Back in 1988, when the world marked the first World Aids Day, contracting HIV was a particularly dire scenario. Fear and paranoia were inexorably associated with HIV and with anyone who was positive, while people’s options to fight or manage the virus were extremely limited.

Twenty-three years later and it seems like it’s (almost) a whole new world. On the one hand a vaccine remains elusive and HIV is still a serious virus to contract; with dangerous long-term implications, especially without treatment. On the other hand, thanks to antiretroviral treatment, it’s become an increasingly managed condition that allows people to live much healthier and longer lives.

Plus, there are more options than ever available to give you additional power to tackle the HI virus. Here are some of the strategies you, and other men who have sex with men (MSM), can use or consider in your life.

Condoms and lube

This is something that hasn’t changed since 1988. We may all be sick of hearing the message, but the fact remains that the correct and consistent use of condoms together with water-based lube is still the best defence against contracting the HI virus. And remember, it must be water-based lube. Your condom could literally fall apart in the middle of sex if you use anything else; oil-based lubes ‘eat’ the latex that condoms are made of. It needn’t be a drag – try different types and flavours of water-based lube and have fun with it!

Post Exposure Prophylaxis (PEP)

Despite our best intentions sometimes things go wrong with the “consistent” part of using condoms and water-based lube. Condoms are not 100% effective as they can tear or burst. Plus, people are human; a drunken one-night-stand or just not thinking properly in the heat of the moment could lead to unprotected sex. Thankfully, today, there is something that can be done in these scenarios.

PEP is a course of medication begun within 72 hours of a risky sexual encounter that will, in most cases, stop the virus in its tracks before it can take hold in the body. It’s not full-proof and can have side effects. It must also be taken exactly as prescribed by a doctor, usually for four weeks, to have the best chance of working. Remember, PEP is not a regular ‘morning-after pill’ for HIV and should only be used for the occasional slip-up or emergency.

Early testing & treatment

If you do become infected, the sooner you know, the better. In fact, knowing earlier rather than later could literally add years to your life. The sooner you know, the sooner you can take action to make sure you stay as healthy as possible. Studies suggest that earlier HIV treatment, before symptoms set in, will improve your life. The more time you allow the HI virus to damage your immune system the more difficult it may become to tackle it later on.

Also, the sooner you know you’re infected and the sooner you start getting treated the less likely you are to infect others. This is not only because, hopefully, you’ll be more careful when having sex, but also because studies show that if the levels of the virus in your body are low enough you are less likely to pass it on. The recent HPTN 052 study confirmed for the first time that HIV positive guys on antiretroviral treatment reduce the risk of infecting their partners by 96%.

All this means that you should man-up, get over your fear of testing positive and get screened for HIV regularly. Dr Oscar Radebe, medical advisor at the Simon Nkoli Health4Men clinic in Soweto and the OUT clinic in Pretoria recommends that if you engage in high-risk activities you should screen yourself at least every three months, otherwise every six months or annually.

Pre-Exposure Prophylaxis (PrEP)

While PEP (discussed earlier) is a course of anti-retroviral drugs (ARVs) taken within 72 hours AFTER a risky sexual encounter, PrEP, is taken as an ongoing course of ARVs BEFORE possible infection by guys who are at continued high risk of exposure. This could, for example, include a couple in which one of the guys is HIV-positive and the other is HIV negative (known as a “servo-discordant” couple).

As part of a strategy to avoid becoming infected by his positive partner, the HIV negative partner could go on to PrEP. Results from the HPTN 052 study showed that PrEp can be up to 90% effective in stopping infection, depending in some cases on the type of medication and how well people stuck to taking the medication correctly and consistently.

Be aware though that using ARVs for PrEP is still experimental and not everyone may be willing to provide it as the long-term effects are not clear. If you think that PrEP is a strategy that could work for you, speak to your doctor or call a gay and MSM friendly health organisation like OUT for more information and advice.


Okay, this isn’t something that’s available for use right now, but keep your eyes open for more news on ‘microbicides’ in the future. In essence, a microbicide is something, such as a gel or a cream, that is applied inside the anus before or during sex that will kill the HI virus.

There’s been a significant amount of research with microbicides among women but not that much among MSM. A November 2011 study by the University of California AIDS Institute, however, found that an anti-HIV microbicide gel intended for vaginal use was also effective on rectal tissue. It appears as if this approach could hold promise; giving us yet another strategy for HIV prevention.

For more information about PEP, PrEP, free HIV screening and other HIV and health and well-being services for men who have sex with men (MSM), contact OUT on 012 430 3272 or go to for clinics servicing MSM. Visit for tips, advice and resources on sex and sexual health.

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