Positive Frontiers.com’s “My Life On PrEP”

[Steven_Draker]

My Life On PrEP

 

Positive Frontiers.com’s "My Life On PrEP"

by Jake Sobo

 

 

Part 1

My Life on PrEP – How I Learned to Stop Worrying, and Start Taking The Pill

 

Editor’s note: PrEP is an HIV prevention option currently available in the U.S. and Truvada is the medication prescribed. PrEP can be a complex issue that raises a number of questions. I wanted to provide a column that captured someone’s authentic experience around PrEP. I wanted it to be honest and frank because issues of gay men’s health must be dealt with candor and sincerity. This is not just a prescription. This is simply one person’s experience with a safe and legal biomedical option for reducing HIV infection. I hope this will be informative and we welcome your feedback.

 

Over the past three years, I’ve noticed something about my sex life. For a host of reasons that this column will be exploring, I’d all but stopped using condoms. This set-in most clearly during a recent out-of-town trip when a guy who’s Manhunt profile lectured others about “wrapping it up” spit on my hole, shoved it in, and fucked me raw. I was absolutely ecstatic. In that moment – caught off-guard by expectations and overcome with pleasure – I realized just how much my desires had changed.

 

It occurred to me some days later that maybe this pre-exposure prophylaxis – or PrEP, as it’s commonly known – might be for me. I was clearly the ideal candidate: a bottom with lots of partners who uses condoms inconsistently (read: almost never) and who doesn’t want to test positive. That last bit is hard for some to understand, since many believe that guys who fuck raw must subconsciously desire to be infected. I care about staying negative and have made strategic choices about my sex partners to that end. Well, “strategic” makes it sound scientific. Let’s be real: some of those choices were more like hopeful wishes. But the desire that drove them was the same as any scientific measure: prevent seroconversion.

 

This column is about my life on PrEP. It’s about how I experience it and how it’s changing my sex. It’s also about the politics of PrEP, which are still being sorted out as we speak – who has access, through what organization, etc. I’m writing because I know there are other guys out there on PrEP who are probably going through the same kinds of experiences and are hungry for any real, down-to-earth talk about it. But I’m also writing because there are HIV-negative guys out there not on PrEP who are curious about it, but too afraid to ask their doctors. They want to know what it’s all about. I’m here to tell them.

 

 

Part 2

How I Got PrEP Covered by Private Health Insurance

 

As one of the lucky people in the United States whose employer provides comprehensive health insurance, let me just preface this column by saying I know a lot of you guys out there aren’t as fortunate. I’m not ignoring you; the next column will be about how to access PrEP through publicly funded clinical trials and private programs that are popping up. But I wanted to start the access discussion with my experience getting a prescription for Truvada – the only drug currently FDA-approved for PrEP – and getting that prescription filled using my private health insurance.

 

When I stepped into my doctor’s office to discuss PrEP, I knew it wasn’t going to be a straightforward issue. Even most gay men I know are completely unaware that the FDA approved Truvada for PrEP, much less that it can reduce the risk of contracting HIV by upwards of 90% when taken daily (a recent study found it to be 99% effective among those that took the pill seven days a week). Having been judged plenty of times before by dumbass doctors who didn’t know what they were talking about when it came to gay men’s health, I didn’t go into my appointment with lofty expectations.

 

 

Part 3

Your Guide to Getting PrEP for Free (In The US)

 

In my column last week, I discussed my experience getting PrEP covered by my private health insurance. But I know many of you folks out there don’t have health insurance. Don’t fret: There are several ways you can get your hands on PrEP without shelling out any dough. Actually, for some of you in urban areas, you might be able to enroll in study that will pay you to participate. There’s a lot of information here, boys, so bear with me.

