How do you minimise the risk of contracting HIV and hepatitis C when you have sex on Tina or other chems, and how do you avoid injuring your cock and asshole?
Research suggests that barebacking is common among guys who use Tina or slam, and that it’s often a deliberate choice. Those that do this know it increases the risk of contracting serious STIs like HIV, syphilis, LGV and hepatitis C, but consider potential infection an unavoidable consequence of having sex without condoms. Which is why they tend to take STI tests on a regular basis. You might recognise yourself in this description.
Or perhaps you don’t bareback deliberately, but find condoms a hassle when you’re on chems.
Either way, we’re not here to lecture you about using condoms, no matter how effective they are against HIV and other STIs. But if you bareback, there are measures you can take to minimise the risk of contracting HIV. More so now with the availability of PrEP. And if you can’t afford PrEP, you can minimise the risk in other ways (risk reduction strategies). You can have yourself vaccinated against hepatitis A and B. You can’t do this for hepatitis C, but there are other things you can do to minimise the risk of contracting it. Even if you bareback.
The following information isn’t merely about STIs, but also about how to avoid injury to your cock and asshole when you’re on chems. Furthermore, it fills you in on what to do to avoid sex-related mishaps that can land you in the emergency room.
Avoid the potential consequences of sleazy sex. Here are the most important recommendations.
Make a habit of taking STI tests every three months. And if you have STI-related symptoms or have received an STI notification, take additional tests between your regular quarterly appointments. The sooner you identify and treat an STI, the better.
Why test?
Sex on Tina increases the risk of contracting HIV, hepatitis C and other STIs. There are several reasons why it does.
Read further - Why test?
Greater risk of STIs:
STIs such as HIV, hepatitis C, gonorrhoea, chlamydia, LGV and syphilis are more common among “chem-friendly” guys. One reason for this is that guys tend to use condoms less often when on chems. Having sex with guys who use chems increases the risk of contracting an STI.
Tina dries out the mucous membrane of the throat, cock and rectum. This increases the risk of tiny cuts, lacerations and bleeding, which can happen easily during:
– prolonged and vigorous fucking (especially if you don’t use enough lubricant)
– gangbangs: getting fucked by multiple sexual partners
– fisting
– playing with toys
– face fucking and throat pumping
In addition, poppers increase the blood flow in your rectal mucous membrane. This makes it easier for STIs to enter your bloodstream.
Booty bumping increases the risk of contracting STIs. Chems damage your rectal mucous membrane. This makes you more vulnerable to STIs.
Accidents can happen even if you slam as safely as possible. Things can go wrong, no matter how careful you are. But an “infection-free” result from an STI test will let you know you’re free of HIV, hepatitis B and C. Better to be safe than sorry: get yourself tested every three months.
Which tests should you take?
Don’t stop at an HIV test. Have yourself tested for all STIs. In addition, take a hepatitis C test every three months. Do this even if you’re HIV-negative.
Read further - Which tests should you take?
Hepatitis C is especially common among HIV-positive men.But HIV-negative men have also been known to contract the virus through sex.
Are you on PrEP via Amsterdam’s public health service (GGD)? If you’re taking part in the AMPrEP project, you will be tested every six months for hepatitis C, by default, and once a year if you’re taking part in the DISCOVER study. Not taking part in either study? Then you’ll have to arrange hepatitis C tests yourself. There are several ways to do this.
Where to get tested?
There are several ways to arrange your quarterly STI tests. For hepatitis C, you can obtain reliable self-testing kits (for home use) by signing up at NomoreC.nl.
Read further - Where to get tested?
Your family doctor The cost will be deducted from your insurance’s deductible excess. This isn’t a problem for some, because the cost of other medical treatments has already taken them beyond the limit of what they need to pay themselves.
Are you HIV-positive? Then you’ve probably already exceeded your insurance’s deductible excess because of the infection. In which case, having your family doctor test you won’t cost you anything.
STI clinics STI nurses can offer better advice about tests if you’re honest with them about chems and slamming. It’s safe to discuss such things here. It’s normal for STI nurses to ask if you take drugs during sex, and none (besides a few exceptions) will judge you. This might come as a surprise, but most STI nurses actually want to help, and will listen sympathetically. And most are familiar with Tina and slamming.
Hepatitis C:
Most Dutch STI clinics will only test you for hepatitis C if you received an STI notification, either from a partner or a health professional. It’s not a test they perform by default. Discuss this with your local public health facility or ask your family doctor for a test.
Public health service STI clinic in Amsterdam (GGD-Amsterdam):
– Are you HIV-positive? If so, you can have yourself tested for hepatitis C twice a year at the STI clinic. They’ll perform the test provided that the last hepatitis C test by your usual HIV specialist was performed at least three months ago, or at least six months ago if the test was performed at the STI clinic itself. Unless you’ve recently been notified of an STI. In which case, you’ll need to present the notification code. It’s not enough to claim to have been notified. This rule exists because hepatitis C tests are expensive. Would you like to be tested four times a year anyway, because you believe you might be more frequently exposed to risk? Then see your family doctor, or obtain a home-testing kit via NomoreC.nl.
– Are you HIV-negative? Then you can have yourself tested at an Amsterdam STI clinic, but only if a partner has sent you a hepatitis C notification. Unless, that is, you’re taking part in one of the city’s public health service PrEP studies; in which case you’ll be tested for hepatitis C once or twice a year by default.
HIV specialists Your HIV specialist will test you twice a year for syphilis and hepatitis C. They won’t typically test for other STIs.
In common with STI clinics, HIV treatment centres are safe environments in which to discuss using Tina or slamming chems. HIV nurses talk to people with HIV about all sorts of things all the time, including chems, so they’re less likely to judge you. Some will gladly lend an ear or offer advice. They can talk to you about things like whom to confide in regarding your sex life and love life; and about what you want from these relationships and setting boundaries.
