Sexuality and prevention
There are many options at your disposal to avoid sexually transmitted and blood-borne infections (STBBIs).
The most important is regular STBBI testing. Condoms are still the safest way to reduce the risk of contracting STBBIs like HIV. And of course, if you have been diagnosed with an infection, your strategies may include telling your partners in order to break the chain of transmission, and a whole range of things to make your sexual encounters as safe as possible.
Testing is a very effective way to know if you have a sexually transmitted or blood-borne infection (STBBI) or the human immunodeficiency virus (HIV). Once you have been diagnosed, you can then be treated and cured, or begin the necessary medical care if you find out you are HIV-positive.
Why should I get tested?
You have never been tested, are starting a new relationship, had sex without a condom, or are pregnant or trying to get pregnant? Getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs) is the only way to detect an infection and get access to medical care and support if you need it
It is confidential and free! Because these infections don’t always have symptoms/can often go undetected getting tested will give you peace of mind and keep you and your partners healthy.
How often should I get tested?
How often you get tested depends on several factors. The most important thing to remember is that getting tested regularly is the best way to quickly detect an infection.
You should think about getting tested if:
- You have a new sexual partner
- You have multiple sexual partners
- You have had sex without a condom
- You use drugs
- You want to get pregnant
Be proactive. Talk to your doctor. You do not need to wait until he or she brings it up to ask for information about getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs). It is important to be able to speak openly and unreservedly with your healthcare professional. The more they know, the better they will be able to determine what tests you need, and how often you should get tested.
Where and how to get tested?
There are many places where you can get tested for HIV and other sexually transmitted and blood-borne infections (STBBIs). Every region of Quebec has at least one CLSC offering HIV and STBBI testing. Your local community HIV organization may even offer this service. For more information on the services offered in your area, refer to the Where can I get tested?
Testing is confidential and free for anyone with a RAMQ Health Insurance Card. It only takes a few minutes. Testing involves a blood test and may involve other exams such as giving a urine sample.
You can get tested as of age 14 without parental consent.
Nominal or anonymous testing?
In Quebec, HIV testing can be nominal (using your name), non-nominal (not using your name), or anonymous. For other STBBIs, testing is nominal, in other words, you have to submit your Health Insurance Card. In all cases, your physician is required to respect your medical confidentiality and is not permitted to share your results with a third party without your consent.
Anonymous HIV testing
At least one CLSC in each region of Quebec offers anonymous HIV testing. At these locations, it is not necessary to present your Health Insurance Card or any other piece of identification and the service is free. However this service will not be offered to you automatically. You will need to request it when you schedule an appointment.
How is the test done?
You will generally have to meet with a doctor or nurse. Before taking samples, they will usually ask you a few questions to determine which tests to perform. Some of us may feel shy about revealing the number of sexual partners we have had or the type of sexual activities we engage into. Know that anything said during the appointment with the healthcare professional is confidential. The more precise the information you share with your doctor or nurse, the better they will be able to assess which tests are needed.
Next, the doctor or nurse will take samples: this generally involves a blood test, urine test, and swabs from the vagina, throat, and/or anus, for example
The results of the tests are generally communicated by phone, with the exception of HIV which requires you to return to the clinic for a second visit to hear the results.
There is also the possibility of doing a rapid HIV test. This test is not free, and is typically offered only in specialized clinics. You will get results from this test on the same visit. If you are interested in this option, ask about its availability when you arrive at the clinic.
What if I don’t have a Health Insurance Card?
A Health Insurance Card is generally necessary to get tested for HIV and other sexually transmitted and blood-borne infections (STBBIs).
If you do not have a Health Insurance Card, visit your nearest CLSC. Many CLSCs will see you even without a card. In addition, they can provide you with information on how to get one.
Anonymous testing is a second option, since this does not require you to show your Health Insurance Card or any other piece of identification. This service is offered in at least one CLSC in each administrative region of Quebec. This service is not offered automatically, you will need to ask for it when you make your appointment.
There is also Médecins du Monde Canada which provides services to certain populations, including refugees and the homeless.
I got tested… Now what?
What if the results are negative?
If your results are negative, it does not mean that you are immune, and will never get an STBBI. Your healthcare professional will discuss with you the strategies to keep up or put in place to reduce the risk of a new infection, or of contracting HIV. In addition, they will let you know when you should get tested again.
What if I test positive for an STBBI
Your healthcare professional will provide you with treatment that should eliminate the infection fairly quickly. Most STBBIs can be treated with medication. For treatment to be effective, you must take every dose, even if you have no symptoms. It is recommended to abstain from sex through the duration of treatment.