 

Let’s start by talking about what these things called “clinical trials” are. There are a few different kinds going on for PrEP and the differences are important. So listen up! In one set of trials, they’re randomly assigning people into different groups that are going to receive a particular drug combination. Once the study is over, they’ll compare the different groups to see if any of the combinations was more or less effective at preventing HIV. Since we already know that PrEP works, nobody in these trials is going to get a “placebo” or fake drug. But some people aren’t going to get Truvada; instead, there are four drug combinations being tested. All of those combinations include powerful drugs that fight HIV – but not all of those combinations have been tested yet.

 

 

Part 4

Learning to Fuck with Poz Guys

 

A few months before I started taking Truvada for PrEP, I got hit up on Manhunt by a gorgeous HIV-positive guy who wanted to fuck me bare. He was frank about it, telling me that his viral load was undetectable and had been for years and that he wouldn’t cum inside me. In all honesty, I blanched at his frankness.

 

For years, I had been telling friends (and anyone else who would listen) that choosing to only have sex with guys who think they’re HIV-negative wasn’t really an effective prevention strategy for guys in areas of the country like mine. Where I live, there are plenty of guys who think they’re negative who are actually positive because they haven’t been tested in eons. Transmission is mostly likely going to occur with these guys – not with guys who know they’re HIV-positive.

 

That may seem confusing at first, but the science behind it is straightforward. When you’re diagnosed as HIV-positive today, most doctors immediately recommend you start taking medication to treat the virus. HIV treatment can fight the virus so effectively that it makes the virus “undetectable” in your system. If the virus is undetectable in your body, it’s virtually impossible for you to transmit the virus. Guys who don’t yet know they’re infected aren’t taking these drugs. Without treatment, there could be tens of thousands or even millions of those tiny little critters in just one milliliter of blood. Having that much virus in your system dramatically increases the odds that the virus will be transmitted during sex.

 

 

Part 5

Feeling Déjà vu: PrEP As The New Condom

 

Back in the 1980s when gay men in New York were dying left and right from an unidentified disease, a group of activists took a stand to argue for condoms. We didn’t know what was causing AIDS at the time – HIV hadn’t yet been identified – but that didn’t stop AIDS activists Michael Callen and Richard Berkowitz from putting together a pamphlet, “How to Have Sex in an Epidemic,” that encouraged gay men to consider adopting safer sex strategies like using condoms to stay safe.

 

That pamphlet came out in 1983. It took years for public health institutions to take up the condom message. Let’s revisit a boring but enlightening scientific paper published in 1993 –a fucking decade after Callen and Berkowitz published their groundbreaking advisory to gay men – that urged caution in promoting condoms:

 

Until more is known about condom effectiveness, condom use promotion may have both positive and negative effects… Condoms will not eliminate risk of sexual transmission and, in fact, may only lower risk somewhat… Empirical data (reviewed in this report) indicate that a 90% reduction in risk due to condom use may be overly optimistic. The protective effect as estimated from human studies, regardless of use definitions, indicates a possible 69% reduction in risk. (p. 1642).

 

Were gay men listening to what this ivory tower, out-of-touch researcher had to say about condoms? No. We listened to our gay brothers who were quickly figuring out that using condoms for anal sex was an extremely effective method for staying negative and staying alive – all while having meaningful, productive sex lives.

[Steven_Draker]

Part 6

Does Taking PrEP Make Me A wh0re?

 

Hooking up online is always a tricky game of disclosure. You’ve got to show enough of your best assets to turn your audience on without coming across as a desperate slut. Nevermind the fact that most of us online are a) somewhat desperate; and, b) by most standards, extremely promiscuous. It’s all about the fantasy.

 

I’ve always been terrible at pretend play. I hate Halloween. I loathe charades. And in reaction to the ridiculous obsession with being “straight acting” on websites like Adam4Adam and Manhunt, my online profiles cheekily (but accurately) inform readers that I’m “gay acting.” When it comes to chatting online, I favor honesty over fantasy – a fact that costs me sex on a regular basis.