The AMPrEP project, the DISCOVER study or InPrEP These studies are conducted at the public health service facility (GGD) in Amsterdam. The doctors and nurses that run the studies hear a lot about chem use from clients on PrEP. It’s a safe environment in which to discuss chems, Tina and/or slamming.
Testlab (online) Testlab’s tests are free, easy to arrange online, and can be scheduled at your convenience. You simply take the printout of their application form to the nearest laboratory. No need to visit your family doctor or STI clinic.
NB: Testlabs don’t test anyone with STI symptoms, or attend to people who’ve been sent an STI notification. In such cases, you’ll be referred to an STI clinic. Testlabs are for standard tests only.
Testlabs don’t test for hepatitis B or C, unfortunately.
NoMoreC.nl (online) You can arrange a hepatitis C test via this website (which is jointly run by GGD Amsterdam, Soa Aids Nederland and the AMC hospital, among others). It offers a highly reliable and very affordable subscription that covers four RNA tests a year. This allows you to detect hepatitis C infections early. Read more about this on their website.
You self-administer a finger prick to obtain a blood sample (it’s easy and virtually painless). Post this to the laboratory (no stamp required). They’ll send you the results online.
Which test?
It’s important to remember that there are different types of tests for HIV and hepatitis C. Some tests are better than others at detecting recent infection.
Testing for HIV:
The Standard HIV test This test can detect HIV three weeks after infection. This is the test routinely offered by STI clinics and family doctors, and it measures two things:
– whether your body has produced any anti-HIV antibodies.
– whether there’s any P24 protein in your blood; its presence indicates the virus.
The HIVRNA test This test identifies HIV infection even earlier than the standard test. It detects the presence of HIVRNA (= HIV particles) in your blood. RNA is detectable from about one week after exposure to the virus, although detection may sometimes take several weeks.
It’s an expensive test, so doctors will only conduct the test if there’s a strong indication of infection.
Are you HIV-negative and:
– have flu-like symptoms or other problems that do not feel like the usual after-effects of tina?
– have recently had sex without a condom?
Perform a symptom check at Hebikhiv.nl. The site will ask you about your symptoms. It may then issue a referral letter for an RNA test.
Note: Referrals for RNA tests via this website are only applicable to those living in the Amsterdam region. Has the site issued a referral, but you live outside the Amsterdam region? Then contact your family doctor or local public health service. Tell them you suspect you have an acute (i.e. early-stage) HIV infection. Also inform them of the results of the symptom check, and tell them Hebikhiv.nl recommended an RNA test.
The Rapid HIV test This test delivers its results within 20 minutes; in other words, rapidly. But it has one drawback: older generation rapid tests have been known to miss cases of recent infection. If you never or almost never use a condom, or if you are frequently at risk of contracting HIV, then best avoid the rapid test; take the standard test instead. The standard HIV test can sometimes detect the virus three weeks after infection. See above.
Testing for hepatitis C:
Hepatitis C antibody test This test detects hepatitis C as soon as your body starts producing antibodies.
This usually happens about two months after infection. It takes longer, though, if you’re HIV-positive: more than four months, in many cases. Thus, bear in mind that the results of an antibody test can be negative (i.e. no antibodies detectable) while you, in fact, have the virus. Antibody tests will not detect a recent infection.
Neither are antibody tests suitable if you’ve had hepatitis C before. Because even after you’re cured, antibodies will often remain in the body. Thus, an antibody test in such a case would yield a false positive result. Therefore, if you’ve previously had hepatitis C, take an RNA test.
Hepatitis C RNA test This test can detect infections at a very early stage: within seven to ten days of exposure to the virus. The test detects and measures the number of RNA (hepatitis C virus particles) in the blood.
It’s an expensive test. Thus, doctors will only conduct this test if there’s a strong indication of infection, or if you’ve received a hepatitis C notification.
Alternatively, you can obtain a more affordable RNA test via NoMoreC.nl. More information about this under the heading “Where to get tested?”
We recommend an RNA test if you’ve previously had hepatitis C.
Liver enzyme test This test detects any rise in liver activity. It measures the level of the ALT liver enzyme (also known as ALAT) in the blood. It doesn’t detect the hepatitis C virus itself. But an increase in ALT levels is often an indication of liver inflammation, i.e. hepatitis.
Your doctor will run a check to eliminate other possible causes of liver inflammation. He or she may subsequently decide to conduct an RNA test. A liver enzyme test is much cheaper than an RNA test, thus doctors usually prefer to conduct the former, first, and an RNA test as a second step.
Additional info if you’re HIV-positive:
Your HIV specialist will perform a liver enzyme test twice a year. Visit your family doctor for the other two test occasions, and ask him or her to share the results with your HIV specialist.
Additional info if you’re HIV-negative:
Visit your family doctor for your quarterly liver enzyme test. Liver enzyme tests aren’t generally offered at STI clinics.
Note: An increase in liver activity can also be the result of alcohol, chems or medication (incl. HIV medication). Therefore, always tell your doctor if you use chems, drink or take medication. Only then can they accurately assess your situation.
Note: The RNA test is always to be recommended if you’ve had hepatitis C before. But even if you’ve never had hepatitis C, measuring your liver activity is not the ideal way to test for the virus. A spike in your ALAT values may be missed (the spike may have subsided just before your levels were checked) or the spike may occur after the test. In which case, your liver values might seem okay when you, in fact, have hepatitis C.
Want to know more about the symptoms and treatment of HIV and other STIs? Click on this link.
For everyone 2. Exchange information about your HIV status and testing habits
Assume nothing! Always ask your sexual partner what his HIV status is, and when he last tested for HIV (and other STIs). Be equally open and honest about your status and tests.
If a partner has HIV, ask for his viral load. If it’s undetectable, then there is no risk of him infecting you.
If his viral load is detectable, then you know that you must protect yourself against HIV (PrEP /condoms).
