Studies show that when taken every day, Truvada® can be between 96%-99% effective at preventing the HIV virus from taking hold within your body. However, it is critical that the pill is taken regularly every day. Skipping days will significantly decrease the effectiveness of Truvada®. According to the iPrex study:

• For people who take 7 PrEP pills per week, their estimated level of protection is 99%.
• For people who take 4 PrEP pills per week, their estimated level of protection is 96%.
• For people who take PrEP less regularly, it is less effective.

Anyone who is at risk for HIV. The people most at-risk include:

• Men who have sex with men, especially young, Black, and/or Latino men
• Trans people, especially trans women of color
• People in relationships with someone who is HIV-positive
• People who inject drugs or anyone who is having sex with someone who injects drugs
• Heterosexual Black and Latina women

Click here to read the CDC guidelines or answer the questions below. If you answer “yes” to any of these questions, PrEP may be right for you:

• Do you ever have sex without a condom?
• Do you have more than one sex partner?
• Do you have a sex partner who is HIV-positive?
• Have any of your partners recently been treated for an STD (sexually transmitted disease)?
• Have you used PEP (pre-exposure prophylaxis) more than once in the last year?
• Have you exchanged sex for money, drugs or alcohol, housing, or other needs?
• Do you or any of your recent partners use injection drugs?
• Have any of your recent partners been in prison?
• Have any of your recent partners forced you to have sex?

There is no specific age restriction for PrEP. However, the Centers for Disease Control (CDC) has approved the use of PrEP for adults and adolescents at risk for HIV who weigh at least 35 kilograms (77 pounds).

Yes, PrEP is well-tolerated by most people. Some people report nausea, vomiting, fatigue, and dizziness in the first few weeks of taking PrEP. These symptoms usually resolve themselves over time. Other possible side effects include changes in kidney function and bone density, so it is important to get check-ups with your physician every 2-3 months while taking PrEP. Drug Interactions Truvada® is not known to interact with alcohol or other recreational drugs. Continuing to take PrEP while drinking or using drugs and having sex will help provide protection from HIV during these periods. PrEP does not interact with other drugs like hormones or birth control.

A PrEP regimen includes a once-daily pill and check-ins with your provider every three months. These check-ins include labs, STI testing, and risk/adherence counseling.

Preliminary studies suggest that when starting PrEP, it may take at least seven days for PrEP to reach substantial protection levels. However, further studies are needed to confirm these findings.

Taking PrEP does not mean that you do not need to wear condoms. When taken every day, PrEP significantly reduces risk for HIV; studies show it is 96-99% effective. However, PrEP does not prevent pregnancy and is not effective against the transmission of other STIs. For this reason, the use of condoms is still strongly encouraged during all sexual activity. PrEP is not meant to replace condoms.

No. The medications in PrEP are not enough to cure or treat HIV. PrEP only prevents HIV from taking hold in the body. If someone has HIV, they need to be on a full treatment regimen and remain in care.

If you are thinking about talking to your doctor about PrEP, here are a few tips. BEFORE YOUR VISIT

• Make an appointment with your healthcare provider.
• Do research. Make a list of reasons of why you think PrEP would be a good choice for you.
• Think about your routine, especially things that make it easy or difficult to take a daily medication.
• Make a health history list for your doctor. The list should include any past illnesses or concerns you have, as well as a list of all current medications (including supplements, herbs, etc.)

DURING YOUR VISIT

• Be clear. Take out your notes and tell your doctor that you are interested in PrEP right away.
• Do not be shy. Give your doctor all the details about your life that could be important to your health. Don’t worry about being judged. If your sex life is a hard thing for you to talk about, say that to your doctor. It will help start the conversation.
• Ask questions. You want to be sure that you understand what your doctor is telling you.
• Take notes during your visit so that you can remember what your doctor said.

AFTER YOUR VISIT

• Review your notes or any information provided by your doctor.
• Consider your options. Your doctor gave you a lot of information. Now it is up to you to make the right decision for yourself.
• Call your doctor if you have any additional questions. Ask to speak to a nurse if your doctor is unavailable.
• Schedule tests or follow-up appointments that your doctor requested.
• Get your results if you had tests done at your appointment.
• If you feel comfortable, you may want to discuss your choice with your partners, family, or friends.

Whether or not you have medical insurance, there are several programs available that can help you pay for PrEP and associated costs like office visits and lab work. This includes the Ohio Department of Health's new PAPI program which is available to residents of Ohio. Learn more aboutPAPI.

Missing doses will not cause immunity but taking Truvada® while HIV-positive will. Truvada® is not sufficient to treat HIV alone, so it is important to be tested for HIV before starting PrEP. If you do contract HIV at any time while taking Truvada®, the HIV strain could develop immunity, which could eliminate Truvada® as an effective treatment option. However, PrEP still offers some protection even if you miss a dose. You do not have to worry or double-up on the medication. Just relax and take it the next day. Keep in mind, the more you take it, the better it will work. Taking it 5-7 days a week is important for maximum protection.

