Pre-fix: A guide for people with Hep C or HIV who inject drugs

Making sex safer

HIV, Hep C and safer sex

Using some drugs and alcohol can make you feel sexy. Together with your sex partner you can make decisions about the level of risk and safer sex practices that you feel are right for you.

The chance of HIV passing during sex depends on different factors, including:

  • The kind of sex you’re having
. HIV passes most easily during condomless anal sex and vaginal or frontal1 sex. HIV can also pass when sharing sex toys. The risk of HIV passing during oral sex is usually low, although other sexually transmitted infections (STIs) can be easily transmitted this way. Cuts, sores or inflammation in the mouth or throat or on or inside the genitals can increase the risk during oral sex.
  • Condoms. 
Using a condom and lots of water-based lube prevents the spread of HIV. Put a condom on sex toys and change it when using them on a different person. Change condoms frequently and use a new one with each partner.
  • HIV treatment and viral load. 
If you’re on HIV treatment and have an undetectable viral load, the risk of HIV passing to a partner is lower.
  • PrEP. 
PrEP (or pre-exposure prophylaxis) involves an HIV-negative person taking certain HIV drugs every day to reduce their risk of getting HIV. Using PrEP correctly involves more than just taking medication every day, so make sure to get all the information. Your HIV doctor can tell you if PrEP is a good option for you or your partner(s).
  • If either partner has another STI. 
STIs can infect the genitals, anus, mouth and throat. Having an STI can increase the chance of HIV passing during sex. Get tested regularly for STIs and get treated.

It is rare to get Hep C (hepatitis C) through sex, although it is possible when there is a chance of blood or anal fluid being present. Anal sex without a condom, group sex and using drugs during sex have all been linked to passing on Hep C during sex among men, particularly gay men who are HIV positive.

What if you can’t ask someone to use a condom?

Sometimes it doesn’t feel safe to ask the person you are having sex with to use a condom. If this is the case, there are still things you can do to protect yourself.

  • You could try to get your sex partner to have types of sex that are less risky for getting HIV, such as oral sex or hand jobs.
  • Use lots of lube when you have sex because this reduces the chances of tearing of the walls of your vagina, front hole2 or ass.
  • Some people who have vaginal sex, front hole sex or anal sex may want to use a type of condom that is put inside the body, sometimes called the “female condom,” to give themselves more control.
  • Your local community health organization may give out “female condoms” for free. You can also get regular condoms at community health organizations.

If it is hard to ask the person you are having sex with to use a condom because you are worried they will become angry or violent, consider talking to someone you trust about how you are feeling. Talking with a social worker or counsellor is also a way to get some support when you are dealing with this situation.

Sex work and drug use

If you use drugs while exchanging sex for things you need, it may be harder to stick to your limits with clients and take care of yourself. Here are some things you can do to keep yourself safer:

  • Consider setting limits on how much dope or alcohol you’ll use when you’re working.
  • If you are using drugs and not sleeping for several days, it may be hard to be firm about your boundaries with clients. To protect yourself consider setting limits on how many days you will go without sleep.
  • Use a good water-based lube with condoms. Some drugs dry out the mucous membranes in your vagina, front hole and ass. Tearing can make you vulnerable to HIV and other STIs.
  • Do your best to negotiate the prices and working conditions you want, including condom use.
  • If you can’t negotiate for condom use, use lots of lube. You can put the lube on and in yourself ahead of time.
  • If you are exchanging sex for money, try to get paid in cash in advance.
  • 1. Frontal sex is a term some trans men use for front hole sex. See below for a definition of front hole.
  • 2. The front hole is what is commonly referred to as the vagina. It is a term that is sometimes used by trans men who feel more comfortable with this language.