Read further - Exchange information about your HIV status and testing habits:
If a partner claims not to be HIV-positive, remember that he may be unaware that he’s contracted it recently. Most HIV infections are transmitted by men who don’t realise they’ve been recently infected. Thus, if a partner assumes that he’s HIV-negative, protect yourself anyway.
Also, protect yourself against HIV if a partner says he just received his HIV-negative test results yesterday. Such a result reveals nothing about recent infection. The standard HIV test won’t usually detect infections less than three weeks old.
Assume nothing. Also ask your sex buddy(s) about his (or their) STI testing habits.
If a partner says he has himself tested every three months, it suggests he takes early STI-detection seriously. Your partner’s testing habits tell you what sort of person you’re dealing with. And if one day he notifies you of an STI, you’ll know you have a fuck-buddy who takes his health seriously.
Make it easy on yourself. Include your HIV status and your STI testing habits in your dating app profile. Or mention it whenever you chat via the app.
It’s much easier to bring these things up at smaller sex parties (with acquaintances) than it is at larger, more anonymous ones, where random strangers come and go. Therefore, try to restrict your use of chems during sex to sessions with familiar faces, men you get on well with even without chems.
For everyone 3. Notify your sexual partners if you contract an STI
By notifying each other, you’ll avoid reinfecting each other. You and your sexual partners can even be treated simultaneously (for certain STIs), if you send them a “notification code”. You can obtain notification codes from whoever gave you your test results. How far back you have to go with respect to notifying partners varies. Sometimes it’s three months, sometimes six; ask the STI nurse. If it’s hepatitis C, go back months. Public health service facilities (GGDs) can also help with anonymous notifications. They will also help you if you suspect you contracted the STI at a sex party, have hardly any contact details of the guys you met at this party, but do have those of the person who invited you.
Read further - Notify your sexual partners if you contract an STI:
Most GGDs (and some family doctors) use the digital notification system partnerwaarschuwing.nl. One of the benefits of this system is that in cases of gonorrhoea or chlamydia, you and your sexual partners will be treated together. In which case they won’t have to wait for their own test results before getting treatment.
Picked up an STI at a sex party? The GGD can assist you in notifying the other participants anonymously. Ask the party’s “host” if you may pass his contact details on to the GGD. He and the GGD can then devise a plan for notifying the others.
Try to keep a record (on your phone) of your sexual partners’ (or party host’s) phone numbers, email addresses and profile names, along with the details of when you had sex with whom. This is useful information for the GGD if you go there to get yourself treated for an STI.
For everyone 4. Have yourself vaccinated against hepatitis A and B
Both viruses are easily transmitted through sex. They are serious diseases. Vaccination against hepatitis B is free; against hepatitis A costs about 60 euro.
Read further - Have yourself vaccinated against hepatitis A and B:
Have yourself vaccinated against hepatitis A. Hepatitis A is on the rise again in gay communities across Europe. Outbreaks have been reported in Spain, Italy, the UK, France and Germany. It’s also on the rise in the Netherlands. The virus spreads through sex, but also through poor toilet hygiene. If you’re visiting any of the pride parades (gay pride, leather pride, fetish pride) or other such festivals, then we strongly advise you to have yourself vaccinated against hepatitis A.
A vaccination (2 shots) costs about 60 euro and can be administered in combination with a hepatitis B vaccination.
If you are yet to have yourself vaccinated against hepatitis B, do so as soon as possible. The vaccination (3 shots) is free for gay men and gives you lifelong protection. Click here to arrange it. The exception is if you’ve once (unconsciously) had hepatitis B, recovered from it and are now immune. In which case, vaccination won’t be necessary. You can have yourself checked out for this, too.
Always reveal your status if you are HIV-positive. If you are, you’ll need a double dose of the hepatitis B vaccine. Your HIV specialist will usually have vaccinated you already. Not sure if he/she already did? Enquire at your HIV treatment centre. Vaccination is especially important if tenofovir (Viread) isn’t included in your combination therapy. Tenofovir has been shown to suppress not only HIV, but also the hepatitis B virus. So if you switch to a combi that does not include tenofovir, vaccination becomes vital.
Meer lezen over hiv en soa’s? En over symptomen en behandeling ervan? Bekijk deze link.
For everyone 5. Minimise the risk of contracting hepatitis C
Even if you bareback, you can still minimise the risk of contracting hepatitis C. In addition to measures you take to do so, have yourself tested for the virus every three months.
Ideally, keep sex within a closed circle of guys you’re well acquainted with, guys you can trust to have themselves tested regularly, and that are likely to tell you if they contract hepatitis C. It’s easier to discuss minimizing transmission risks with familiar faces. The larger the group, the more difficult it is to monitor everything.
Having safe sex on Tina isn’t always easy. Taking measures to ensure you don’t contract hepatitis C can be difficult when you’re going with the drug-induced flow. Difficult, but not impossible. It helps to be vigilant at critical moments, such as when a sexual partner grabs a sex toy, or when switching partners. It’s important to think about such moments while you are still sober, i.e. before you start using Tina or other chems, think about what to be on the lookout for and what to do when. See also “What measures can you take to avoid hepatitis C before taking chems?“.
How is hepatitis C transmitted?
Hepatitis C is transmitted during sex through blood, sperm, rectal fluid and poo particles containing the virus.
Blood particles are not always visible.
Read further - How is hepatitis C transmitted?
Minor lacerations in the rectal lining occur quite easily during fisting, (prolonged and vigorous) fucking, and when dildos or other toys are used. In fact, anal sex always involves a bit of bleeding due to little tears in the small veins in the rectum. You just don’t always notice.
Hepatitis C enters the body via the damaged lining, or through small wounds or sores (caused by an STI, for instance).
You don’t have to be fisted to contract hepatitis C. It can happen while fucking, too. The risk of the latter is particularly high if you get fucked by multiple men, be that at a sex party (of whatever size) or in a darkroom, cruising area or sauna.
You run the greatest risks as a bottom (i.e. you get fucked or fisted).
