ARV:ODEFSEY.

ODEFSEY
(rilpivirine + emtricitabine + tenofovir alafenamide)

WHAT IS ODEFSEY?
Odefsey is a tablet that contains three antiretroviral drugs (ARVs) used to fight HIV: rilpivirine (Edurant), emtricitabine (Emtriva), and tenofovir alafenamide (TAF). Odefsey is manufactured by Gilead and Janssen. It is the second single tablet regimen that includes TAF, a new version of tenofovir that has lower bone and kidney risks.
The drugs in Odefsey are a non-nucleoside reverse transcriptase inhibitor (rilpivirine) and two nucleoside analog reverse transcriptase inhibitors, or nukes (emtricitabine and tenofovir). These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes.

WHO SHOULD TAKE ODEFSEY?
Odefsey was approved in March 2016 as an antiretroviral treatment for people 12 or older with HIV infection who have not already taken antiviral drugs and whose viral load is below 100,000. Odefsey is also approved as a replacement for stable antiretroviral therapy (ART) in people who have had undetectable viral loads for more than 6 months and never experienced failure of past ART.
While there are no absolute rules about when to start ART, treatment is now recommended for all people living with HIV, independent of your CD4 count. You and your health care provider should consider your viral load, any symptoms you are having, and your attitude about taking ART.
If you take Odefsey, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.
Odefsey provides three drugs in one pill. It can be more convenient to use Odefsey than some other combinations of drugs. This could mean fewer missed doses and better control of HIV. Odefsey can be an effective regimen of ARVs in one pill.

WHO SHOULD NOT TAKE ODEFSEY?
Odefsey should not be used by people who have virus with resistance to the any of the three anti-HIV medications it contains. Odefsey is not recommended for people less than 12 years of age.
Odefsey is a fixed-dose combination. Dosages of the individual components cannot be adjusted. Patients who have severe kidney disease, or severe liver disease, should not use Odefsey.

WHAT ABOUT DRUG RESISTANCE?
Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called “developing resistance” to the drug.
Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called “cross-resistance.”
Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

HOW IS ODEFSEY TAKEN?
Odefsey is taken by mouth as a tablet. The normal adult dose is one tablet, once a day. Odefsey should be taken with a meal. Each tablet includes 25 milligrams (mg) of rilpivirine, 200 mg of emtricitabine, and 25 mg of tenofovir alfafenamide.
Don’t change your dose or stop taking Odefsey without talking to your healthcare provider.

WHAT ARE THE SIDE EFFECTS?
When you start any ART, you may have temporary side effects such as headaches, or a general sense of feeling ill. These side effects usually get better or disappear over time.
Odefsey is usually very well tolerated. The most common side effects of Odefsey are the same as with the drugs it contains: rilpivirine can cause depression, trouble sleeping and headache. Emtricitabine, and tenofovir can cause nausea. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

If you have had hepatitis B or C, your liver function tests may increase significantly. Your healthcare provider should monitor your liver health before and during treatment with Odefsey.

HOW DOES ODEFSEY REACT WITH OTHER DRUGS?
Odefsey can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.
Drugs to avoid include some antacids. Drugs to watch out for include other ARVs, drugs to treat tuberculosis for lowering stomach acid (such as omeprazole), erectile dysfunction (such as Viagra), for heart rhythm (antiarrhythmics), and for migraine headaches. Interactions are also possible with several antihistamines (allergy medications), sedatives, drugs to lower cholesterol, and anti-fungal drugs.
The herb St. John's Wort lowers the blood levels of some HIV medications. Do not take it with Odefsey.

FACTS ABOUT HIV/AIDS

What does undetectable viral load mean?

When you test positive for HIV, you will be offered treatment and the drugs are called Antiretroviral (ARV). Typically, if your HIV medication is working, and you take them exactly as prescribed, your viral load should reach undetectable levels within 3-6 months after you begin treatment.

There has been a lot of confusion over the issue of viral load and testing positive for HIV. I will try to explain this so that it becomes clear to everyone and should help people to stay safe and not let ignorance kill us.

Viral load is only tested in those that are HIV positive because they have the virus so checking the amount of the load is important in monitoring their treatment.

The term “viral load” refers to the amount of HIV in a sample of your blood. When your viral load is high, you have more HIV in your body, and that means your immune system is not fighting HIV as well.

A viral load test is a lab test that measures the number of HIV virus particles in a milliliter of your blood. These particles are called “copies.” A viral load test helps provide information on your health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission.