If your risk level changes, or if you decide PrEP is no longer right for you, you can absolutely stop taking it. Any decision about starting or stopping treatment should be made with your doctor. 1. Get tested for HIV and STIs and choose a different HIV prevention strategy like using condoms and/or only having sex with one partner who you trust to remain monogamous. 2. Confirm with your doctor or nurse practitioner that you are negative for Hepatitis B. The medication used for PrEP is also used in Hepatitis B treatment and discontinuing treatment when you need it may cause harm. 3. Continue taking PrEP for at least two days after a potential exposure to HIV.

STIs are typically spread through the following ways:

• Unprotected oral, vaginal, or anal sex with someone who has an STI.
• Contact with infected blood (sharing needles, open wounds).
• Skin-to-skin contact in some cases (such as HPV).
• From labor or breastfeeding (parent to child).

Many people with STIs are often "asymptomatic", meaning they have no symptoms at all. When a person does have symptoms, they may experience:

• Discomfort
• Itching
• Burning
• Discharge
• Rash/Redness
• Odor
• Painful urination

Each person is unique, and STIs may have different levels and types of symptoms for different people. Since it’s difficult to know if you have an STI, getting tested regularly is important.

No. It’s common to see STIs appear in the throat, eyes, and anal areas, in addition to the genitals. Some STIs, like syphilis and hepatitis, affect a person’s entire body.

Yes. Each STI can cause different health problems depending on the individual. However, most STIs can easily be treated or managed if they are detected early — with no long-term health problems. If left untreated, some STIs can cause:

• Infertility or Fertility Problems
• Pregnancy Complications
• Organ Damage
• Cancer
• Death

Getting tested for an STI can be easy and convenient. Depending on which STI(s) you are being tested for and where the infection may be, tests can be performed on a:

• Urine sample
• Oral fluid sample
• Blood sample (finger prick or needle draw)
• Swab (fluid, cell swab)

Visit the Know Your Status page to find a testing site near you.

What is it?

Gonorrhea can infect anyone. It can appear in the vagina, anus, and throat. It is a bacterial infection that can have long-term complications, such as infertility, if left untreated.

What are the symptoms?

Not everyone experiences symptoms of gonorrhea, but when they do, symptoms may include:

• • • Burning sensation during urination
    • White, yellow, or green discharge from the infected area
    • Itching
    • Discomfort
    • Painful or swollen testicles
    • Vaginal bleeding between periods

How do I get tested?

Most of the time, only a urine sample is needed to test for gonorrhea. However, if you had anal and/or oral sex, swabs may also be used to collect fluid samples from these areas. It is recommended that you call ahead to confirm a test site is able to administer swab tests.

Can it be treated?

Yes. Gonorrhea can be cured with prescription medication. It is important to take the medication as prescribed even if symptoms are no longer noticeable. It is also possible to be infected with gonorrhea again if exposed. If you've been diagnosed with gonorrhea, it is also possible to get medication for your sexual partner - they may not even need to see a doctor. This is called expedited partner therapy (EPT) and it is available in most states, including Ohio. For more information, please visit: http://cdc.gov/std/Gonorrhea/

What is it?

Chlamydia can infect anyone. It can appear in the vagina, anus, and throat. It is a bacterial infection that can have long-term complications, such as infertility, if left untreated.

What are the symptoms?

Not everyone experiences symptoms of chlamydia, but when they do, symptoms may include:

• Burning sensation during urination
• White, yellow, or green discharge from the infected area
• Discomfort
• Bleeding
• Painful or swollen testicles

How do I get tested?

Most of the time, only a urine sample is needed to test for chlamydia. However, if you had anal and/or oral sex, swabs may also be used to collect fluid samples from these areas. It is recommended that you call ahead to confirm a test site is able to administer swab tests.

Can it be treated?

Yes. Chlamydia can be cured with prescription medication. It is important to take the medication as prescribed even if symptoms are no longer noticeable. It is also possible to be infected with chlamydia again if exposed. If you've been diagnosed with chlamydia, it is also possible to get medication for your sexual partner - they may not even need to see a doctor. This is called expedited partner therapy (EPT) and it is available in most states, including Ohio. For more information, please visit: http://cdc.gov/std/chlamydia/default.htm

What is it?

Syphilis can infect anyone. Syphilis can be passed through oral, vaginal, and anal sex and will affect a person’s entire system. It is a bacterial infection that can be fatal if left untreated. If a woman has a syphilis infection and becomes pregnant, she can transmit the infection to her baby during pregnancy. When this happens, it is known as congenital syphilis (CS). CS can cause prematurity, low birth weight, miscarriage, stillbirth, and a range of health issues or death after birth. Cases of congenital syphilis have been rising in Ohio and around the country, so it is important that every pregnant woman get tested for syphilis during her first prenatal visit. For more information about congenital syphilis, please visit: https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm

What are the symptoms?