 

Let’s take a look at a recent example. Over the Thanksgiving holiday, I was chatting with a 38 year-old guy with the most gorgeous nine-inch cock. He was handsome, built, and wanted to breed me till the sun came up. I was game, but there was just one problem: my ass was still sore from the night before. I always hate making up lame excuses for not hooking up, so I told him point blank my problem:

 

Me: I’d really love to fuck, but to be totally honest, I’m still sore from getting fucked last night.

Him: Dude, that’s gross. I’m gonna pass. Being first to the party is great, but second… or third… no thanks.

Me: And I say this with all sincerity: nobody on this site is first to any party. Ever.

Him: Whatever. Nobody wants to fuck a wh0re.

I’ve been faced with encounters like this ever since I started hooking up with guys 15 years ago; generally they involve much harsher language. I’ve never been ashamed about my sex life or my desires. For many guys, that’s a deal breaker. Too many guys out there are deeply ashamed of their sex. It’s embarrassing for them. They’d rather pretend that we’re all boys next door who “never hook up” but make an exception or two (or 264) on their road to monogamy.

 

When I started taking Truvada for PrEP, I thought somehow that it would help me cut through some of the bullshit out there. I could finally have the sex I wanted, without shame or regret. I suppose I was naïve. Two weeks ago, you may have noticed a column over at The Huffington Post by David Duran bemoaning that only “wh0res” were lining up to take Truvada. “Having a ‘there’s a pill for that’ attitude is absolutely disgusting,” Duran complained. Reading his woefully inaccurate piece, I found myself face-to-face with the same kind of shaming and pretend play nonsense that has plagued HIV prevention since the beginning.

 

 

Part 7

Does PrEP Have Side Effects?

 

I brought my pills to work for three days while waiting for my HIV test results. I was eager to start taking Truvada for PrEP, but I knew that I needed to wait for my HIV test results to come back to confirm that I was HIV-negative before I began popping them. My doctor had gone ahead and written me a prescription when I had my blood drawn – before my test results had come back.

 

I went straight from my doctor’s office to the pharmacy to drop off my prescription. I was eager to get my hands on those pills – in part because I didn’t know if my insurance would cover them. It was only later, when doing research for this column, that I learned that insurance companies have been extremely good at covering PrEP.

 

The call with my negative result came on an ordinary afternoon while I was working on a project with a friend. I wasted no time, heading directly to the water fountain to wash down the first of many blue pills. I came back to my desk distracted. I was waiting… for what, exactly? Side effects? The feeling of being 92% less likely to contract HIV?

 

I’ve received a lot of emails from readers inquiring about what side effects I experienced when I started taking PrEP. That day at the office, I was anxiously awaiting the answer. I’ve been taking Truvada for three months now, and the honest answer is that I haven’t experienced any noticeable side effects since.

 

As it turns out, I’m like most people in that regard. Let’s revisit the iPrEX study results to get a sense of what side-effects participants reported in the original PrEP study. These fell into four main categories, ordered here in most to least common:

 

Nausea: 9% of those who received Truvada reported nausea in the first month, compared to 5% of those who received placebo. After the first month, there was no difference in reported rates of nausea among those who received Truvada and those who received a placebo.

 

Headaches: 4.5% of participants who received Truvada reported 66 headache events, as compared to 3.3% of those who received the placebo that reported 55 headache events.

 

Weight Loss: 2.2% of those who received Truvada reported unintentional weight loss of more than 5%, compared with 1.1% of placebo users

 

Small Increases in Serum Creatinine: Truvada is known to cause small increases in serum creatinine, a naturally occurring molecule filtered by the kidneys. In this study, 0.3% of those who received Truvada experienced mild increases in serum creatinine that persisted until the next test. All creatinine elevations resolved with discontinuation of the pill. Four of the 5 participants restarted PrEP without recurrence of the creatinine increase. Investigators monitored renal function throughout the study and found no serious kidney problems.