The goal of ART is to move your viral load down, ideally to undetectable levels. In general, your viral load will be declared “undetectable” if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test.

Having an “undetectable” viral load doesn’t mean that the virus is completely gone from your body, just that it is below what a lab test can find. You still have HIV and you are still HIV positive and need to stay on ART to remain healthy.If one is HIV negative, then they do not have the virus in their body and there is no need to check the viral load because it will be ZERO.

If my viral load is undetectable, does that mean I am cured?

No, “undetectable” does not mean you are cured or that the virus is gone from your body. It means that the virus is below the level that a lab test can find. You still have HIV and need to stay on ART to remain healthy.

Can I infect anyone with undetectable viral load?

Having an undetectable viral load greatly lowers your chance of transmitting the virus to your sexual partner who is HIV-negative. However, even when your viral load is undetectable, HIV can still exist in semen, vaginal and rectal fluids, breast milk, and other bodily fluids. For this reason, you should continue to take steps to prevent HIV transmission. So, the answer is; yes you can infect other people even if your viral load is “undetectable”. Remember “undetectable ” means that the virus is below the level that a lab test can find, i. e. below 40-75 copies in a sample of blood. This explains why a person with undetectable viral load can have unprotected sex with different partners and not all of them will be infected. This practice is wrong and the advice is that an HIV positive person should have protected sex regardless of the level of viral load.

HIV DRUG RESISTANCE

WHAT IS RESISTANCE?
HIV is “resistant” to a drug if it keeps multiplying rapidly while you are taking the drug. Changes (mutations) in the virus cause resistance.
HIV mutates almost every time a new copy is made. Not every mutation causes resistance. The “wild type” virus is the most common form of HIV. Anything different from the wild type is considered a mutation.
An antiretroviral drug (ARV) won’t control a virus that is resistant to it. It can “escape” from the drug. If you keep taking the drug, the resistant virus will multiply the fastest. This is called “selective pressure.”
If you stop taking medications, there is no selective pressure. The wild type virus will multiply the fastest. Although tests may not detect any drug resistance, it might come back if you re-start the same drugs.
Resistance testing helps health care providers make better treatment decisions for their patients.

HOW DOES RESISTANCE DEVELOP?
HIV usually becomes resistant when it is not totally controlled by drugs someone is taking. However, more people are getting infected with HIV that is already resistant to one or more ARVs.
The more that HIV multiplies, the more mutations show up. These mutations happen by accident. The virus doesn’t “figure out” which mutations will resist medications.
Just one mutation can make HIV resistant to some drugs. This is true for 3TC (Epivir) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, HIV has to go through a series of mutations to develop resistance to other drugs, including most protease inhibitors.
The best way to prevent resistance is to control HIV by taking strong ARVs. If you miss doses of your medications, HIV will multiply more easily. More mutations will occur. Some of them could cause resistance.
If you have to stop taking any ARV, talk to your health care provider. You may have to stop some drugs sooner than others. If you stop taking drugs while the virus is under control, you should be able to use them again.

TYPES OF RESISTANCE
There are three types of resistance:
Clinical resistance: HIV multiplies rapidly in your body even though you’re taking ARVs.
Phenotypic resistance: HIV multiplies in a test tube when ARVs are added.
Genotypic resistance: The genetic code of HIV has mutations that are linked to drug resistance. 
Clinical resistance shows up as a higher viral load, lower CD4 count, or opportunistic infections. Laboratory tests can measure phenotypic and genotypic resistance.

PHENOTYPIC TESTING
A sample of HIV is grown in the laboratory. A dose of one ARV is added. The growth rate of the HIV is compared to the rate of wild type virus. If the sample grows more than normal, it is resistant to the medication.
Phenotypic resistance is reported as “fold” resistance. If the test sample grows twenty times as much as normal, it has “20-fold resistance.” Phenotypic testing is the preferred method for people with known or suspected resistance, especially to protease inhibitors.
Phenotypic tests cost about $800. It used to take over a month to get the results. New phenotypic tests are somewhat quicker.

GENOTYPIC TESTING
The genetic code of the sample virus is compared to the wild type. The code is a long chain of molecules called nucleotides. Each group of three nucleotides, called a “codon,” defines a particular amino acid used to build a new virus.
Mutations are described by a combination of letters and numbers, for example K103N. The first letter (K) is the code for the amino acid in the wild type virus. The number (103) identifies the position of the codon. The second letter (N) is the code for the “changed” amino acid in the mutant sample.
Genotypic testing costs about $250. Results come back in about two weeks. Genotypic testing is the preferred method for people having problems with their first or second treatment regimen.