As a bottom, you can contract hepatitis C from another bottom without even having sex with him! Merely being in the same room creates the possibility. If the other bottom has hepatitis C and you’re both fucked or fisted by the same top, this top can transmit the virus from the other to you. The top himself runs minimal risk; he is merely the “carrier” of hepatitis C. It’s vital, therefore, for tops to take certain measures to avoid this.
Hepatitis C is easily transmitted. In contrast to HIV, the hepatitis C virus can survive outside the body for weeks. It appears to be able to do so for six weeks at room temperature on materials such as steel, plastic, rubber and in lubricant. If slings and shared mattresses are not properly disinfected during and after sex, the hepatitis C virus can be transmitted.
Studies have shown that hepatitis C can also exist in sperm, rectal fluid and poo particles (in other words, in your ass). The chance of this occurring may be higher in cases of recent infection, i.e. acute hepatitis C. This is when someone is in the first six months of infection. It is currently unknown if hepatitis C can exist in pre-ejaculate.
Hepatitis C can also be transmitted by needle sharing, pricking yourself on someone else’s needle, sharing syringes for booty bumping, or sharing straws or snorting equipment. Sharing meth pipes can also be tricky. You are very likely to suffer dry lips if you don’t drink enough water. When this happens, the heat from the pipe can crack your lips. This makes you vulnerable to hepatitis C if the virus ends up on the mouthpiece because you’ve shared your pipe with someone who already has the infection. For more on this, see Harm Reduction.
What can you do to avoid hepatitis C?
There is a lot you can do to minimise the risk of transmitting hepatitis C. This holds true even if you don’t use condoms.
Read further - What can you do to avoid hepatitis C?
Use your own lubricant/crisco when being fucked or fisted. Invisible traces of hepatitis C-infected blood may be present in other people’s lubricant or on the outside of the jar.
Don’t let partners come inside you.
Does your sexual partner have a cock piercing, e.g. a Prince Albert? Ask him to remove it. Being fucked by someone with a piercing increases the risk of tears and bleeds.
Use your own toys, and don’t share them with anyone. Invisible traces of hepatitis C-infected blood may be present on other people’s toys, or on yours if you have the infection.
If a guy who’s been fucking someone else wants to fuck you: ask him to first wash his cock of all “old” lubricant. To be absolutely certain, accompany him to the bathroom and wash it with him.
Wear gloves when fisting.
If someone wants to fist you: ask him to put on a new pair of gloves before he even touches your ass. Tiny wounds and bruises may be hidden under fingernails. Hepatitis C can be transmitted through this way.
If during a sex party, a guy who already fisted another guy wants to fist you: ask him to first degrease and disinfect his hands and arms all the way up to the elbows. It doesn’t matter if he does or doesn’t wear gloves when he fists. Even if he wears gloves, invisible blood particles containing hepatitis C can end up on his forearms. The virus can also end up on his hands when he removes his gloves. Furthermore, if he has hepatitis C and has been playing with his own ass before playing with yours, he can transmit the virus to you on his fingers (see info box on disinfection).
When having sex on a bed, mattress or in a sling: do not lie in the residue of lubricant left by the previous occupant. First get rid as much of the lubricant residue as possible; degrease and disinfect the area; and lay your own towel over the spot (see info box on disinfection). If a top, whilst playing with another bottom, touched the sling’s chains and frame with “lubricated hands”, make sure you disinfect these parts, too. (See info box on disinfection).
Always use your own anal douche when cleaning your butt.
Do not share needles, syringes, spoons, filters, cotton balls for staunching blood, or cups or containers for your equipment.
Bin used needles in a needle container immediately after use. You can order these online. This prevents needlestick injuries.
Do not share meth pipes or syringes for booty bumping (anal insertion of chems).
Do not share straws for snorting. Tip: Prepare lots of short plastic straws in advance. Place these in a glass and tell your sexual partners to bin each straw immediately after use. This helps avoid confusion.
If you’ve recently had any medical treatment involving your anus, wait a few days before having sex again. You may have had a wart removed, for instance, or had a biopsy taken as part of a study or test, such as for AIN (precursors to anal cancer).
If you shave your balls, do so a few days before having sex. Shaving can leave tiny cuts. This makes it easier to contract hepatitis C.
Do not have sex if you’ve got herpes. The blisters that develop with herpes can facilitate the transmission of hepatitis C.
Reduce the risk of contracting hepatitis C while fisting or playing with toys:
Avoiding injury
– Proceed slowly when fisting. Never use force.
– If you’re the top, keep your fingernails clipped and smoothly filed (to avoid causing injury).
– Never wear rings, bracelets, etc. when fisting.
– Use lots of lubricant. This minimises the risk of causing bleeds. Buy the kind in squeeze bottles, such as this. These are typically sold as intimate douches for women (vaginal douches). That way, whoever’s about to fist you can squeeze the lubricant deep into your rectum. There is no better way to get lubed up. They’re sold for single use only, but if you disinfect both bottle and nozzle for 5 minutes in a bleach solution (see disinfection) after each occasion, you can use them multiple times.
– If you notice the lubricant turning pink, take a break. This indicates a bleed. If bleeding continues, stop fucking or fisting altogether. If necessary, rinse your butt with cold water to tighten the blood vessels. Then take a long break.
Fisting gloves
– Allergic to latex? Then buy fisting gloves made of nitrile.
– Use condoms when footfucking. Use the largest sized ones. This not only guards against hepatitis C, but also against foot bacteria.
– Wear a new pair of fisting gloves (and new condoms) with each new partner.
– Remove fisting gloves carefully. If someone with hepatitis C has just been fisted, the virus will be on the outside of the protective material. Always degrease and disinfect your hands afterwards.
– Preferably, use silicone- or water-based lube, such as J-lube, Amos or other brands typically used by veterinarians. These do not damage the latex in fisting gloves. You’re thus less likely to tear the gloves. Prefer oil or grease? Buy nitrile gloves. Nitrile isn’t weakened by oil or grease.