 

source: http://www.frontiersla.com/MyLifeonPrEP/story.aspx?ID=1835702

 

_____________________

 

Huffington Post: There’s No Shame in PrEP

by Alex Garner

 

For over 30 years gay men have struggled around issues of shame, risk, pleasure, safety, death and life. HIV is an integral part of our daily lives, and we’ve learned what the risks are and how to protect ourselves. Until recently there were two ways to prevent HIV: abstinence and condoms. Now we have a new option in pre-exposure prophylaxis (PrEP). PrEP is a safe, legal and effective option for preventing HIV, and no one should be ashamed of choosing it.

 

The Stigma Project has taken the proactive step of creating an anti-stigma campaign in regard to PrEP. The groundbreaking campaign is pictured above. Unfortunately stigma is already being used to scare and confuse people about the option of PrEP. And stigma doesn’t just devastate our community; it can claim people’s lives.

 

The science on PrEP is sound. If an individual takes Truvada every day, as instructed, they will reduce their chances of infection by more than 90 percent. So we have a new tool that is safe and legal and can prevent HIV. Why are we arguing about it?

 

PrEP provides our community with a great opportunity for self-reflection. Are we still the community that believes that health care is a right and that everyone should have access to medical care regardless of circumstance? Are we the type of community that values privacy and respects the personal medical choices of the individual? Are we committed to sexual health and self-determination? Are we committed to ending the epidemic by pursuing all options to reduce infections?

 

I believe we are. However, the vitriolic tone of the PrEP debate has given me pause.

 

We all share the same goal of reducing infections, but you have to ask yourself if you are truly committed to combatting stigma. If you aren’t, if you want to wield stigma as a weapon to impose your point of view, then you are part of the problem. To stigmatize PrEP or the people who take it will only lead to more infections.

 

To some, PrEP seems to signal complete and total sexual chaos, just like another pill that came onto the scene in the middle of the last century. People opposed the birth control pill because they claimed it was “risky,” or “immoral,” or “promoted promiscuity.” Does any of that sound familiar?

 

We don’t need to go back to last century to hear those sorts of arguments, because we heard them in 2012 around the contraception debate. Women who believed that contraception should be covered by insurance were derided as “sluts.”

 

When it comes to PrEP, we don’t have Rush Limbaugh; instead we have people like David Duran writing about “Truvada wh0res.”

 

Women risked their reputations and their lives to take the birth control pill. They understood what choosing the pill could cost them, but they chose self-determination instead. The ability to prevent pregnancy was so important to these women that they risked depression, nausea, weight gain and stroke. They weren’t reckless wh0res. They were trailblazers for women’s independence and social justice.

 

Let’s all take a step back and look at the opportunity PrEP provides us. It’s one more tool to prevent HIV. Is it perfect? No. Neither are condoms. But it’s safe, legal and effective.

 

Why don’t we also stop patronizing gay men? If an individual chooses to go on PrEP, he will be required to visit his doctor and get a prescription. The doctor will draw blood, do an HIV test and counsel the patient about condom use and side effects. The decision to use a condom is an extremely personal one that it is arrived at after consultation with a medical professional. Why should anyone other than the doctor, the patient and the patient’s partner be involved in that process?

 

source: http://www.huffingtonpost.com/alex-garner/theres-no-shame-in-prep_b_2247775.html?utm_hp_ref=gay-voices

[doitb4ugo]

Wow....Thanks Steven. A very thought provoking blog. I am so grateful you pasted it here for us to mull over. So much of what is said here rings true to my thoughts and experiences. And gives me much food for later thought.

 

Living and loving with HIV

[+ Chris Eisenhower]

I like the part where the guy doesn't want to "fuck a w-hore," but he wants to fuck the guy all night long and breed him as though he IS one. He sounds so awesome, selfless and giving in bed… not.

[Gar1eth]

#1. I thought he was wrong about the risk reduction. And I just relooked it up. The article I read said there were two studies using Truvada for Pre-exposure prophylaxis (PrEP) one showed approx a 45% reduction in catching HIV and the other showed a 75% reduction. I believe in both of those studies people were still using condoms.