VIRTUAL PHENOTYPE
This test is really a method of interpreting genotypic test results. First, genotypic testing is done on the sample. Phenotypic test results for other virus samples with a similar genotypic pattern are taken from a database. These matched samples tell you how the virus is likely to behave. The virtual phenotype is faster and less expensive than a phenotypic test.

CROSS-RESISTANCE
Sometimes a mutant version of HIV is resistant to more than one drug. When this happens, the drugs are called “cross-resistant.” For example, most HIV that is resistant to nevirapine (Viramune) is also resistant to efavirenz (Sustiva). This means that nevirapine and efavirenz are cross-resistant.
Cross-resistance is important when you change medications. You need to choose new drugs that are not cross-resistant to drugs you’ve already taken.
We do not totally understand cross-resistance. However, many drugs are at least partly cross-resistant. As HIV develops more mutations, it gets harder to control. Take every dose of your ARVs according to instructions. This reduces the risk of resistance and cross-resistance. It saves the most options for changing medications in the future.

PROBLEMS WITH  RESISTANCE TESTING
Resistance tests are not available everywhere. They are expensive. However, they are becoming more common, faster, and cheaper.
The tests aren’t good at detecting “minority” mutations (less than 20% of the virus population). Also, they work better when the viral load is higher. If your viral load is very low, the tests might not work. Tests usually cannot be run if the patient’s viral load is less than 500 to 1,000 copies per ml.
Test results can be difficult to understand. Drugs that should work according to the tests sometimes don’t work, and vice versa. Sometimes genotypic and phenotypic tests give conflicting results for the same patient. Some mutations can “reverse” or reduce resistance to some medications.
Recent research suggests that a genotypic resistance test should be done for every patient before they start taking ARVs. This saves money by avoiding putting someone on ARVs that will not work for them.

CD4 and viral load

CD4 and viral load… Which one should you focus on? Both!  says Otieno.

Your CD4 count is a good overview of how well your immune system is working and how much damage HIV has done to it. Viral Load (VL) will show you how active the HI Virus is in your body.

It’s really important to get a number of readings of both, over the course of a year or two, rather than making a decisions based on any single test result. Results change constantly, so it’s best to get several tests and see how they compare over time. A CD4 count below 200 is an immediate cause for worry because you have a much higher risk of developing an opportunistic infections (OI’s).

CD4 Cell Count  - CD4 cells are the immune system’s leaders, issuing commands to nearly every other cell. For people living with HIV, CD4 counts are the No. 1 sign of how strong or weak the immune system is. Most experts recommend CD4 measurements every three to six months—more often if they’re lower or changing quickly. Low CD4 counts are a sign that the HIV is in need of treatment. HIV may cause other numbers (e.g. neutrophil counts) to fall as well, which may call for treatment. Talk to your healthcare provider about your options.

HIV Viral Load measures how much HIVirus is in your blood. This information will help you and your healthcare provider make decisions about starting HIV treatment (ARV’s) and will show whether the medications are working or not. Fewer than 50 copies of HIV per mL—about a teaspoon of blood—will show as “undetectable”. Results can range from undetectable up to millions of copies per mL

When should you have a viral load test done? If you can, at the same time as you get your CD4 counts done—typically every 6 months or more frequently, based upon your health care providers recommendation. —then between you, you can monitor your HIV infection and see if any change in treatment are needed. A sudden or dramatic change in viral load may call for an immediate repeat test.

An undetectable result doesn’t mean the virus has left your body, but rather indicates the success of your treatment and less chance of the disease getting worse. If you are on HAART (Highly Active Antiretroviral Treatment/ ARV’s—a potent combo of HIV-fighting drugs), an undetectable viral load is considered the ultimate prize and shows that your treatment is working.

If you’ve just started treatment, this could take several months— another test in two or three months will tell for sure. Even if the viral load is considered undetectable, it may occasionally bounce up to small but measurable amounts. Continual, detectable viral load, while you’re on HAART/ARV’s, is cause for concern, as it signals that your treatment isn’t controlling the virus. You and your healthcare provider need to talk about switching treatment.

HOW DOES DRUG USE RELATE TO HIV?