Symptoms of syphilis depend on which stage of infection a person is in: Primary Syphilis The first sign of infection is a skin sore called a chancre, which is painless and usually appears one to three weeks after exposure. Common areas for a chancre to appear is on or around the area that was first infected, like: the mouth, vagina, penis, and anus. The chancre typically disappears after a few weeks even though someone is still infected with syphilis.

Secondary Syphilis Secondary signs and symptoms of syphilis occur two to three weeks after infection and can overlap with the primary stage. A unique rash of raised red spots often appears on a person’s palms, bottom of their feet, and back. This rash is not itchy and causes little to no discomfort.

Latent/Late Stage The latent stage of syphilis starts when all other symptoms have disappeared. If someone does not receive treatment, they will continue to have syphilis in their system for years without any other signs. Later, after ten to thirty years, it is possible for syphilis to cause paralysis, numbness, blindness, dementia, and/or death.

How do I get tested?

A blood test is used to test for syphilis. It is recommended that you call ahead to confirm a test site is able to complete a Syphilis blood test.

Can it be treated?

Yes. Syphilis can be cured with prescription antibiotics from your healthcare provider. However, treatment will not undo any damage that the infection has already done. For more information, please visit: http://cdc.gov/std/syphilis/default.htm

What is it?

Bacterial vaginosis (BV) is a bacterial infection caused by an imbalance of the normal bacteria found in the vagina. It is the most common vaginal infection in younger persons. While BV is not generally considered a sexual transmitted infection, it is most common in sexually active individuals and can be transferred between sexual partners with vaginas. Having sex with new or multiple partners can increase one's risk of BV. Other activities that can increase someone's risk include douching and using perfumed products around the vagina, which cause changes in the vagina's natural pH (acidity).

What are the symptoms?

Not everyone experiences symptoms of bacterial vaginosis, but when they do, symptoms may include:

• Thin vaginal discharge that is white or gray in color
• A fish-like odor that is especially strong after sex
• Burning or itching in/around the vagina, including during urination

How do I get tested?

A vaginal examination and/or sample of vaginal fluid is used to test for bacterial vaginosis. It is recommended that you call ahead to confirm a test site is able to complete a test for BV.

Can it be treated?

Yes. Bacterial vaginosis sometimes goes away on its own, but it can be cured with prescription medication. It is important to take the medication as prescribed even if symptoms are no longer noticeable. For more information, please visit: https://www.cdc.gov/std/bv/default.htm

What is it?

Shigella is a bacterial infection caused by germs in someones stool (poop), it is spread through poor hand-washing or hygiene from someone who has the bacteria. It can also be spread through oral sex on the anus (butt) or fingering the anus (butt) and having the fingers touch the mouth. It is incredibly contagious and takes very few germs to spread.

What are the symptoms?

Symptoms may include:

• Diarrhea (sometimes bloody)
• Fever
• Stomach Pain
• Feeling the need to pass stool (poop) even when your bowels are empty

How do I get tested?

The only way to know if you are dealing with Shigella is for your doctor to collect a stool (poop) sample.

Can it be treated?

Most people infected with Shigella will get better without medicine in 5-7 days. It is always recommended to speak to your doctor about testing and treatment. For more information, please visit: https://www.cdc.gov/shigella/index.html

What is it?

Hepatitis is an inflammation of the liver, usually due to a viral infection. The most common types of viral hepatitis are hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV). To protect yourself against hepatitis A and B, vaccinations are available; however, a vaccine for hepatitis C does not currently exist.

What are the symptoms?

Not everyone experiences symptoms of hepatitis, but when they do, symptoms may include:

• Fever
• Fatigue
• Dark urine
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Joint pain
• Jaundice

How do I get tested?

A blood test is used to detect all types of hepatitis. It is recommended that you call ahead to confirm that a test site is able to complete a hepatitis blood panel.

Can it be treated?

Hepatitis A, B, D, and E cannot be cured but are able to be managed with regular treatment and medical supervision. Recently, medication has become available that can cure hepatitis C and is covered by many medical insurance plans. For more information, please visit: http://cdc.gov/hepatitis/index.htm

What is it?

HPV is the most common STI. It is so common that nearly all sexually active people get HPV at some point in their lives. There are many different types of HPV with some potentially able to cause health issues like genital warts and cancers. To protect yourself from HPV, vaccinations are available. All children 11+ should be vaccinated to protect them from future cancer risk.

What are the symptoms?

Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people with certain HPV strains may develop genital warts. Someone with a vagina may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.

How do I get tested?

Currently, the only HPV test on the market is used to screen for cervical cancer - however, it should only be used when screening someone who has a vagina aged 30 years and older. There is no approved HPV test recommended for a person with a penis or to find HPV in the mouth or throat.

Can it be treated?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

• Genital warts can be managed under medical supervision. If left untreated, they have the potential to grow in number and become worse.
• Cervical precancer can be treated. Someone with a vagina who gets routine Pap tests and follow up as needed can identify problems before cancer develops.
• Other HPV-related cancers, such as anal cancer, are also more treatable when diagnosed early.

