The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme.

The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general.

After an introduction to MSM in Episode 1, Episode 2 of The Steam Room focuses on MSM first-timers.

This week, we spoke to Bruce Little, Content Creator at the Anova Health Institute, to gain insight into the experiences of MSM first-timers.

What does it mean to be an MSM first-timer?

An MSM first-timer is a man who is having sex with another man for the first time.

Little says that a more open-minded society where sexuality is considered to be more fluid has led to more men becoming curious and less inhibited by the norms of society. This has lead to a greater willingness to experiment within the realm of sexuality.

What should first-timers keep in mind before diving into MSM?

Little recommends that first-timers take it easy. When embarking on your first sexual experience with another man, it is important that both parties give their consent and are preferably not too inebriated by alcohol or drugs. Pacing yourself is also important – don’t force yourself to do anything that you’re not enjoying or doesn’t feel right.

“It’s supposed to be a pleasurable and enjoyable intimate experience with another person. Take your time and don’t expect yourself to be this stellar porn star the first time you have a sexual experience with another man,” says Little.

What about the stigma surrounding MSM?

We live in a time where there is still some stigma surrounding MSM, and you do need to be careful about promoting your sexual orientation in certain communities.

Little recommends that you consider your environment. “Make sure that you’re safe and not in a situation where you could come to harm or be the victim of someone else’s ignorance or stupidity”. You can do this by choosing safe spaces and platforms where you will be supported when being open about your sexuality and exploring your sexual fluidity.

Little maintains that shame is not exclusively the domain of people who fall within the LGBTQ+ spectrum, as many cisgendered and heterosexual people are also faced with issues surrounding shame. However, men who have sex with men should keep a rational and analytical perspective surrounding their shame about MSM and the reasons for it. In this regard, Little says that deep introspection is important: “Do you have a rational reason for feeling shameful about your sexuality or your desire to experiment, or are you just adopting someone else’s discriminatory perspective?”.

We also spoke to Dr. Itzio Barraldi, a Pretoria-based family physician who specialises in men’s health and HIV treatment, about the physiological implications that MSM may have.

What are the main differences between MSM and MSW sex?

Dr. Barraldi says that anal tissue is more permeable by viruses and bacteria than vaginal tissue, due to a difference in density. Anal bleeds may lead to a higher entry level for pathogens, and the overall potential for the transmission of HIV and STIs is greater when engaging in anal sex.

What are the best defence methods when engaging in MSM?

Dr. Barraldi recommends the consistent use of condoms and a water-based lubricant when engaging in MSM. Using an oil-based lubricant may damage condoms, leading to a higher risk of infection, but using enough water-based lubricant is paramount. “When having anal sex, the old adage is that too much lube is almost enough.”

In terms of PrEP, how can it be acquired discreetly?

PrEP, or pre-exposure prophylaxis, is a new tool that is doing a lot to control the spread of HIV. Treatment with PrEP is, in essence, antiretroviral treatment to men who are HIV-negative. In the case of the virus entering the body, two antiretroviral drugs are already there to block its replication and prevent infection.

Should a man get infected by HIV, an third drug will need to be added to the combination of two antiretroviral drugs that are used with PrEP as soon as possible, as the body could build up resistance to the drugs, which can have an influence on future treatment of the virus.

This is why Dr. Barraldi recommends that MSM go for a fourth-generation HIV test before starting PrEP, and again every three months thereafter. Fourth-generation HIV tests have a shorter window period of just 4 to 21 days, as opposed to the traditional finger-prick HIV tests’ larger window period.

PrEP can be prescribed by all private practitioners, and medical aids cover the costs of treatment, but should you want to acquire it anonymously, you will have to order it privately through a medical practitioner. Various NGOs also offer treatment with PrEP, free of charge.

How do you stay safe when engaging in oral sex?

Although the risk of transmission of HIV and other STIs is generally lower with oral sex, Dr. Barraldi advices that any body fluid can still lead to transmission, which is why you should always use condoms when engaging in oral sex.

What measures should MSM take?

Like gay men in general, men who have sex with men should take special care when engaging in sexual activity with other men.

• Use condoms

In conjunction with a water-based lubricant, high-quality condoms dramatically reduce the risk of transmitting STIs. Be careful not to use oil-based lubricants, which could dissolve the condom, rendering it ineffective.

• Get tested

Men who have sex with men are at a higher risk of contracting STIs than MSW (men who have sex with women) and WSW (women who have sex with women), which is why it is highly advisable to get tested for HIV and other STIs every six months, even if you use protection.

• Be ready in the moment

A sexually active MSM should always have lubricants and condoms at hand, on the off chance that they might have a sexual encounter.

• Pay attention

Having an open and honest discussion with your partner about your status not only keeps things comfortable, it is also the responsible thing to do. Use enough lube and make sure that the condoms you are using are not damaged in any way. Certain minor things – like not brushing your teeth directly before oral sex (this can cause tiny abrasions which could be passageways for STIs) and paying attention to not aggravate any sore spots in the anal area – will also do a lot to ensure your peace of mind throughout your encounters.

• Keep track of your health

After engaging in any act of MSM, pay particular attention to your body. In the hours and days following a sexual encounter with another man, keep an eye out for any burning in the genital or anal area, or anything abnormal like rashes or fever. Should anything seem out of sorts, consult with a medical professional immediately, as it’s always better to catch things that are out of the ordinary early.

What online resources are there surrounding MSM?

There are a number of online resources available to men who have sex with men. Younger men between the ages of 15 and 21 can visit Young Heroes, a website which explores different aspects surrounding sexuality, including sexual expressions and identity, gender expression and identity, as well as information about puberty in general.

We the Brave is intended for men from their 20s to their 40s, and has a treasure trove of information about internalised homophobia, online bullying, stigma, HIV prevention and treatment, information about how to protect yourself against STIs, information about HIV prevention and treatment and other topics related to MSM.

Click on the player below to listen to our full discussion about MSM first-timers on Episode 2 of the Steam Room, brought to you by the National Department of Health’s Phila programme.