Some infections, like herpes and the human papilloma virus (HPV) cannot be cured. However, with herpes for example, there are treatments to relieve symptoms, reduce the duration and frequency of flare-ups, and lower the risk of transmission.
What if I test positive for HIV?
Today, HIV treatments are more effective than ever. The life expectancy of a person living with HIV is nearly as long as the life expectancy of an uninfected person. The more rapidly the infection is detected and controlled after a person is infected, the better their chances of living a long, healthy life. Effective treatment can also greatly reduce the risk of transmitting HIV. Knowing your HIV status is a good way of maintaining your health and protecting your partners.
After diagnosis, you will have regular check-ups in order to control the infection and stay healthy.
HIV treatment is covered by both private and public (RAMQ) health insurance.
Should you disclose your HIV status?
Telling someone that you are living with HIV can be stressful. It is impossible to predict how the other person will react. As a result, the vast majority of women living with HIV are selective about whom? They disclose to, and when. For more information about disclosure or non-disclosure of your HIV status, refer to the site Pouvoir partager / pouvoirs partagés (French).
Choosing to disclose your HIV status involves real risks. In spite of scientific advances in the treatment of HIV, social prejudices have not changed very much. Discrimination, rejection, and even the criminalization of people living with HIV are still real challenges. And the fear that people living with HIV experience as a result of these realities is legitimate.
There is no magical, one-size-fits-all answer when it comes to deciding whether to disclose that you are living with HIV. The rule of thumb is to act with integrity, and make decisions that will allow you to protect yourself, and allow your partners to make informed decisions. One thing is certain, the decision to have sex and the responsibilities that come with it, whether you use protection or not, rests equally on both partners. This moral obligation on the part of both partners is widely recognized throughout the HIV community. However, legally, you should know that you could be prosecuted for failing to disclose your HIV-positive status to your partner.
One day you may be faced with having a conversation about the fact that you’ve contracted an STBBI. It can be a difficult topic to bring up. Often our partners react by accusing us of being the source of the infection. As much for HIV as for other STBBIs, there are different ways to inform your current and previous partners, and deal with negative reactions:
Here are a few suggestions that might help:
- Prepare for your meeting or call by thinking ahead about what you plan to say
- Choose a time when your partner will be able to give you their undivided attention
- If you break the news by phone, make sure it is a good time to talk before you broach the topic
- If you break the news in person, choose a neutral, quiet and safe location where you can speak without being disturbed
- Keep it simple:
- The name of the infection you have
- That a person can be infected even if they don’t have symptoms
- That it is essential that they see a doctor (or nurse) quickly to get tested, be evaluated, and get treated, as the case may be
- Invite your partner to learn more about chlamydia, gonorrhea, syphilis or HIV by giving them fliers, or suggesting that they visit sante.gouv.qc.ca (website for the general public) or itss.gouv.qc.ca (website for youth)
- Give them the notification card that your doctor or nurse provided you. This card contains information on the infection you have contracted, and provides useful references
- Encourage your partner to see a doctor
- If your partner accuses you of being the source of the infection, remind them that looking for someone to blame solves nothing. The important thing is that they get tested, and stay healthy
Getting help from a doctor or nurse
Some people do not feel comfortable, for a number of reasons, telling their current and previous partners themselves. If this is the case for you, a healthcare professional can notify your partners for you. They will ask you for information (your partner’s phone number, for example) then will attempt to anonymously make contact and suggest that they see a doctor.
Receiving a disclosure
You might also find yourself in the reverse situation: your partner reveals that he or she has an STBBI. It is normal to feel worried and upset by what the person has told you. However, remind yourself that this information was shared with you because that person was worried about your health and wanted you to be able to be treated quickly if necessary.
Condoms are not the only way to avoid getting HIV and other STBBIs, but they are certainly the best known and most accessible. They are also highly effective against HIV and hepatitis. However, the desire to use them could lead to delicate situations where you want to use one, but your sexual partner does not. Here are a few suggestions to help make that discussion easier:
Fear is one factor that sometimes prevents us from talking about condoms:
- Fear of what the other person will think
- Fear that the other person thinks differently about using them?
- Fear that the other person will think that you are sleeping around, or are being unfaithful
- Fear that the other person will refuse, or argue with you
- Fear that the other person will think that you have an STBBI
If using a condom is important for you, here are a few strategies to help you broach the subject. Who knows? Maybe your partner wanted to talk about it too… but was too shy to bring it up.