For more information, please visit: http://cdc.gov/hpv/

What is it?

Herpes is a common viral infection that affects the mouth or genitals and is caused by the herpes simplex virus (HSV). There are two types of herpes viruses called herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). While HSV-1 typically causes oral herpes, it can also be spread to the genitals through oral sex. HSV-2 causes genital herpes.

What are the symptoms?

Not everyone experiences symptoms of herpes, but when they do, symptoms may include:

• Blisters around the genitals, rectum, or mouth
• Sores
• Fever
• Body aches
• Swollen glands
• Discharge
• Burning sensation during urination
• Bleeding in between periods

How do I get tested?

A person may be diagnosed with herpes through a visual examination by a physician or a fluid sample test gathered from an open sore.

Can it be treated?

There is no cure for herpes. However, medication can be used to prevent and manage blister outbreaks. Be especially aware to wash your hands often and not to touch an outbreak and potentially transfer the infection to another area of the body (ex. genitals to eyes). For more information, please visit: https://www.cdc.gov/std/herpes/default.htm

What is it?

Trichomoniasis is a common STI that is caused by infection with a protozoan parasite. Trichomoniasis can affect anyone and is passed from person to person during sex. You can only get infected by having sex with someone who is infected.

What are the symptoms?

Most infected people do not have any symptoms. For individuals that do have symptoms, they may experience itching, burning, irritation, redness or discomfort in the genital area. Pain during urination or sexual activity and unusual discharge/smells are common.

How do I get tested?

Your healthcare provider may perform a physical exam and look at symptoms (rash, discharge, sores, bumps, etc.) which are present. During this physical exam, swabs of sores, discharge, and/or infected tissue may be performed to look for the presence of bacteria or viruses. Sometimes treatment is prescribed right away. Other times, your health care provider may need to send a sample to a lab to be tested. The results may not be available for several days. Check with your health care provider when getting tested to see what the wait time is for results.

Can it be treated?

Yes, trichomoniasis can be cured with antibiotics. However, people who have been treated can be infected again if they are exposed. For more information, please visit: http://cdc.gov/std/trichomonas/default.htm

What is it?

Pubic lice are tiny insects that attach themselves to the skin and hair in the pubic area. Pubic lice is also often referred to as ‘crabs’.

What are the symptoms?

Not everyone experiences symptoms of pubic lice, but when they do, symptoms may include:

• Itching
• Mild fever
• Redness
• Presence of small, dandruff looking spots in pubic hair

How do I get tested?

Typically people are able to diagnose themselves, but a healthcare provider can also help.

Can it be treated?

Yes. Pubic lice can easily be treated with over-the-counter medication like A-200, RID, and Nix. It may take several applications to fully work. Be aware the shaving and hot baths do not work. Pubic lice has the ability to hide in the hair follicle pore and remain on the skin. All bedding, towels, and clothing should be thoroughly washed and your home vacuumed. For more information, please visit: http://cdc.gov/parasites/lice/pubic/index.html

What is it?

Scabies is a skin infection by a human itch mite. The microscopic mite hides under the upper layer of skin and is known to be problematic in cities and crowded places.

What are the symptoms?

Not everyone experiences symptoms of scabies, but when they do, symptoms may include:

• Itching
• Redness
• Rash
• Dryness
• Skin sores

Scabies symptoms will typically appear, but are not limited to, in/around: wrists, elbows, armpits, between the fingers, nipples, genitals, waist, and buttocks.

How do I get tested?

Typically people diagnose themselves, but a healthcare provider needs to confirm to provide a prescription. This includes a visual inspection of the infected area.

Can it be treated?

Yes. Scabies can easily be treated with topical prescription medication. It may take several applications to fully work. Be aware the shaving and hot baths do not work. All bedding, towels, and clothing should be thoroughly washed and your home vacuumed. For more information, please visit: http://cdc.gov/parasites/scabies/index.html

What is it?

Giardia is a microscopic parasite. Giardia causes severe diarrhea known as giardiasis. Giardia is found on or in dirt, food, or water that has feces (poop) from animals or humans. It can also be transmitted through oral sex when performing oral sex on someones anus/butt (analingus).

What are the symptoms?

Not everyone experiences symptoms of giardia, but when they do, symptoms may include:

• Diarrhea
• Gas
• Greasy stools (poop) that usually float
• Stomach cramps and pain
• Upset stomach, and or nausea/vomiting
• Dehydration (loss of fluids)

How do I get tested?

A healtcare provider will need to collect one or more stool (poop) samples and run tests.

Can it be treated?

Yes. Giardia can be cured with antibiotics. For more information, please visit: https://www.cdc.gov/parasites/giardia/index.html

Condoms are usually made of latex or polyurethane. Polyurethane condoms are good for people who are allergic to latex, but can be used by anybody. Both types equally protect against HIV, STIs, and unwanted pregnancy.