HOW DOES DRUG USE RELATE TO HIV?
Injection drug and alcohol use are a major factor in the spread of HIV infection. Outside of Africa, injection drug use now accounts for 1 in 3 new HIV infections. Shared equipment for using drugs can carry HIV and hepatitis viruses, and drug and alcohol use is linked with unsafe sexual activity.
Drug and alcohol use can also be dangerous for people who are taking antiretroviral medications (ARVs). Drug users are less likely to be adherent to their medications, and street drugs may have dangerous interactions with ARVs. Drug and alcohol treatment to stop drug use can lower your risk of HIV infection.

INJECTION AND INFECTION
HIV infection spreads easily when people share equipment to inject drugs. Sharing equipment also spreads hepatitis B, hepatitis C, and other serious diseases.
Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone’s bloodstream. Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be enough to infect another user.
To reduce the risk of HIV and hepatitis infection, never share any equipment used with drugs, and keep washing your hands. Carefully clean your cookers and the site you will use for injection.
A recent study showed that HIV can survive in a used syringe for at least 4 weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between users. If possible, re-use your own syringe. It still should be cleaned because bacteria can grow in it.
The most effective way to clean a syringe is to use water first, then bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because hot water can make the blood form clots. To kill most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning does not always kill HIV or hepatitis. Always use a new syringe if possible.

ACCESS TO CLEAN NEEDLES
Access to clean needles and syringes reduces the spread of HIV and viral hepatitis. In some states, adults can purchase new syringes in pharmacies without a prescription. Some communities have started needle exchange programs to give free, clean syringes to people so they won’t need to share.
Programs that provide easier access to new syringes are controversial because some people think they promote drug use. However, research on needle exchange shows that this is not true. Rates of HIV infection go down where there are needle exchange programs, and more drug users sign up for treatment programs.
The North American Syringe Exchange Network has a web page listing several needle exchange programs at http://www.nasen.org/

DRUG USE AND UNSAFE SEX
For a lot of people, drugs and sex go together. Drug users might trade sex for drugs or for money to buy drugs. Some people connect having unsafe sex with their drug use. Research shows that sexual behavior is the main HIV risk factor for injection drug users.
Drug use, including methamphetamine or alcohol, increases the chance that people will not protect themselves during sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Drug and alcohol use may reduce condom use and safer sex practices.
Often, substance users have multiple sexual partners. This increases their risk of becoming infected with HIV or another sexually transmitted disease. Also, substance users may have an increased risk of carrying sexually transmitted diseases. This can increase their risk of becoming infected with HIV, or of transmitting HIV infection.

MEDICATIONS AND DRUGS
It is very important to take every dose of ARVs. People who are not adherent (miss doses) are more likely to have higher levels of HIV in their blood, and to develop resistance to ARV medications. Drug use is linked with poor adherence, which can lead to treatment failure and disease worsening.

Some street drugs interact with ARVs. The liver breaks down some medications used to fight HIV, especially the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol. When drugs and medications are both “in line” to use the liver, they might both be processed much more slowly. This can lead to a serious overdose of the medication or of the recreational drug.
An overdose of a medication can cause serious side effects. An overdose of a recreational drug can be deadly. At least one death of a person with HIV has been blamed on mixing a protease inhibitor with the recreational drug Ecstasy.
Some ARVs can change the amount of methadone in the bloodstream. It may be necessary to adjust the dosage of methadone in some cases. See the fact sheets for each of the medications you are taking, and discuss your HIV medications with your methadone counselor and your HIV health care provider.

THE BOTTOM LINE
Drug use is a major cause of new HIV infections. Shared equipment can spread HIV, hepatitis, and other diseases. Alcohol and drug use, even when just used recreationally, contribute to unsafe sexual activities and an increase in sexually transmitted infections.
To protect yourself from infection, never re-use any equipment for using drugs. Even if you re-use your own syringes, clean them thoroughly between times. Cleaning is only partly effective.
In some communities, new syringes can be bought without a prescription. Also, needle exchange programs in some areas provide free, new syringes. These programs reduce the rate of new HIV infections.
Drug use can lead to missed doses of ARVs. This increases the chances of treatment failure and resistance to medications.
Mixing recreational drugs and ARVs can be dangerous. Drug interactions can cause serious side effects or dangerous overdoses.