Dildos and toys
– Keep each dildo and toy apart from all the others. Don’t put them all together in one container. This will curtail the possibility of someone with lubricated hands touching the other toys when he grabs the one he wants to use on you.
– Don’t try to share dildos by encasing them in condoms. This’ll only give you a false sense of security. The hepatitis C virus may be present on the bits not covered by the condom.
– Sharing dildos or toys? Wouldn’t advise it. Want to anyway? Then degrease and disinfect before sharing (see info box on disinfection).
Disinfection. The virus appears to be able to survive outside the body for up to six weeks:
Hepatitis C can be transmitted via invisible blood particles. Small bleeds are more likely to occur when you engage in prolonged or vigorous fucking or fisting, if the top has a cock piercing, or when you use dildos. Blood particles with hepatitis C can end up on your skin, but also on toys, anal douches and on the bedding or sling. The virus appears to be able to survive outside the body for up to six weeks.
Therefore, it is vital to keep disinfecting your skin, bedding/sling/couch, etc. and all the sex equipment during sex sessions. It’s vital, even if you wear latex gloves while fisting. Gloves usually only cover up to the wrists. With deeper fisting, traces of blood with hepatitis C may end up on your forearms.
Perfect disinfection won’t always be possible. But an attempt at disinfection is better than none at all. Before the sex begins, reach an agreement with everyone about continual disinfection.
Disinfecting your skin after fisting
Focal points
– Not only the hands, but also the forearms!
– First degrease with soap and plenty of water! Hepatitis C may be hidden in the grease.
– Dry your hands and forearms completely. Otherwise the disinfectant won’t do its job effectively.
– Disinfect with Sterilium med®. Make sure your hands and arms remain wet with this solution for at least 30 seconds after application. Reapply, if necessary. Then hold out your arms to dry naturally. Don’t dry your arms with a towel instead. It may be home to hepatitis C.
– Alternative: use Betadine® Scrub. Wash your hands and forearms in this solution for at least 30 seconds before rinsing.
Disinfecting sex area surfaces (sling, bed sheets and plastic sheets, etc.)
Focal points
– First wipe off and degrease the sex area surfaces to get rid of as much lubricant as possible (use a spray bottle filled with 1 part cleaning liquid, 9 parts water).
– Disinfect thoroughly (use a Blue Wonder® disinfectant wipe; allow surfaces to remain damp for at least 15 seconds). See the instruction video at NoMoreC.nl
– Don’t forget the sling’s chains and frame.
Disinfecting sex toys (dildos and anal douches)
Focal points
– Ideally, only use your own dildos and anal douche. Otherwise, disinfect the ones you use.
– First degrease with detergent and plenty of water! Hepatitis C may be hidden in the grease.
– Disinfect thoroughly (bleach solution of 1 part bleach, 9 parts cold water; for at least 5 minutes).
– No one knows if “toy cleaners” kill all traces of hepatitis C. But household bleach is effective, cheap and doesn’t damage dildos.
– Do you want to know more about disinfection? See the instruction videos at NoMoreC.nl
Want to know more about disinfection? Then click here.
What measures can you take to avoid hepatitis C before taking chems?
Let’s consider two scenarios:
– Sex is happening at your place
– Sex is happening at someone else’s place
Sex is happening at your place:
The playroom
– Provide a stack of “party towels” (laundered at 60 degrees). That way everyone has a towel of their own to lie on. Provide different coloured towels. This will minimise confusion, and ensure that no one mistakenly reuses someone else’s towel.
– Place several rolls of paper towels around the playroom (better yet: loose paper towels). Paper is handy for wiping off lubricant residue before degreasing and disinfecting your skin and the sex area.
– Disinfect dildos thoroughly before use, and spread them out so there’s no contact between them. That way you avoid the possibility of someone accidentally touching the others when he reaches for one.
– Place empty bins and buckets around the room. This gives people somewhere to chuck used toys.
– Set out boxes of fisting gloves in a variety of sizes.
– Lay out condoms (for fucking and footfucking).
– Place a waste bin near the action (so that used kitchen towels, fisting gloves and condoms aren’t left lying around).
– Place a needle container within easy reach (if anyone will be slamming).
– Ask everyone to initial their lubricant bottle with water-resistant marker. This will ensure you don’t mistakenly use each other’s lubricant.
– Fill a spray bottle with water and all-purpose cleaner (1 part cleaning liquid, 9 parts water) and have a packet of Blue Wonder® disinfectant wipes to hand. Both the spray bottle and wipes should be within easy reach of the action.
– Give some thought to adequate lighting (you need to be able to spot immediately if a partner starts to bleed).
The bathroom (see also the info box on “Disinfection”)
– Make sure you have at least one litre of bleach at home. If you use lots of toys, you’ll need a big bucket of bleach solution. The ratio is 1 part bleach to 9 parts cold water. In other words, add one litre of bleach to nine litres of water.
– Put soap or washing-up liquid and Sterilium med® (or Betadine® Scrub) next to the sink or shower.
– Fill a bucket with bleach solution (1 part bleach, 9 parts water). This is for degreased toys and anal douches. NB: Ideally, your guests will have brought their own toys and douches. But if not, the bucket of bleach solution allows you to keep the shared toys and douches disinfected (you must soak the toys and anal douches in the solution for at least 5 minutes).
– Keep piles of clean towels close at hand (to ensure that everyone has their own towel, and to avoid transmitting hepatitis C via towels).
When your guests arrive
– Show everyone where you’ve placed all the disinfection aids, fisting gloves, towels, etc.
Sex is happening at someone else’s place:
Take along
– Your own anal douche
– Your own toys
– Your own lubricant, bearing your initials
– Fisting gloves and condoms
– Your own meth pipe
– Your own straws
– Your own syringes for booty bumping
– Your own needles and other slamming equipment (including a pocket-sized needle container)
– Sterilium med® (or Betadine® Scrub) to disinfect your skin (see “Disinfection”) en Blue Wonder® desinfectiedoekjes om de speelplek te desinfecteren (see “Disinfection”).