Yes. Lube is necessary to reduce the risk of the condom breaking. Some condoms already have lube on them, while others allow you to use your own. Latex condoms can only be used with water-based lubricants, not oil-based lubricants (like Vaseline or lotions), as they weaken the latex and can lead to the condom breaking. Both oil- and water-based lubricants can be used with polyurethane condoms.

Part of practicing safe sex and using a condom properly is making sure that you are wearing the correct size of condom. Many condom manufacturers create a standard size, but that is often larger than the average-sized penis in the United States. However, it’s easy to start the search for your correct condom size by using the “toilet paper roll” method.

How does the toilet paper roll method work? If your erect penis has plenty of room inside the empty tube, almost too much, you need a small condom. If you have just enough room — not too tight, but not too loose — you need a medium-sized condom. And if the tube is extremely tight and almost painful, you're in the large category.

Then, you should purchase (or get for free at your local test site) a few varieties of condoms in your general size. Different brands will have unique textures and sensations, so have fun trying new condoms on until you find something that works best for you.

Penetrative condoms can be used for oral, vaginal, and anal sexual activity. Never use the same condom twice.

Here are a few other tips:

1. Discuss using a condom with your partner.
2. Buy latex or polyurethane condoms or get them for free at a local testing site.
3. Check the listed expiration date. Check for an air bubble in the package. If there is no air bubble, the condom could be compromised. Throw it away and get a new one.
4. Open the package carefully and remove the condom.
5. Use a correct water- or oil-based lubricant (depending on condom type).
6. Pinch the tip of the condom, leaving one-quarter- to one-half-inch tip.
7. Roll the condom down entire length of the penis. Continue with planned activity. If a condom breaks during sex, pull out quickly and replace the condom.
8. Hold the base of condom and withdraw from your partner while the penis is still erect. This will reduce the chance of fluids escaping.
9. Dispose of the condom properly.

Internal condoms (sometimes called "female condoms") can be used for both vaginal and anal sex. Never use the same condom twice.

For vaginal sex:

1. Discuss using a condom with your partner.
2. Buy internal condoms or get them for free at a local testing site.
3. Check listed expiration date.
4. Open the package carefully and remove the condom.
5. Hold the condom at the closed end, with the open end hanging down. Grasp the flexible inner ring and squeeze with the thumb and middle finger so it becomes long and narrow.
6. Choose a position and insert. Squat, raise one leg, sit or lie down. Gently insert the inner ring into the vagina. Push the inner ring up and back into the vaginal canal, moving it into place. Push the condom as far as it will go — near pubic bone. Make sure it is not twisted. The outer ring remains outside the vagina.
7. Continue with planned activity. Gently guide your partner’s penis into the vagina. Make sure that it enters properly. Once the penis is inserted, if there is discomfort, withdraw the penis and reposition the inner ring.
8. To remove the condom, twist the outer ring and gently pull the condom. Do not flush or reuse the condom.

For anal sex:

1. Discuss using a condom with your partner.
2. Buy internal condoms or get them for free at a local testing site.
3. Check listed expiration date.
4. Open the package carefully and remove the condom.
5. Hold the condom at the closed end, with the open end hanging down. Grasp the flexible inner ring and squeeze with the thumb and middle finger so it becomes long and narrow.
6. Choose a position and insert. Squat, raise one leg, sit or lie down. Gently insert the inner ring into the rectum as far as possible..Make sure it is not twisted. The outer ring remains outside of the rectum.
7. Continue with planned activity. Gently guide your partner’s penis into the rectum. Make sure that it enters properly. Once the penis is inserted, if there is discomfort, withdraw the penis and reposition the inner ring.
8. To remove the condom, twist the outer ring and gently pull the condom. Do not flush or reuse the condom.

Visit your local health department, test site, or call 1-800-332-2437 to find out where you can get free condoms in your area. For residents of Ohio over the age of 16, the Hotline offers the option of ordering free condoms from our website. The condoms are mailed to your home in a discreet package. We mail out 25 condoms and 2 packets of lube in each package and individuals can order once per month.

Though no one has ever gotten pregnant from anal sex, it is still very important to wear a condom. The anus has not naturally evolved to be penetrated and has thinner lining in the anal cavity. It is prone to tearing when condoms and lubricant are not used. These micro-tears in the anal cavity put a person at much greater risk for contracting HIV and STIs in comparison to other condomless sexual activity. Since the anal cavity also does not produce its own lubrication (depending on hormonal activity), using a water-based lubricant will reduce the risk of tearing and prolonged discomfort after anal sex.

The anal cavity and the lower part of the rectum have lower levels of fecal material in them than many people may think. Make sure to wash the anus, genital area, and your hands with antimicrobial soap before and after sexual activity. Even after cleaning yourself properly, it is still important to remember not to transfer any bacteria or fluids by switching directly from anal sex to oral or vaginal sex. Even microscopic fecal material and bacteria can cause oral, vaginal, and eye infections. To prevent infections, change condoms between each activity and wash your hands.