You can help your partner understand that using a condom is non-negotiable by:
- Always having condoms on you (in your purse), and in every room of your home
- Leaving condoms and lubricant in sight, on the night table, for example
- Giving your partner a condom before any form of penetration
If you choose to talk about it before hand, here are a few tricks to facilitate the conversation:
- Bring it up before sex is initiated, in a calm environment that lends itself to talking about it, during dinner, for example
- Be aware of the reasons you want to use a condom. Write them down. It is easier to negotiate when you know what you want
- Talk about it with your friends. They might have some ideas that could help you talk about it
- Think of a situation when you had to negotiate using a condom. What challenges did you come up against? How did you overcome them?
Emergency contraceptive pill
In situations where a condom was either not used or broke during sex, emergency contraception (the morning after pill) can prevent unplanned pregnancy if taken right away. Although it is possible to take it up to five days (120 hours) after unprotected sex, it is recommended to take it as soon as possible to maximise effectiveness. for maximum effectiveness it is better not to wait.
Post-exposure prophylaxis (PEP)
In situations where a condom was either not used or broke during sex, and you believe there is a risk of HIV infection, you should be aware that there is a treatment that can minimise the risk of HIV infection. See a doctor immediately or visit the ER.
Sexuality can be expressed in many ways. Sexual practices are just as numerous. From kissing to kink, there are ways to reduce the risk of contracting STBBIs, including HIV.
Touching, kissing, massaging
Stimulating the erogenous zones by touching, kissing, massaging, enjoying a bath together, etc. are all activities you can practice with no reservations. They involve no risk of HIV transmission.
If you insert your fingers in your partner’s anus or vagina, keep your nails short and filed to avoid cuts. You could also use latex or vinyl gloves and lots of lubricant for this type of activity.
Genital to genital contact presents a negligible, even non-existent risk of HIV infection. In fact, there is very little risk of HIV transmission during sex between women, except during your period or if you engage in activities involving blood. There is, however, the risk of transmitting other STBBIs. If this is a practice you enjoy and do often, make sure you get tested regularly.
To protect yourself and reduce risk:
- Keep your mouth clean and avoid oral sex if you have cuts, lesions, ulcers, gingivitis (inflammation of the gums), or other infections in your mouth.
- Avoid oral sex on a day when you have been to the dentist.
- Avoid brushing your teeth, using dental floss, or using mouthwash for an hour before and an hour after oral sex. This will minimize the possibility of lesions, irritations, or blood in your mouth.
- Avoid getting semen or vaginal secretions in your mouth.
- When you are being tested for sexually transmitted and blood-borne infections (STBBIs), ask the doctor to take a sample from your throat.
- sing a condom or latex square (dental dam) for oral sex is another way to minimize risk. Flavoured ones exist, as well as those without lubricant.
Vaginal and anal sex
To reduce risk:
- Correctly use a latex, polyurethane, or polyisoprene condom for vaginal and anal penetration.
- Use water- or silicone-based lubricant. Do not hesitate to reapply, as this reduces your risk of lesions. Be careful! Oil-based lubricants are not compatible with latex condoms. This information will be indicated on the package.
- If you are practicing vaginal and anal sex, remember to change condoms when you change orifices to avoid transmitting bacteria from the anus to the vagina.
- Flavoured condoms can be used for penetration. However, some women may be prone to infections as a result. Flavoured condoms are best kept for oral sex.
- Remember that condoms also protect you from unplanned pregnancies.
- When you are being tested for STBBIs, ask your doctor to take a sample from the anus if you practice anal sex.
- For cultural reasons or personal hygiene, some women use vaginal douches or other substances to clean their vaginas before or after sex. These substances can irritate the mucus membrane of the vagina and potentially increase your risk of STBBIs. It is recommended that you wash your vagina daily with water, nothing else.
Role-playing games and sadomasochism are not high-risk practices for transmitting HIV and other STBBIs. You can play out your favourite scenarios safely, as long as you stick to the precautions mentioned on this site, depending on which sexual activities are involved.
Hardcore practices can cause bleeding or lesions on the surface of the skin, and practices involving surgical tools can involve significant risk of bacterial infection and transmission of HIV or hepatitis C. Make sure you are familiar with basic precautions you should be taking, and play out your scenarios with an experienced partner.
Sex toys (Dildo, butt plug, vibrator)
A sex toy has the same potential for transmitting an infection as a penis. If you plan on sharing toys, it is important to put a condom on them. In addition, if you and your partner decide to go from vaginal penetration to anal penetration, you should change condoms.
Toys are often porous, which means that viruses and bacteria can get trapped. After each use, make sure to clean your toys thoroughly. You can use dish soap and hot water, making sure to rinse well. Specialized stores also sell cleaning products specifically designed for different types of toys.
In addition to vaccines for certain sexually transmitted and blood-borne infections (STBBIs), there are a few HIV prevention methods based on pharmaceutical treatment. Depending on the type of sexual behavior you engage in, they could be used before or after high-risk sexual activity.
