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.

For everyone:
1. Take quar­ter­ly STI tests
2. Exchange infor­ma­tion about your HIV sta­tus and STI test­ing habits
3. Warn your sex­u­al part­ners about your STIs
4. Have your­self vac­ci­nat­ed against hepati­tis A and B
5. Min­imise the risk of hepati­tis C
6. Avoid (per­ma­nent) injury to your cock and asshole

HIV neg­a­tive:
1. Take PrEP
2. Adopt risk reduc­tion strategies

HIV pos­i­tive:
1. Adhere to your anti­retro­vi­ral therapy
2. Be sure your med­ica­tion isn’t ampli­fy­ing the effect of your chems

For every­one 1. Take quar­ter­ly STI tests

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

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
        – 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.
      • (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 HIV RNA test
        This test iden­ti­fies HIV infec­tion even ear­li­er than the stan­dard test. It detects the pres­ence of HIV RNA (= 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 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 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 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 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
        – 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

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 NO ONE ELSE 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
        • 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 QUAR­TER­LY TESTS 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.

HIV-neg­a­tive 2. Adopt risk reduc­tion strategies

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.

Read fur­ther - Adopt risk reduc­tion strategies:

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 DO NOT 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.
– 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.

Using meth in com­bi­na­tion with oth­er chems