Topics
Information on psychoactive substances, biomedical prevention, hormones, sexual practices, and care.
What the risk levels mean
Labels such as Low, Moderate, High, or Very high summarise the level of caution for each topic based on the interactions or harms described in the source material. They are not a moral scale or a diagnosis: they are a quick guide to help you orient yourself before opening the full page.
Cannabis
ModerateCannabis contains THC and CBD, acts on the endocannabinoid system, and may have relevant interactions with some antiretrovirals, especially protease and integrase inhibitors.
Chemsex: the architecture of care in encounters with substances
VariableA practical guide to planning encounters with substances, reducing harm, and caring for the body before, during, and after.
Cocaine
HighCocaine is a central nervous system stimulant that increases dopamine, noradrenaline, and serotonin. It carries important cardiovascular risks and may interact dangerously with erection medicines, antidepressants, and other stimulants.
Community care and identity in sexual spaces
Guide to community care and identity: building community, respect for diversity, collective consent, support networks, safe spaces, pride and identity, and activism.
Erection medicines (PDE5 inhibitors)
VariablePDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) help erections by increasing blood flow; when combined with some medicines or substances they can cause serious effects.
Feminising hormones and interactions with psychoactive substances
VariableInteraction table between feminising hormones (estradiol, spironolactone, progesterone, cyproterone acetate) and psychoactive substances, with risk levels.
General recommendations for reducing risks and harms
Nine general harm reduction recommendations for people who use substances and/or take HIV treatment or HIV prevention medicines.
GHB and GBL (liquid ecstasy, G, Gina)
Very highGHB and GBL are central nervous system depressants that act on GABA receptors. The margin between a recreational dose and an overdose is very narrow, especially when combined with alcohol, other depressants, or antiretrovirals that can increase their effects.
Hepatitis B medicines and psychoactive substances
Interaction table between hepatitis B medicines (TDF, TAF, entecavir) and psychoactive substances. Table 02A.
Heroin and other opioids
Very highOpioids act on the central nervous system, producing pain relief, relaxation, and euphoria. The main risk is respiratory depression and overdose, which gets worse with other depressants and some antiretrovirals. Naloxone can reverse an overdose.
Inhalants (glues, solvents, thinner, aerosols, and gases)
Very highInhalants are chemical substances whose vapours are breathed in to produce a brief high and disinhibition. Repeated use may cause brain, heart, liver, and kidney damage. Relevant pharmacological interactions with modern antiretrovirals are not expected.
Ketamine (K, Special K)
HighKetamine is a dissociative anaesthetic that acts on NMDA receptors. It may interact with several antiretrovirals that change its levels, increasing the risk of deep sedation or reduced effectiveness.
LSD (Acid)
ModerateLSD is a psychedelic that alters perception and consciousness for 8 to 12 hours. Relevant pharmacological interactions with modern antiretrovirals are not expected, although emotional and environmental context strongly shape the experience.
MDMA (Ecstasy, Molly)
HighMDMA is a stimulant and empathogen that increases serotonin, dopamine, and noradrenaline. It may have important interactions with protease inhibitors and some integrase inhibitors, increasing the risk of hyperthermia and cardiovascular toxicity.
Methamphetamine (crystal, tina)
HighMethamphetamine is a central nervous system stimulant with effects that may last 6 to 24 hours or longer. It may reduce ART adherence and has relevant interactions with antidepressants and erection medicines. The risks of psychosis, sleep deprivation, and redosing are especially important in chemsex contexts.
Most commonly used hormones by trans people: general interaction table
VariableGeneral interaction table between the feminising and masculinising hormones most commonly used by trans people and psychoactive substances, with risk levels.
Most commonly used hormones for trans people: masculinising hormones and interactions
VariableInteraction table between masculinising hormones (testosterone in different formulations) and psychoactive substances, with risk levels and recommendations.
PEP (Post-Exposure Prophylaxis)
VariablePEP is an emergency treatment that reduces HIV risk after a possible exposure; it should be started within 72 hours and taken for 28 days without interruption.
Poppers (alkyl nitrites)
ModeratePoppers are inhaled alkyl nitrites that produce brief euphoria, muscle relaxation, and vasodilation. They are frequently used in sexual contexts.
PrEP (Pre-Exposure Prophylaxis)
PrEP is a highly effective medicine (>99%) that reduces the risk of acquiring HIV in HIV-negative people; daily, 2-1-1, and injectable regimens are available.
Sexual practices with power dynamics: emotional care
VariableGuide to sexual practices involving power dynamics and emotional care (D/s, Master/Slave, Humiliation, Degradee, Primal, Age Play, Brat), with emphasis on consent, communication, and aftercare.
Sexual practices: emotional and relational care
VariableGuide to sexual practices involving power dynamics and emotional bonds (D/s, Master/Slave, Humiliation, Degradee, Primal, Age Play, Brat), with levels of care and harm reduction strategies.
Sexual practices: financial care and material boundaries
Guide to financial care in relationships and sexual practices: clear agreements, financial boundaries, conscious payment, financial autonomy, and prevention of economic exploitation.
Sexual practices: physical care, body safety, and erotic exploration
VariableGuide to sexual practices with physical and body care (bondage, spanking, electro, wax, breath play) and erotic and sensory exploration, with care levels and harm reduction strategies.
Sexual practices: sexual care and sexual health
VariableGuide to sexual practices (vaginal sex, anal sex, oral sex, frottage, group or shared sex, fluid exchange, and sex toys) with levels of care, risks, and harm reduction strategies.
Trans hormones and psychoactive substances: specific interaction table
VariableDetailed interaction table between trans hormones (estrogens, antiandrogens, progestogens, testosterone) and psychoactive substances, including mechanisms and risk levels.
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