– A few towels for lying on when being fucked or fisted. Your host may not have enough towels.
During sex
– Make sure NOONEELSE uses your lubricant or toys.
For everyone 6. Avoid (permanent) injury to your cock and asshole
Uninhibited sex is great, but it can be a bit of a downer if it results in you or your sexual partner having to visit the emergency room. Below are tips and tricks to help you avoid permanent injury to your cock and asshole.
Injury to the cock and asshole
You’re less sensitive to pain when you’re on Tina or other chems, and easily overstep your boundaries. It’s sometimes only afterwards that you realise how far you went: bruises on your cock, nipples shredded, severely raw asshole. These will heal, but the risk of such injury is greater the longer the sessions. Here’s how to reduce the likelihood of injury.
How do I minimise the risk of injury?
Douche carefully and patiently. Careless douching can damage the intestinal wall. Use a soft jet of water. Never douche with laxatives or soap; these irritate the intestinal lining.
Apply silicone lubricant before inserting the anal douche for the first time. And apply a bit more lubricant as you repeat the process.
Take 30-minute (or longer) breaks when you douche. This places less stress on your intestinal lining.
Wait at least an hour after douching before fucking. This gives your mucous membrane a bit of time to recover.
Use lots and lots of lubricant when playing. Tina dries out your mucous membrane. Guys often use spit as lubricant when the fucking begins. But spit dries quickly. This increases the risk of injury. So fuck carefully when you begin, and introduce lubricant — lots of it — as soon as possible. Ideally, use lube from the very beginning.
Lubricate your cock when jacking off at length to avoid masturbation-related injury.
Avoid using urethral sounds when you’re on Tina. Inserting urethral sounds demands attention. If you’re bent on inserting them anyway, make sure everything’s sterile. Sterilize the sounds (boil for 30 minutes) and do not touch them with your bare hands (always wear latex gloves). Use sterile, water-based lubricant (KY), if possible. Start with small sounds. Never force a sound into the urethra. They should slide in effortlessly.
When using vacuum pumps, avoid pumping to the max. Otherwise you may bruise yourself or suffer some other temporary “mechanical injury” to the cock.
Preventing intestinal perforation:
Rough play that ends in a bowel peroration is no joke. It doesn’t happen often, fortunately, but everyone’s heard at least one such story: torn intestinal wall, ambulance, emergency room … Desire can be greater than the asshole. Especially when you’re on chems. Then you want more, more, bigger, deeper.
Fisting is harmless and so is using (big) dildos, as long as you listen to your body, force nothing and communicate clearly with your top or bottom. In addition, the old rule still holds true: the bottom is always the boss. If you say “stop”, “hold steady” or “back”, the top must comply immediately.
Chems like Tina can mess up this communication. A top may become too pushy. Or a bottom can get so wrapped up in himself that it becomes hard to tell what he wants from his reactions.
Here follows the most important pieces of advice:
If you and your partner find it difficult to communicate because of the chems, take a break.
If a top becomes too pushy or distracted, stop immediately.
Make sure any top that’s about to fist or use toys on you hasn’t just had a chems “refill”. You’d be asking for trouble otherwise. As a general rule, tops should stay as sober as possible; they shouldn’t even take poppers. That way they can remain attentive to the bottom’s reactions.
If a bottom stops indicating his enjoyment, stop immediately.
Don’t start with a big dildo; build up to it with smaller ones.
Never push the end of a dildo beyond the sphincter. Always leave the end sticking out.
If the lubricant starts turning pink, take a break. This indicates a bleed. If the bleeding doesn’t stop, or turns dark red, stop fucking or fisting immediately.
Fever or abdominal cramps after fisting or playing with toys:
Experiencing (severe) abdominal pain, stomach cramps or a high fever shortly after being fisted or fucked with a toy? Then call the emergency services immediately. You may be suffering gastrointestinal inflammation, and, if so, you need urgent medical attention. Acute gastrointestinal inflammation occurs when you rupture your intestinal wall and leak bowel bacteria into the body. It can be fatal.
When in doubt, call the emergency number (‘Spoedeisende Hulp’) of the nearest hospital. Tell them what you suspect and why.
Other symptoms of gastrointestinal inflammation (besides a fever, (severe) abdominal pain or stomach cramps) include impaired consciousness, blood loss and abdominal swelling. These are warning signs. Call for an ambulance (112) immediately.
Impotence resulting from taking Androskat or Caverject:
Another highly risky situation can arise if you take Androskat or Caverject erectile dysfunction medication. These drugs are administered by injection. But the resulting erections can persist for too long, potentially causing lifelong impotence. Avoid having to call for an ambulance or visit the emergency room.
Some guys use Androskat (papaverine/phentolamine) or Caverject (alprostadil), instead of Viagra, Kamagra or Cialis. Urologists and sexologists sometimes prescribe these to people whose erectile dysfunction is rooted in a physical cause (surgery, chemotherapy, etc).
Androskat and Caverject are not typically prescribed if a client’s erection problem is psychological. As such, these drugs aren’t meant to assist people who can get hard under normal circumstances, but can’t when they’ve taken chems. The risk with these drugs is that your erection may persist for too long; such is their potency. This might sound great. Especially if you’re into long, drawn out sex sessions fuelled by chems. But the picture might start to look less rosy if you consider that an erection like this can destroy your cock. Without the right precautions, this could — in the worst-case scenario — result in lifelong impotence. You’ll no longer be able to get a stiffy without a prosthetic devise.
Those prescribed these drugs also need to be on the alert for persistent erections. The drugs come with a leaflet that states that if an erection lasts longer than three hours, the patient must call the emergency services. The likelihood of permanent damage increases if the erection is not treated after six hours.