Effectiveness is not the only important factor when choosing a birth control method. Factors such as cost, insurance coverage, availability, ease of use, potential side effects, and personal beliefs also play a role. Birth control methods are something that people are encouraged to discuss, especially in regards to future family planning. Including a physician in your discussions and decision processes may also provide clarity and information for methods that will best fit your needs. There is no one method that works best for everyone and only condoms protect against HIV and STIs.

The Pill

The pill is an oral contraceptive taken daily and is offered in varying chemical structures and hormone dosages. Two hormones commonly used in oral contraceptives are synthetic estrogen and progestin. Depending on the chemical makeup of the birth control pill someone takes, they may experience menstruation monthly, every few months, or not at all. The use of oral contraceptives has also been effective in reducing acne, hair loss, premenstrual syndrome (PMS), and heavy bleeding.

The Vaginal Ring and Transdermal Patch

The NuvaRing and Ortho Evra are two hormone-based methods of birth control that do not require taking a pill every day. Both use synthetic estrogen and progestin in the same way as the pill and deliver hormones through the skin/tissue. Persons using these methods experience menstruation monthly during set periods of time.

Injected Contraceptives

Depo-Provera (progestin) and Lunelle (progestin and estrogen) are contraceptives that are injected by a medical provider every four to twelve weeks depending on the hormone composition.

The Implant

The Implanon is about the size of a matchstick, is implanted under the skin of the upper arm, and releases the hormone progestin. It is inserted by a medical professional with local anesthetic and is effective for up to three years.  Note: It may not be effective for individuals more than 30% heavier than their medically ideal weight, consult a physician for more information.

Cervical Barriers

Covering the cervix provides protection against pregnancy. The diaphragm, cervical cap, FemCap, and Lea’s Shield are four common methods that prevent sperm from entering the uterus. Cervical barriers should be used with spermicide.

Spermicide

Spermicide is a chemical that kills sperm and is available in foams, sponges, suppositories, creams, and jellies. These spermicides are not all safe to use with condoms and directions for spermicide use (available in the packaging and varies by type) should be read in advance of sexual activity.

Intrauterine devices (IUDs) are small, plastic objects inserted into the uterus by a medical professional. The two IUDs currently available are ParaGard and Mirena. Paragard is a plastic T-shaped implant with a copper wire wrapped around its stem and copper sleeves on the side. It is hormone-free and is effective for 10 years. Mirena is a polyethylene T-shaped implant containing a cylinder of progestin. It is effective for 5 years. Both Paragard and Mirena have plastic threads attached that hang through the cervical opening into the vagina. These threads are used to check placement of the IUD and ensure it hasn’t slipped out of place. Individuals using an IUD may experience spotting, lightened, or absent menstruation.

There are many reasons and circumstances in which unprotected sex could put a person at risk for unintended pregnancy. Pregnancy can be prevented through the use of emergency contraceptives. Emergency contraceptives are not abortion pills and do not terminate a pregnancy if the fertilized egg has already attached itself to the uterine wall. Hormonal pills such as Plan B and Next Choice use higher doses of progestin and estrogen than are common in other hormonal birth control methods. Non-hormonal methods such as Ella (pill) or the insertion of a ParaGard IUD are also effective at preventing pregnancy. Anyone over the age of 17 can purchase Plan B or Next Choice by asking a pharmacist, though the pharmacist is not required by law to dispense emergency contraception.

Fertility awareness methods are those that use the signs of cyclic fertility to prevent or plan conception.

Standard Days Method

The standard days method requires a person to avoid unprotected sex for a twelve-day period in the middle of the menstrual cycle. Menstrual cycle between 26 and 32 days long. Unprotected sex should be avoided between days 8 through 19. These twelve days include days surrounding ovulation and account for potential variations in timing. "Cycle Beads", a string of color-coded beads that represent days of a menstrual cycle, can assist people in tracking their menstrual cycles and know when they can and cannot get pregnant. There are also several smartphone apps available that can be used to track one's cycle.

Mucus Method

The mucus method determines the time of ovulation by monitoring the cyclical changes in cervical mucus color and texture. A person will “read” their mucus by putting their fingers insider their vagina and noting the consistency of secretions.

• After menstruation, some dry days will pass where no vaginal discharge appears on the vulva.
• When there is yellow or white sticky discharge, unprotected sex should be avoided.
• The ovulatory mucus is clear, stringy, and stretchy. Unprotected sex should be avoided.
• Approximately 4 days after the ovulatory mucus begins and 24 hours after a cloudy discharge resumes, it is considered safe to resume unprotected sex that won’t result in pregnancy.

Calendar Method

The calendar method is often also referred to as the rhythm method. This method estimates the time during an individual's cycle when they are ovulating and fertile through the use of a monthly chart that notes the length of their cycles. At minimum, a chart should have at least six months of cycle data; ideally, it will have at least a year’s worth of data.

