Feelin' PEPpy

I'm HIV-negative, and I faithfully strap on a rubber every time I ride a hottie. I feel pretty good about my safety practices, but what do I do if the condom breaks? It's happened a couple of times in my sexual tenure, but I usually notice right away and pull out. I don't have to worry about pregnancy, but what about other stuff?

-On Top Of It in Seattle

Dear Seattle Top,

Condom breakage is a fact of life....in fact, I don't know too many guys who haven't experienced a break. It's great that you're educating yourself about risk. If a condom breaks, you might come in contact with fluids like semen or vaginal secretions, STI sores, and tiny breaks in the skin. What they all have in common is the potential to transmit sexually transmitted infections, including HIV.

If you're HIV-negative, and think you might have come in contact with HIV through a condom break or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? After a possible exposure to HIV, you take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.

If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). If it has been more than 72 hours since possible exposure, you can still seek HIV prevention counseling around reducing your sexual risks. Keep in mind, even if you've been exposed to HIV, it doesn't mean that you will necessarily get infected with the virus. Keep calm, continue your safe sex practices, get tested, and take care of yourself.

Taking PEP does not guarantee that you won't get HIV. More research is needed to find out how effective PEP is in preventing possible HIV infection. PEP should not be used as a regular prevention tool!

NOTE: PEP is often confused with PrEP (Pre-Exposure Prophylaxis). PrEP is designed for daily use for individuals who have a high risk of getting infected with HIV (like someone in a long-term monogamous relationship with a partner who is known to be HIV-positive, particularly if the partner is off HIV treatment), while PEP is designed for use in emergencies, AFTER a possible exposure to HIV. Taking PrEP means you take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill http://projectneon.org/learn/drdick/hiv/that-little-pill/

Things to keep in mind:
• PEP and PrEP can be costly. Check with your insurance if PEP and PrEP are covered. If not, ask if there are assistance programs to help cover the cost of the medication. http://www.nastad.org/docs/PrEP%20and%20PEP%20PAP%20fact%20sheet.pdf
REDUCE THE CHANCE OF CONDOM BREAKAGE:
• Lube, lube, lube! Water based lube is the safest option to use with condoms.
• If you're having marathon sex, change a condom if it starts to dry out or just doesn't feel right. Don't be afraid to stop and add lube throughout your escapades.
• Make sure you're wearing the right size and shape of condom for you. There are so many options. Extra-long, snugger fit, baggy head, insertive condoms...don't be afraid to experiment, and don't let anyone shame you about your condom preferences!
• Add some lube to the tip of the condom, and pinch the tip before rolling the condom on. Both of these will reduce the chance of breakage.