How does Androskat work? When you have an erection, the erectile tissue in your cock fills with blood. Androskat functions by keeping the blood there to maintain your erection. But this mustn’t happen for too long. If blood isn’t refreshed in time, the erectile tissue becomes starved of oxygen and the blood starts to congeal. This can damage the erectile tissue irreparably. Once that happens, you can forget about erections. Not even Viagra will help then.
These drugs demand precision when gauging dose size. Half a millimetre too much can result in a dangerously persistent erection. That’s why those prescribed these drugs are typically injected by a medical specialist over a period of weeks, gradually and safely building up to the required dose.
Here follows the most important pieces of advice:
Never inject Androskat or Caverject unless you’ve been gradually introduced to it by a doctor and, as a result, know the required dose. Dose size must be gauged extremely precisely. You must build up to it very carefully. You and the doctor who prescribed the drug will eventually determine a dose size that’s effective, but that poses a low risk of a dangerously persistent erection (aka priapism). Thus, don’t let yourself be tempted to ask a sex buddy to inject you if you weren’t prescribed the drug and introduced to it by a specialist. No matter how hot it sounds.
Never wear a cock ring, and avoid bondage of the balls if you’re on Androskat or Caverject.
Never combine Androskat or Caverject with other erectile dysfunction medication (Viagra, Kamagra, etc.).
Stay on the alert for erections lasting longer than three hours. If you’re still erect after five hours, you’ve entered the critical stage. Wait no longer. You must receive treatment before the six-hour mark. Head straight to the emergency desk at your nearest hospital. They will drain the blood from your cock and give you an adrenaline shot. This will usually relax your cock. If you’re lucky, you won’t have suffered permanent damage.
Never take cocaine or Ritalin in combination with these erectile dysfunction drugs. Cocaine and Ritalin themselves can result in persistent erections. Take this cocktail of drugs and you might as well head straight to the emergency room.
HIV-negative 1. Take PrEP
If you take Tina or slam chems and prefer barebacking, we recommend you take PrEP. You increase the risk of HIV transmission when you’re on chems. Don’t forget to take a PrEP pill every 24 hours.
Read further - Take PrEP:
PrEP is an HIV prevention pill. You can choose a daily PrEP regimen or take it on an event-driven basis (the day before, during sex and two days after). Whichever you choose is a matter of personal preference. A doctor can write you a prescription; however, PrEP pills aren’t yet covered by Dutch health insurance. PrEP is available from €50,00 for 30 pills. Some research projects include free PrEP pills, but these are currently fully subscribed. Those that can’t bear to wait for Dutch health insurance to cover PrEP sometimes buy cheaper pills from other countries or acquire them by other means.
These cheaper pills aren’t usually the officially approved brand (Truvada). Nonetheless, provided you order the alternative pills from a reliable source, they will typically comprise the same ingredients and be just as effective, but cheaper: €30–€100 euros for 30 pills. The downside is that your medication won’t come with medical supervision. It’s always better to take these pills under medical supervision. The fact that the doctor providing supervision will also keep an eye on your kidney function is enough to recommended this option.
If you’re considering PrEP without supervision, there are a few important things to consider. Make sure you:
get your pills from a reliable source. Inquire at PrEPnu.nl
confirm that you’re not HIV-positive before you start taking PrEP. Have yourself tested by your family doctor, at an STI clinic or via the Aids Health Care Foundation in Amsterdam. To ensure they use the appropriate test, tell them you’re getting tested because you intend to take PrEP. A Rapid HIV test (which usually involves a fingerstick blood sample and delivers results within minutes) won’t do.
keep taking quarterly tests for HIV and other STIs.
Have your kidney function tested before you start taking PrEP pills, one month after you’ve started, and every six months thereafter. Ask your family doctor to arrange the tests, or find out where to have this done via PrEPnu.
take your pills consistently, even when Tina blurs your awareness of time.
be sure PrEP doesn’t interact unfavourably with any other medication you’re taking.
Buying abroad
It’s legal to bring PrEP back with you when you return from abroad. Customs classifies up to 300 pills as “own use”. More than 300, and customs will have to confirm that these are indeed for own use. In either case, you need a prescription. The pills must also be identifiable as medicine. Not every customs officer is familiar with these guidelines. It is thus advisable to travel with a copy of the guidelines.
Ordering PrEP online (i.e. by post) from a non-EU country is not allowed. The risk of suffering a seizure is very high.
Make sure you’re not HIV-positive
Take an HIV test before you start taking (or resume taking) PrEP. You need to be absolutely certain that you are not HIV-positive. If you take PrEP when you’re already HIV-positive, the virus could become resistant to PrEP and antiretroviral treatment. There have been only a few such cases in the Netherlands, and we should try to keep it that way. The ingredients used in PrEP are similar to those in anti-HIV medication. This is also why it’d make no sense to simply hand out PrEP pills to other HIV-negative men unless they’d taken an HIV test.
Keep getting tested, even after you start taking PrEP. Take QUARTERLYTESTS for HIV and other STIs, including hepatitis C.
Keep an eye on your kidney function
Contact your family doctor for kidney function tests (which measure creatinine levels). STI clinics will eventually be equipped to offer this, too. NB: Your family doctor is bound by a duty of care, even if you acquired your PrEP yourself. However, bear in mind that only a handful of Dutch family doctors are aware of PrEP. Broach the subject with your family doctor. Inform him or her about the necessity of quarterly kidney function and STI tests for anyone on PrEP pills.
If your family doctor or pharmacist has any questions, tell them to visit this website. You can also suggest they look up the PrEP guidelines. Alternatively, they can consult the experts at seksHAG.These family doctors are sexual health specialists. They know all there is to know about PrEP and are more than happy to assist other family doctors. Last but not least, your doctor or pharmacist can have a peer consultation by phone — the telephone number is on this page of the GGD Amsterdam website.
Take PrEP consistently
PrEP only provides adequate protection against HIV if you take them consistently (they offer >90% protection).