TODAY IS FATHER'S DAY AND I WANT TO TALK ABOUT PROSTATE CANCER

It’s important to their sex life, yet few men know anything about their prostate or what can go wrong with it. The prostate is a small gland in the pelvis found only in men. About the size of a walnut, it is located between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Causes of prostate cancer
These figures are a cause for concern but we need to look at the causes of prostate cancer. The causes of prostate cancer are largely unknown. However, a number of things can increase one’s risk of developing the condition. The chances of developing prostate cancer increase as one gets older. Most cases develop in men aged 50 or older. For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are at slightly increased risk as well. It is thought that lycopene-rich foods are best in protecting one from the disease. Lycopene is an antioxidant that is commonly found in fruits and vegetables that are red in colour like tomatoes, watermelon and guavas. Chillis of all sorts are also lycopene powerhouses.

Diagnosing Prostate cancer

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy (taking a piece of the prostate and testing it for cancer). The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer.

What is PSA?

PSA is made by the prostate gland and some of it will leak into the bloodstream depending on age and the health of the prostate. A raised PSA may mean that one has prostate cancer. However other conditions which are not cancer do cause raised PSA such as enlargement of the prostate, urinary infection and prostatitis. This test has problems in that 2 out 3 people with raised PSA will not have prostate cancer and the test can miss prostate cancer.
PSA test is sensitive to a lot of things hence the need to follow the instructions carefully otherwise one will get high levels due to not following the right procedure of testing. One should not have PSA testing if they have urinary infection, has ejaculated in the last 48hrs, exercised heavily in the last 48hrs , had a prostate biopsy in the last 6 weeks or had a digital rectal (anal) examination in the previous week.

What should one look for in order to see a doctor about this prostate cancer?

Prostate cancer usually develops slowly, so there may be no signs resulting in one having it for many years without knowing. Symptoms often only become apparent when one’s prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, one may notice things like an increased need to urinate, straining while urinating and a feeling that the bladder has not fully emptied. However, these signs do not mean one has prostate cancer. It is more likely they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
Because of the problems highlighted above men in UK are not routinely offered PSA tests to screen for prostate cancer as results can be unreliable. However PSA testing is offered on an individual basis after a full discussion with your doctor. A lot of research is currently taking place to come up with evidence based screening that is also safe because raised PSA levels also cannot tell a doctor whether a man has life threatening prostate cancer or not ( the one that can kill you and the one that won’t.). This means that a raised PSA can lead to unnecessary tests and treatment.

What is the take away home message about prostate cancer?

I have tried to present the facts to you and I apologise if l have confused some of you but the “take away home” message to my fellow African men is that prostate cancer is on the rise but rare below 45 years of age. If your father or brother was diagnosed with prostate cancer then you are at high risk of developing it. I suggest that if you have family history of prostate cancer and you are above 45 years then you must see your doctor to discuss screening options available regardless of whether you have symptoms or not.
Your doctor should be able to clearly discuss with you the advantages and disadvantages of the tests allowing you to make an informed decision about your situation. If you do not have family history of cancer and have symptoms such as constant urge to rush to the toilet to pass urine, passing urine more often than usual, especially at night and difficulty in passing urine then you should see your doctor for further tests. If you do not have family history and do not have symptoms either, but you are now worried after reading this article, l suggest that you also see your own doctor for further discussions.
If you are found to have prostate cancer, how then is it treated one may ask.
For many men with prostate cancer, treatment is not immediately necessary. If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
Sadly some people are being diagnosed at a later stage when cancer has already spread. In these situations the relatives and doctors can feel hopeless but having worked in a hospice myself, I feel passionate about end of life care that we are delivering to our loved ones in their last days on this earth. No one should be allowed to die in pain.
We may not be able to cure the cancer but we should guarantee to relieve pain and I know that it can be done. Family members need to work with doctors and pharmacists to get the best pain killers. There is need for education to both doctors and the public about the safe use of strong pain killers . This will make sure that people with cancer can die with dignity and pain free.

CONDOMS - HOW TO USE A MALE CONDOM

CONDOMS - HOW TO USE A MALE CONDOM

By practising safer sex, you can protect yourself from an unplanned pregnancy and sexually transmitted infections (STIs), including HIV. This means always wearing a condom, but first it’s a good idea to know how to use one and what to do if something goes wrong.

How do condoms work?

There are wide range of condoms and female condoms available, with varying levels of thickness, texture, material, size, colour and taste. They work by forming a barrier between the penis and anus, vagina or mouth. This prevents fluids (blood, semen or bodily fluids) being passed into, or on, each other.

The most popular type of condoms is made from a thin latex (rubber). However, if you are sensitive to latex you can use polyurethane or polyisoprene condoms instead.

Why is it important to wear a condom?