• The first day of menstruation is counted as day 1.
• To determine high-risk days on which unprotected sex should be avoided, a person subtracts 18 from the number of days in their shortest cycle. Then, they would subtract 10 from the number of days in the longest cycle. The days spanning the first and second number are the "fertile days".
• Example: The length of a person's cycle varies between 28 and 33 days. To determine which days they should avoid unprotected sex, they would subtract 18 from 28 (10), then subtract 10 from 33 (23). They find that the "fertile days" are days 10-23 of their cycle.

Basal Body Temperature Method

This method monitors the body’s slight temperature changes that take place during ovulation and high fertility days. Hormonal changes from ovulation typically increase the body temperature slightly by 0.2 degrees Fahrenheit/F. Thermometers have been developed to effectively indicate high-fertility window periods.

These methods have been proven to be ineffective at preventing pregnancy.

Nursing

Though nursing does create hormonal changes in a persons body that delays the start of ovulation, there is no way to accurately predict when ovulation will resume. Ovulation also often occurs before a nursing mother menstruates again, so waiting until the first menstruation after birth is not effective at preventing pregnancy.

Withdrawal

Removing the penis before ejaculation does not guarantee that sperm was not deposited. Pre-cum is common and often occurs without the insertive partner realizing that it happened. The withdrawal method is unreliable and known to fail more often than other methods.

Douching

Douching after intercourse does not wash out sperm, but actually pushes it further into the vagina and uterus. It also can irritate the vaginal lining and cause dryness when used often.

Hormone Replacement Therapy (HRT)

Utilizing Hormone Replacement (HRT) is not an effective birth control method. There is still a risk of pregnancy while taking HRT, for more information consult your primary care physician.  

Condoms are widely regarded as the most trusted way to reduce transmission of HIV and STIs, so choosing the correct lubricant while using condoms is especially important. Using incorrect lubricants like Vaseline or mineral oil with condoms can break and/or disintegrate the condom during use and put you at higher risk. Similarly, not using lubricant while using a condom or during condomless sex increases the likelihood of tearing (including micro-tears) which puts you at higher risk.

 Safe with Condoms

• Water-based or silicone lubricant
• Aqualube
• Astroglide
• Glycerine
• All ID lubricants (except ID cream)
• Aloe­9
• H­R Lubricating Jelly
• K­Y Lubricating Jelly
• Prepair
• Probe
• ForPlay
• Gynol II
• Wet (except Wet Oil)
• DeLube
• Spermicides

Not Safe with Condoms

• Aldara cream
• Baby oil
• Cold cream
• Edible oils (vegetable, olive, peanut, corn, sunflower, coconut, etc.)
• Body lotions
• Massage oils
• Mineral oils
• Petroleum jelly/Vaseline
• Rubbing alcohol
• Shortening
• Suntan oils and lotions
• Whipped cream
• Vaginal yeast infection creams/suppositories

You are the same person that you were before you got your diagnosis. Yes, this may be the most shocking thing to ever happen to you, but you are resilient and adaptive! Once you make it through this period, you will do what many have done before you - adjust and continue with your life. Just take it step by step…

1. Stop and Breathe. Close your eyes and take a deep breath in through your nose and out through your mouth. Focus on your breathing and allow your mind to clear. Remember how good this feels and use this technique when you feel overwhelmed.
2. Focus on the present. Right now, your imagination is your worst enemy. Your mind is probably thinking about the future and the bad things that could occur. Be focused on the present, because that’s the time you have. Nobody can change the past or control the future. The only time you can do anything about is right now. What you do in the present can help shape your future.
3. Forgive Yourself. Stop blaming yourself for what happened. Stop blaming who might have given you HIV/AIDS. Blame usually leads to anger, and anger can lead to violence and hate toward yourself and others. Forgiving yourself allows your healing to start and it also allows you to forgive others in time.
4. Anger and Revenge. Feelings of anger and revenge toward who might have given you HIV/AIDS may lead to violence and hate. Acknowledge these feelings, then let them go. Do not act on these feelings, but do discuss them with others who have experienced what you are experiencing. Talk with a counselor, social worker, or case manager. Learn to forgive!
5. Make your own experience. Everyone’s life is a unique experience, unique set of events, and unique outcomes. Don’t get caught up in what has happened to other people with HIV/AIDS. Your experience is what you make it. What happens in your future is unique to you; it is shaped by what you do in the present.
6. Use your support networks. Support networks are people in your life who are on your side when you need them, helping you with no judgement, no lectures, and no hesitation. Support networks take on different forms for each person. Yours may be family members, close friends, or a mixture of both.
7. See a Doctor. It is recommended that you see an HIV specialist or a doctor who has experience treating HIV patients. You have a choice of what doctor you see for your medical care. Make your decision based on their knowledge of HIV and your comfort level with your specialist. Many people with HIV/AIDS see an Infectious Disease doctor or Special Immunology doctor. Specialists are likely to know about the latest treatments for HIV/AIDS. Don’t let pride or embarrassment stop you from telling a doctor about your condition. Your long term health is important.
8. Manage Information Overload. People commonly have two extreme reactions after being diagnosed. They either completely avoid any mention of HIV/AIDS or they seek out, read, and absorb as much information as they can about the topic. Aim for information flow control. That means figuring out how much information about HIV/AIDS is enough for you at a particular time. It is up to you to set your own limits on what you can handle.