Keep a few days’ supply in your everyday backpack or in a pillbox attached to your key fob.
Create a system to yourself when to take your pills. Ask other PrEP users or friends with HIV for tips. Everyone has his own methods.
Taking PrEP daily: you’ll need to take a pill at roughly the same time every day.
Taking PrEP before and after sex: you’ll need to take at least four pills over several days. The longer your sex session (in days), the more pills you’ll need to take. More here about the appropriate pill regimen.
If you use Tina or slam chems, consider following a daily PrEP regimen. When you have prolonged sex sessions (followed by crashes), there’s always the risk that you will forget to take your pills. A daily regimen is more forgiving if this happens. Because while you shouldn’t miss a single dose, a daily regimen will leave enough PrEP in your bloodstream to protect you against HIV should you forget. You don’t have as much leeway if you only take PrEP before and after sex.
Set a repeating phone alarm to remind yourself when to take your PrEP. That way you won’t forget even when playing.
Before and during a crash, make sure your (fully charged!) phone is right next to you. You’ll be more likely to hear the alarm when it goes off.
Make sure your PrEP and a glass of water are within easy reach. That way you won’t have to get up to take it.
Read this to find out what exactly PrEP is.
Read the seven precautions to take when sourcing PrEP yourself.
Read the PrEPnu protocol for taking generic PrEP pills safely.
Click here to find out what to do if you forget to take PrEP.
Do you bareback and don’t take PrEP, but would like to minimise the risk of contracting HIV? You can do so with risk reduction strategies. They are not completely fail-safe protection against HIV, but we recommend them highly with respect to your lifestyle. These strategies provide additional protection even if you take PrEP.
Adopt the strategies that suit you.
Our aim here is to provide honest information, thus we list the pros and cons, relative to wearing condoms or taking PrEP.
Viral load sorting: you bareback with HIV-positive men whose viral load is undetectable owing to successful treatment. Pro: If they’ve been treated successfully, they can’t transmit the virus. Con: You can never be certain that a casual partner’s viral load is really undetectable. If you’re not that close, you have to base your certainty on trust. Never assume that your partner’s viral load is undetectable. Always ask if it is.
You’re always the active partner (the “top”): you bareback, but always do the fucking. Pro: The risk of contracting HIV is lower if you’re the top rather than the bottom. Con: tops can still be infected. The risk is lower, but it happens. To find out why, read this.
You don’t come inside each other: you bareback, but you don’t come inside each other. Pro: It’s safer if you don’t come inside each other than if you do. Con: Even if you don’t come inside each other, a top can still transmit HIV to a bottom. To find out how, read this.
Three risk reduction strategies that we DONOT recommend:
Serosorting (inadvisable): you bareback with men who claim to be or think they’re HIV-negative. Pro: This strategy is safe for avoiding HIV infection, provided that you know the other guy quite well and can trust that he’s really HIV-negative because:
– you know when he last took an HIV test.
– he always wears a condom with others. Con: Serosorting is very risky in practice. Your sexual partner may be HIV-positive without knowing it. Bear in mind that only 20 per cent of all HIV-negative men have themselves tested every six months. Furthermore, HIV is highly infectious when the carrier has only been recently infected. Recent infection means a sky-high viral load. Most infections are transmitted by men who, unbeknown to them, have been recently infected. Conclusion: serosorting involves too many uncertainties. The risk of contracting HIV is high.
PrEP-sorting (inadvisable): You’re HIV-negative and don’t take PrEP, and you bareback with HIV-negative partners who do take PrEP. Pro: If a partner is well protected against HIV owing to PrEP, he can’t infect you. Con:
– you can’t be certain the other guy really is on PrEP. You can make him wear a condom, but you can’t monitor his PrEP regime
– you can’t be certain he takes his pills consistently. In which case he could become infected without knowing it. Conclusion: PrEP sorting involves too many uncertainties. Consider taking PrEP yourself to ensure your protection against HIV.
HIV-positive 1. Adhere strictly to your treatment regimen
Your viral load will only remain undetectable if you maintain your daily regimen of HIV medication. Keep a few days’ supply in your everyday backpack or in a pillbox attached to your key fob.
Read further - Adhere strictly to your treatment regimen:
Set a repeating phone alarm to remind yourself when to take your HIV inhibitors. That way you won’t forget even when playing.
Click here to find out what to do if you forget to take your medication or throw up after taking it.
Before and during a crash, make sure your (fully charged!) phone is right next to you. You’ll be more likely to hear the alarm when it goes off.
Make sure your HIV medication and a glass of water are within easy reach. That way you won’t have to get up to take it.
You may on occasion find yourself constrained by your regimen. Perhaps you forget to take your medication because your memory has been compromised by Tina or slamming. Or Tina might suppress your appetite just when you need to eat in order to take your HIV medication. Talk to your HIV nurse. He or she might be able to suggest a more suitable form of combination therapy.
It’s much better to identify and discuss such problems as soon as possible than to start trying to customise your regimen or stopping treatment altogether. If you need help or advice, call the ‘Servicepunt’ of the HIV Association (this is a helpdesk).
HIV-positive 2. Make sure your medication isn’t amplifying the effect of your chems
Chems do not appear to adversely affect the performance of HIV medication. But chems can make you forget to take your medication.
Some HIV inhibitors amplify the effects of ecstasy, MDMA, GHB, GBL, ketamine, speed, meow meow, Tina and tranquilizers. You’re more likely to overdose when this happens.
Read further - Make sure your medication isn’t amplifying the effect of your chems:
HIV inhibitors known to have an amplifying effect: Efavirenz (one of the items in Atripla, the combination pill), and Norvir (ritonavir) and Cobicistat, both boosting agents. Stribild, the combination pill, contains Cobicistat.
If you take any of these inhibitors, take lower doses of tina, ketamine, ecstasy and MDMA, or ask your HIV specialist to change your medication because you take chems and would like to avoid an overdose.