If someone has an STI this can be passed on during unprotected vaginal, anal or oral sex, or by sharing a sex toy. Vaginal sex without a condom can also result in pregnancy, even if it’s just the once. 

Wearing a condom is the best option when it comes to practising safer sex, especially because some STIs have no symptoms in the early stages, for example chlamydia.1 This means that you and your partner may not know you have an infection until much later on, which can affect your fertility and overall health. Similarly, one of the earlier stages of HIV infection may also not reveal any symptoms.2

When do you need to use a condom?

You should use a condom during any sexual activity where you may be at risk of sharing bodily fluids. The main purpose of other contraceptives such as the Pill or contraceptive injection is to prevent pregnancy, but they won’t stop you from catching an STI.

How do I use a condom?

A condom is less effective if the penis touches the vagina or anus before a condom is worn, or if it slips off during sex. Some people prefer to use a condom with added lubrication to make sex feel more comfortable, but more importantly this helps prevent condoms from breaking.

There’s no harm in practising how to put a condom on beforehand and this can help you both to feel more at ease when the time comes. You will also find instructions on the packet, but in general you should follow these rules:

•Check that the condoms are in date, in good condition and have the CE mark on it – this means they’ve been tested to European safety standards.
•The man needs to have an erection before the condom is put on. Always put the condom on before the penis touches a woman or man’s genitals.
•Open the packet carefully so that there's less chance of ripping it. There's usually an arrow on the packet to guide you in the direction you should open it. Avoid using your teeth and be careful with sharp fingernails or jewellery.
•Condoms come rolled up and need to be placed on top of an erect penis. Some people like to use a little bit of extra lubrication to help it go on easily. If you do this, use a water-based lubrication, rather than vaseline, hand cream or anything that contains oil - these can all break the condom.
•Pinch the teat at the end of the condom before you start to roll it down the penis. By doing this you will be helping to squeeze any air bubbles out and this will prevent friction that can cause condoms to break. It will also help you know if the condom is on the right way.
•Roll the condom down to the base of the penis. If it's on correctly it will roll downwards easily (or you may be able to feel the texture of the outside of the condom if it's ribbed). If you're not sure then use a new condom and try again. This is important even if the man hasn’t ejaculated because there can still be sperm on the penis (pre-cum).
•Only take the condom off when the penis is withdrawn completely from the body and while the penis is still erect. Tie a knot in the end of the condom, wrap it up, and throw it away in a bin (don’t put it down the toilet as it can block up your plumbing).
•Always use a new condom if you have sex again.
Remember: Avoid using two condoms at once or a female condom at the same time - this can cause friction and they're more likely to split or slip off.

What should I do if a condom breaks?

Condoms are highly effective if used consistently and correctly, so it's very unlikely that one will break. Wearing one is really important, but if a condom does split, break or slip off,  squeeze out as much semen as you can and avoid washing inside your vagina or anus (douching) as this can spread infection further or cause irritation.

You should always use a condom for oral sex too. It carries a low risk of HIV, but this risk is increased if there are any cuts, sores or inflammation on the man’s penis or a woman’s vagina, if you have a throat infection or there is any damage or bleeding in your mouth.3

Most sexual health professionals will advise you to have a sexual health test around 10 days after unprotected sex or if a condom breaks (or earlier if you are worried about any symptoms) and then again around three months later. This is because different STIs are detected at different times. In the meantime, avoid sexual contact or practice safer sex by always wearing a condom. 

What should I do if a condom breaks and my partner is HIV-positive?

If a condom breaks and you know you are having sex with someone who is living with HIV or who doesn't know their HIV status, you will need to visit a sexual health professional as soon as you can. You may be offered post-exposure prophylaxis (PEP) treatment.4 This is a month-long treatment of antiretroviral drugs (ARVs) that can reduce your chances of becoming HIV-positive.

PEP has a high success rate; however, it is not a replacement for condoms. PEP is a powerful drug that has side effects and it's not an option available to everyone.

How can I talk about condoms with my partner?

Some people feel embarrassed bringing up the subject of using condoms, especially in the early stages of a relationship. But it’s important to remember that the other person won’t think any less of you for wanting to practise safer sex – and if they do, it’s worth asking yourself if they are the right person to be with.  

Talking about condoms with your other half isn’t about you saying that you don’t trust them – it’s as much for them as it is for you. Be firm and confident in your decision and prepared for any excuses that you may hear. If someone loves and respects you, or wants to get closer to you, they will want you to enjoy sex and feel safe at the same time.