Sex in the Age of PrEP and U=U

Sex in the Age of PrEP and U=U

Sex in the Age of PrEP and U=U Presented by: Tim Vincent, MS [email protected] f.edu 20

18 Riverside County SYPHILIS COMMUNITY COLLABORATIVE Notes for Reviewer Riverside County has long led the way in activities to address the syphilis epidemic amongst gay men and other MSM. As seen in many programs providers are struggling with talking to their patients about the reality of U=U and PrEP. There are

many provider concerns about promoting these and the effect they have on STD rates. The Syphilis Community Collaborative sought assistance with helping providers gain trust in the effectiveness of biomedical interventions, and began the dialog of how they can inform patients. Additionally, the Collaborative wanted to assure providers are being sensitive to the sexual context of gay men and other MSM and interacting in a sex positive, affirming manner. The presentation starts with the evidence for effectiveness of

U=U, discusses the impact of sex negativity and lays the foundation for a sex positive approach. POLLEVERYWHERE To participate follow the directions below To: 22333

Text message: CAPTC2 Youve joined CAPTC2 session Note: Interactive poll presented in live

session. Note: Virtual whiteboard used during live session. Participants are able to type via their phone to populate the whiteboard. Tenets to Set Context

Harm Reduction Sexual Health Focus Sex Positive Messaging 6

DefinDeition of Sexual Health (World Health Organizations 2006a) a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the

possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. 7 Note: Interactive poll presented in live session.

Healthy Sexuality I am comfortable with my body and my sexuality. I can talk effectively with my peers, family, and partners. I know my body and how it functions.

I understand the risks, responsibilities, and consequences of sexual behavior. I know how to access and use health care services and information.

I am able to set boundaries when it comes to sex and sexual relationships. I act responsibly according to my personal values. I am able to form and maintain healthy relationships.

I am able to recognize risks and ways to reduce [1] New York State Department of Health: Guiding Principles for Sexual them. Health Education for Young People: A Guide for Community-Based Risk of HIV Transmission: if no condoms, no PrEP, and no treatment, transmission per 10,000 sex acts

https://wwwn.cdc.gov/hivrisk/estimator.html#-~sb Patel et al (2014). Estimating per-act HIV transmission risk: a systematic review. AIDS, 28(10), 1509-1519 CDC Estimates of Efficacy Treatment >96% PrEP for MSM >92%, heterosexuals 90% Condoms 63% to 80%

https://wwwn.cdc.gov/hivrisk/estimator.html#-~sb Patel et al (2014). Estimating per-act HIV transmission risk: a systematic review. AIDS, 28(10), 1509-1519 https://wwwn.cdc.gov/hivrisk/estimator.html#-~sb History Matters Risk Compensation

When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission. Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no

risk of sexually transmitted the virus to an HIV-negative partner. Emphasis Added Video link to the community talking about U=U Risk Compensation Risk homeostasis is defined as a system in which individuals accept a certain level of subjectively estimated [or perceived]

risk to their health in exchange for benefits they expect to receive from the behavior. In accepting a particular level of risk of an adverse event, individuals maintain an approximate risk set point. However, introduction of an intervention that reduces the perceived risk of the behavior or activity may cause a person to increase risky behaviorthis is called risk compensation [8] so that the discrepancy between the level of risk he or she takes and the perceived risk increases.

Risk Compensation in PrEP: An Old Debate Emerges Yet Again- Blumenthal, J, Haubrich, R. Sex Negativity The idea or belief that sex is BAD Dangerous Sinful Dirty

Shameful Redeemed only by procreation, marriage, and/or love Judges the what & who, rather than the how & why Charlie Glickman, PHD. Adapted from, The Language of Sex Positivity, Loving More Magazine #21 Spring 2000.

Negative Effects on Sexual Health Makes us question our normality Fosters Secrecy & Silence Stops exploration Barrier to Client/Provider communication Promotes unrealistic

expectations Funding issues Glickman, PHD. Adapted from, The Ineffective programsCharlie Language of Sex Positivity, Loving More Magazine #21 Spring 2000. Note: Virtual whiteboard used during live session. Participants are able to

type via their phone to populate the whiteboard. Thank You Tim Vincent [email protected] California Prevention Training Center 300 Frank Ogawa Plaza, Suite #520 Oakland, Ca. 94612

510.625.6000 www.californiaptc.com @CA PTC_CBA www.facebook.com/ californiaptc

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