sexual health
Looking after your sexual health is part of playing well. The tools available now are better than they have ever been: HIV can be prevented with a pill or an injection, people living with HIV on effective treatment don't pass it on through sex, and many bacterial STIs can be prevented after the fact. This page covers what each tool does and how often to get tested.
This page is general information, not medical advice. Medicines, doses and recommendations vary by country and change over time, so talk to a sexual health clinic or a doctor before starting or stopping anything. See our legal policies.
Had sex that might have exposed you to HIV in the last 72 hours?
Ask for PEP now, at a sexual health clinic, an emergency department or an urgent care service. It works best the sooner you start, ideally within hours, and it isn't given after 72 hours. Our support & crisis lines page lists where to get it.
prep
Pre-exposure prophylaxis is HIV medicine taken by people who don't have HIV, to stop them getting it. Taken as prescribed, it is highly effective at preventing HIV through sex.
daily pills
One pill every day. It's the most widely available option, and it suits people whose sex isn't predictable.
on demand
Also called event-based or 2-1-1 dosing: pills taken before and after sex on a set schedule. It's recommended for cis men having anal sex, not for everyone, and it isn't suitable for people with hepatitis B. Ask your clinic before switching to it.
injections
Long-acting injections given every couple of months, or twice a year in some countries. They're good if remembering pills is hard.
what it involves
An HIV test before you start and regular check-ups while you're on it, usually every three months, with STI and kidney tests.
PrEP doesn't protect against syphilis, gonorrhoea, chlamydia or mpox. Pair it with testing, and with condoms or DoxyPEP where they fit.
pep
Post-exposure prophylaxis is a course of HIV medicine started after a possible exposure, such as a condom breaking, condomless sex with someone whose status you don't know, or a sexual assault. You take it for 28 days.
- Start as soon as possible. It must be within 72 hours, and the sooner the better.
- It's an emergency medicine, not a regular prevention plan. If you need PEP more than once, ask about PrEP.
- Where to get it in your country is on our support page.
doxypep
Doxycycline post-exposure prophylaxis is a single dose of a common antibiotic taken within 72 hours after condomless sex. It greatly lowers the chance of getting syphilis and chlamydia, and it helps less against gonorrhoea.
- Several countries now recommend it for gay and bi men and trans women who've had a bacterial STI in the past year. It's prescribed by a clinician, who will talk you through whether it suits you.
- It doesn't prevent HIV, so it isn't a replacement for PrEP or condoms.
- Keep testing regularly while you use it. Doctors are watching for antibiotic resistance, so take it only as prescribed.
u=u
Undetectable = Untransmittable. A person living with HIV who takes treatment and keeps an undetectable viral load does not pass HIV on through sex. This is backed by large studies of thousands of couples, and by every major health body.
- "Undetectable" means a viral load that stays below the level their clinic confirms. It usually takes up to six months on treatment to get there, and regular tests keep checking it.
- U=U is about sex. It doesn't cover sharing needles or other injecting equipment.
- It doesn't protect against other STIs.
Disclosure laws differ by country. In some places, not telling a partner about HIV can still be a crime even with an undetectable viral load, so check the law where you live. Knowing about U=U helps fight stigma, and many people living with HIV find it changes how they date and play.
condoms & lube
- Condoms greatly lower the risk of HIV and most STIs, though they protect less against infections passed by skin contact, like herpes, HPV and syphilis. They're the only option that covers both at once.
- Use water-based or silicone lube with latex condoms. Oil, petroleum jelly and most lotions weaken latex and make it break.
- Use plenty of lube for anal sex and fisting. Tears in the lining raise the risk of infection.
- Put a fresh condom on any toy that moves between people, or between ass and mouth.
- Gloves make fisting and fingering safer, especially with cuts or long nails.
testing
Many STIs have no symptoms, so regular testing is the only way to know. A common guide for sexually active gay and bi men:
| If you… | Test for HIV, syphilis, gonorrhoea and chlamydia |
|---|---|
| have one regular partner | at least once a year |
| have several or new partners, or anonymous play | every 3 to 6 months |
| take PrEP | every 3 months, at your PrEP check-up |
| have symptoms, or a partner tells you they've tested positive | now, whatever your last test was |
- Test every site you use. A urine test alone misses infections in the throat and ass, so ask for throat and rectal swabs too. Many clinics let you take them yourself.
- Window periods. A test can't pick up a very recent infection. Lab HIV tests usually detect it from about 6 weeks, and some rapid tests take up to 3 months. Retest if you had a risk just before testing.
- Get checked for sores, rashes, discharge, burning when you pee, pain in the ass, or flu-like illness a few weeks after a risk.
- Home and postal test kits are available in many countries, and clinics are confidential.
vaccines
Ask your clinic about vaccines for hepatitis A and B, HPV (which protects against genital warts and some cancers, often offered free to gay and bi men up to a certain age), and mpox. Some places also offer meningococcal vaccines during outbreaks, and some countries, such as the UK, offer the MenB vaccine to lower the risk of gonorrhoea.
chemsex harm reduction
Chemsex, or party and play (PnP), means using drugs such as crystal meth, GHB/GBL, mephedrone or ketamine to have sex, often for long sessions or with groups. If you choose to use, these steps lower the risk. They don't make it safe.
Someone won't wake up, or is breathing slowly or strangely?
Call your local emergency number. If they're breathing, put them in the recovery position on their side and stay with them. If they're not breathing, the call handler will talk you through what to do. Tell responders what was taken. Some places, including most US states and Canada, have laws that protect people who call for help in an overdose from some drug charges. Whatever the law where you are, call: a life matters more.
- GHB/GBL: the gap between a dose and an overdose is tiny. Measure doses exactly with a syringe or pipette, leave at least two hours between doses, write down the times, and never mix it with alcohol. GBL is stronger than GHB, so the same amount isn't the same dose.
- Don't mix. Combining depressants (G, alcohol, ketamine, benzos) is how most overdoses happen. Some HIV medicines also interact with party drugs, so ask your clinic or pharmacist.
- Test your drugs where testing is available. Fentanyl and other strong substitutes turn up in drugs sold as something else.
- Don't share needles, syringes, pipes or straws. Hepatitis C and HIV spread this way. Needle exchanges give out clean kits for free.
- Consent still counts. Someone who is too high to know what's happening can't consent. Agree limits before you use, and stop if someone is out of it.
- Look after your body: drink water, eat, sleep between sessions, and use plenty of lube, since long sessions cause more tears. Keep PrEP, condoms and DoxyPEP within reach.
- Have a plan: one person who stays sober enough to help, and a friend who knows where you are.
If chemsex is taking more from you than it gives, specialist chemsex services and LGBTQ+ drug support exist in many cities, and they won't judge you. Find them on our support page.