#2. I realize this is my belief- but I think he is living in a fool's world- by ignoring using condoms. I can believe him not wanting to catch HIV- but his sexual practices negate that wish so that it doesn't matter. It's like trying to pretend to a high moral stance by saying- I don't hunt or personally butcher my own meat, but I have no problem eating meat. The fact that I have nothing to do with catching/obtaining the meat is negated by my willingness to eat it.

 

I urge everyone not in a committed relationship whether on Truvada for PrEP or not to continue to wear condoms. We don't need a return of the death rate of the '80's and '90's.

 

 

 

Gman

[Mark450]

I have to agree with Gman. Use a condom and get over it. Your life is worth more than condom free sex.

[Steven_Draker]

I had to take Post-exposure prophylaxis (PEP) twice in my life and both times the treatment was heavy and hard to take (especially for my stomach). I don't see myself taking PrEP as described in the article above. I know it's not for everybody ... it wasn't for me.

[Gar1eth]

I had to take Post-exposure prophylaxis (PEP) twice in my life and both times the treatment was heavy and hard to take (especially for my stomach). I don't see myself taking PrEP as described in the article above. I know it's not for everybody ... it wasn't for me.

 

Steven- I am not trying to sway you one way or the other. But I had to do it twice. They were minor exposures. And my physician did it most likely for my peace of mind. What they put me on was Atripla- a medication with 3 drugs combined. Two of he drugs are the same as Truvada. The third drug is Efavirenz- that's the one that is the 'culprit'- it causes most of the nausea- sweating , dizziness, and vivid dreams. People are told to take it at bedtime, so they can sleep through the side effects. I had to wear an anti -nausea ear patch the entire time I was on it. And if the ear patch accidentally fell off- which occurred a few times- I knew- not because I felt it fall off but the almost immediate increase in nausea.

 

So the point of this- is if the post exposure prophylaxis you were given was Atripla- you most likely felt awful due to the Efavirenz. Truvada which is what they are giving for the PrEP does not contain Efavirenz- and you most likely would tolerate it without many problems.

 

Oh- and the OP may have been right --looks like there is one new study out that says protection from high risk behaviors may be 99%. But I couldn't tell if this was among a group of barebackers or condom users. There's a big difference if the 99% reduction is in condom users only.

 

Gman

[rickp]

I can't imagine putting an unnatural chemical into my body everyday simply to avoid using condoms. Not to mention the pill won't protect you from any of the other STDs a condom can.

[Gar1eth]

I can't imagine putting an unnatural chemical into my body everyday simply to avoid using condoms. Not to mention the pill won't protect you from any of the other STDs a condom can.

 

I'm not sure if the risk reduction in catching HIV was in those using condoms or not. I couldn't tell from the way the article was written. But I don't mind condoms that much- it's better than getting sh-t on my tallywacker if the guy hasn't cleaned himself well.

 

Gman

[Steven_Draker]

Steven- I am not trying to sway you one way or the other. But I had to do it twice. They were minor exposures. And my physician did it most likely for my peace of mind. What they put me on was Atripla- a medication with 3 drugs combined. Two of he drugs are the same as Truvada. The third drug is Efavirenz- that's the one that is the 'culprit'- it causes most of the nausea- sweating , dizziness, and vivid dreams. People are told to take it at bedtime, so they can sleep through the side effects. I had to wear an anti -nausea ear patch the entire time I was on it. And if the ear patch accidentally fell off- which occurred a few times- I knew- not because I felt it fall off but the almost immediate increase in nausea.

 

So the point of this- is if the post exposure prophylaxis you were given was Atripla- you most likely felt awful due to the Efavirenz. Truvada which is what they are giving for the PrEP does not contain Efavirenz- and you most likely would tolerate it without many problems.

 

Thank you for your input.

 

I wasn't talking about nausea or feeling awful. I was talking about "stomach" problems. Once I was given PEP in Belgium (a combination of three drugs) and once I was given the same Truvada mentioned in the article as part of a research study at Fenway Boston. Both times I had the same side effects.

 

I understand that the human body could react differently to different drugs and side effects can vary from person to person.