-to-one-support Not Your fault support group: notyourfault.support
Funding for this booklet was provided in part by
This resource has been designed and developed by
SX is provided by Waverley Care Scottish Charity No. SC036500