It is important that you get the medical and social services that you need to maintain a healthy lifestyle. Take charge of your healthcare by honestly telling medical care and social service professionals what you need.

Tips for getting the services you need:

• Always get a contact person’s name and phone number.
• Ask questions if you don’t understand.
• Keep a copy of everything

Know your rights:

• The Americans with Disability Act protects people with HIV from discrimination (www.ada.gov).
• In Ohio, no one can tell your HIV/AIDS status to anyone else without your written permission.
• Ask your local AIDS service organization about these and other laws.

There are many community resources available to people living with HIV/AIDS. To find support services near you, visit our Find Care and Services page.

“Disclosure” means telling someone you have HIV. Who to tell about your HIV status and how to tell them is a complex and personal decision. While disclosure is never easy, it may help to plan ahead so that you are able to disclose under the best possible conditions.

• Tell people you have had sexual contact with.
• Tell people you have shared needles with.
• Tell your doctors and other healthcare providers to ensure you receive appropriate care.

You do not need to tell your family, friends, or the general public that you are HIV-positive. However, many people feel those closest to them provide both emotional and practical support.

You do not have to tell your employer. If you do, remember that as long as you are performing your job, your employer cannot legally discriminate against you. People living with HIV are protected under the Americans with Disabilities Act (www.ada.gov).

In most cases, sharing your HIV status is a personal choice. But in the case of sexual relationships, it is a legal requirement. Under Ohio law [ORC 2903.11(B)], you are required to disclose your HIV-positive status before knowingly exposing or transmitting HIV to someone else. It is a second-degree felony to have sexual contact (oral, vaginal, or anal sex) with someone without telling them you are HIV-positive. Even if you are undetectable or if you do not happen to transmit HIV to your partner during sexual activity, you could still be prosecuted.
Head to https://www.seroproject.com for more information about HIV criminalization.

There is no one best way to tell someone. It will help to ask yourself a few questions before disclosing.

• Who do I want to tell and why do I want them to know?
• How much am I ready to share or are they ready to hear?
• How will disclosing my HIV status affect me and how will it affect the people around me?

Consider where you want the disclosure to take place. It could be at home, at a friend’s house, or in a healthcare setting so that support is readily available. You can also use a site like https://tellyourpartner.org/ to anonymously inform your sexual partners of your status. Although there is generally no one right time, you should tell when you feel ready or when you are legally required to do so (for example, if you are going to be involved in an activity where HIV could be transmitted).

If children are part of your life, it is important to ask yourself why you want to tell them:

• Will they be angry if you keep a secret?
• Do they suspect something?
• Do you look or feel sick?

Children can react to the news of HIV in many different ways. Older kids may be upset that you kept a secret from them. Younger children may not show emotion because they are just too young to understand. You may decide only to tell them as much as you consider appropriate for their age.

Don’t forget that kids need support too. Give them the name of another adult they can talk to, like an aunt or grandparent. Several books and organizations are available to help guide HIV families and their children.

You can stay healthy or even improve your health by keeping your immune system strong. A strong immune system helps fight infections and gives you more energy. To best support your immune system, you may need to make some healthy changes to your lifestyle. Changing a habit is hard, but the benefits can make your life much less stressful. Eat Well A healthy diet gives you the important nutrition you need to maintain weight and prevent other health issues. Eating fruits, vegetables, proteins, and grains along with drinking at least 8 glasses of water daily allows your immune system to properly function. For a guide on proper nutrition, please visit www.choosemyplate.gov. Often, many people living with HIV/AIDS experience difficulty eating at some point. Contact your doctor if you experience any of the following:

• Loss of appetite
• Sore mouth and throat
• Reduced taste
• Fatigue
• Nausea
• Diarrhea

Stay Fit If you haven’t been exercising regularly, this is the time to start. Ease yourself into a new routine by first starting to take a 20-minute walk 3 days a week. Build up the duration and frequency of your workouts to 45 minutes to an hour of exercise 4 or 5 days per week. Do a combination of exercises for strength (such as lifting weights or doing push ups), flexibility (such as yoga), and endurance (such as jogging). And of course, talk with your doctor prior to starting any new exercise plan. For more information about staying fit, please visit www.fitness.gov.

Pregnancy and HIV/AIDS If you’re pregnant or thinking about getting pregnant, it is important to ask your doctor for more information and for what to expect. Many women with HIV/AIDS are living healthy lives and have had healthy children. However, those living with HIV are at higher risk for complications during pregnancy. Specialists in high-risk pregnancies are available to help you to stay healthy and deliver healthy children. Make sure to visit Women’s Health - Pregnancy and HIV/AIDS. This page was adapted from the Ohio Department of Health’s “STEPS: living positive, being healthy” handbook.