If you are under the age of 20, you were probably vaccinated for hepatitis B at a very young age. The vaccine is known to be effective for life. If you are over the age of 20 and have not been vaccinated or are not sure if you have been, speak to your doctor. They can do a blood test to find out whether you have been vaccinated, and whether the vaccine is still effective.
The HPV vaccine is offered to girls aged 9 to 17, and women with weakened immune systems or who are living with HIV. Speak to your doctor.
Post-exposure prophylaxis (PEP)
PEP, for post-exposure prophylaxis, is a treatment available if you have had unprotected vaginal or anal sex with a partner whose HIV status is positive or unknown. Your doctor will evaluate your risk level before prescribing this treatment.
In order for this treatment to work, it needs to be initiated as quickly as possible and no more than 72 hours after the risk occurs. Not all healthcare professionals are familiar with this treatment, particularly those who are not specialized in HIV. In view of this, it is strongly recommended that you visit a clinic specialized in HIV and sexually transmitted and blood-borne infections (STBBIs).
You can make an appointment in a specialized clinic or go to the ER of your nearest hospital. Remember that it is important to be seen as quickly as possible within the first 72 hours after the high risk sexual activity takes place. Do not hesitate to call your local community HIV organization for guidance.
You may also have heard of PrEP, or pre-exposure prophylaxis, an HIV treatment used to prevent infection before it happens. In Quebec, there are still no official guidelines on this. For the time being, to learn more about PrEP and the possibility of getting a prescription, you need to speak with a physician specialized in HIV.
Viral load and non-transmission of HIV
The risk of HIV transmission fluctuates with the viral load. Viral load refers to the quantity of HIV in the blood: the lower it is, the lower the risk of transmission. According to current data, a newly infected person has a higher risk of transmitting HIV at the beginning of the infection, because that is normally a time when one’s viral load is very high.
Conversely, the risk of HIV transmission is very low when an HIV-positive person receiving treatment, who has had an undetectable viral load for more than six months, who has no other STBBI, and whose partners have no STBBIs. Advances in treatment as well as the conclusions of several large-scale national and international studies have led to a degree of consensus among the scientific community with regards to the impact of antiretroviral treatment on the risk of HIV transmission.
Consequently, the Institut national de la santé publique du Québec has confirmed that antiretroviral therapy reduces the risk of HIV transmission in the case of vaginal sex between heterosexual couples, if the following conditions are met:
- Undetectable viral load maintained for a period of at least six months, as shown by two consecutive viral load tests, thanks to ARV therapy.
- Minimum 95% adherence to treatment.
- Stable, monogamous partner.
- Confirmed absence of STBBIs in both partners.
- Both partners receive intensive medical follow-up every three or four months, including viral load monitoring and STBBI screening for the person living with HIV, and STBBI screening, including HIV, for the HIV negative partner.
- Regular, appropriate counseling for both partners, around the conditions listed above, and methods for reducing risk, including the adequate use of condoms.
For more information on this subject, speak with your doctor.
It is important to remember that, though this is the position of Quebec public health, it does not protect you from the risk of criminal prosecution if you have not told your partner(s) that you are HIV-positive. For more information, see the section of the COCQ-SIDA website (French) on criminalization of HIV exposure or the website Pouvoir partager / pouvoirs partagés (French).
Do I still need to use a condom?
If you are in a relationship and meet the above-listed conditions, the choice is yours. However, we suggest that you and your partner meet with a doctor beforehand to discuss your options before making a decision.
Antiretroviral therapy and condom use are both recognized as effective strategies for reducing the transmission of HIV. Condoms also protect you against other STBBIs and unplanned pregnancies.
Mixing drug use and sexuality can make you feel good. However, be conscious of the fact that drugs can affect the way you perceive risk. Be aware of the risks, find ways to reduce or avoid them, establish your limits, and prepare yourself accordingly. When your judgment is impaired, you will be glad you did.
Make sure you have plenty of condoms and lubricant (have a few different kinds in your purse, for example). If the condom breaks or does not get used, plan to take emergency oral contraception and, if needed, post-exposure prophylaxis.
Plan to bring enough materials to inject or inhale drugs. Better to have too much on you than to run out in the middle of the party. You can get injection kits in select pharmacies and community organizations.
If you use straws to sniff drugs, do not share them. The same goes for syringes.
If you are living with HIV, prepare your treatment doses before taking any drugs, and find a way to remember to take them, maybe by setting an alarm on your phone. Remember that certain anti-HIV medications, like Ritonavir, enhance the effects of drugs. Wait at least 30 minutes after taking Ritonavir before taking any drugs, and start with a half dose.