Road Blocks Didn't Stop Him From Getting PrEP

I finally got up the courage to seek PrEP in April 2013. 

by K.W.
Austin, TX

There's a lot of detail I'm going to spare you, but essentially in 2013 I moved to a different group practice in Austin, TX. I established care with a new Doc at the beginning of 2013. PrEP started to come into focus for me as I discussed it with friends and did a lot of research. I finally got up the courage to seek PrEP in April 2013.

I look back 11 months ago, and realize how difficult it was for me to do this. It was nearly on par with coming out to my family in 2005.

So I called to make an appointment with my new Doc and the nurse immediately shut it down, said I'd probably do better to find a specialist. I asked for a referral within the group, and was told they didn't have an HIV care specialist. Lovely.

The nurse did me a favor. I went back to my old group practice, researched their website and booked an appointment with a new Primary Care Physician, w/ HIV Speciality. One week later, sitting across from my new Doc, he looked at me and said "You're number 2"... meaning, I was the second to request PrEP. He began the discussion of all that was involved and quickly realized I'd done my homework. That was it, pending labs results, my Rx was written.

What prompted me to share this with you?

It's been nearly a year- and to my knowledge, my old group practice lost (first hand knowledge) 4 patients over denial of PrEP. Today I called the Administration office of my old group practice to share my story. Somehow the phrases "Issues regarding your Standard of Care" and "Possible Denial of Care" got my phone call forwarded to a very interested party on the other end of the line.

I was forgiving, and spoke highly of my previous Doctor. I framed this as a "missed opportunity" x 4 for very well established Clinic that prides itself in it's depth and breadth of services. The person taking down my information said the Medical Director will probably be calling me back.

So please, if you hit a road block, do what you can to get your doc in the loop.

[EDITOR: If you have a personal PrEP experience you would like to share, send it to myprepexperience@gmail.com. Words or video.]

I am a Truvada Whore

by @pupbones

San Francisco

What is it about Truvada PrEP that is so upsetting to some people? 

We all know change is hard… especially after you’ve been trained to have sex a certain way your entire life, after you’ve watched dozens of your friends pass away in mere months, after you’ve repressed your sexuality since childhood, all the while fearing death, disease, and social-rejection. These things are hard to talk about. There is certainly a great deal of stigma surrounding HIV/AIDS, even in San Francisco. Conversations about HIV status, viral load, and PrEP aren’t happening as often as they should be.

New HIV diagnoses in San Francisco have remained steady over the past decade (according to the SFDPH HIV/AIDS Epidemiological Annual Report 2012). We can only speculate about these new cases, but it is safe to say that HIV stigma often plays a role in new transmissions. Take for example, a man who doesn’t know he is HIV-infected (with a spiked viral load) and declines free HIV-testing services due to perceived stigma of HIV. Also take for example, the awkward young man who just got invited back to a hot guy’s place for sex, but feels that a discussion about HIV status and condoms will kill the mood. Take for example, the man who decides to utilize Truvada PrEP (pre-exposure prophylaxis) in order to prevent HIV infection, but is “slut-shamed” by both HIV negative men and men living with HIV. 

What we've done in the past to prevent HIV simply isn’t working anymore. Public health has to evolve with the changing social landscape. PrEP is a great tool to address the reality of the world we live in today.

What is it about PrEP that makes HIV-negative men so uncomfortable? 

Is it that they think PrEPsters are a bunch of rich, sex-crazed SF dudes who go wild at our private sex parties? Is it that they think we take anonymous dick at Steamworks, and then use PrEP as a morning-after-pill? Is it that they think we’re a bunch of disease-ridden, Typhoid Marys who take load after load from poz dudes? I don’t know the exact reason; maybe they’re just jealous that we’re having all the fun! I’ve heard all their anti-PrEP justifications: “it doesn’t protect against sexually transmitted infections” (which are totally treatable/manageable BTW), “it’s expensive” (it can be free if you try hard enough), “it will turn you into a slut” (most clinical studies have shown PrEPsters actually reduce their number of sex partners after starting  PrEP), that “it’s not effective” (daily Truvada adherence yields a 99% reduction of risk… safer than  condoms), and that Truvada has nasty side-effects (most people don’t have side-effects, it is very easy on the body). 

For those reasons I say, perhaps Truvada is not right for you! But it is right for me and many other people. I would much rather remain HIV negative and take Truvada in my “whorish” 20s and 30s, than be HIV+ and have to take medications for the rest of my life.

What is it about PrEP that makes HIV-positive men so uncomfortable? 

They love telling me how their anti-retroviral medications make them feel so terrible and that they wish they didn’t have to take them. I can empathize with the fact that you feel that way, but I have not been living with HIV for 20 years, so we definitely cannot compare our current states of health. Truvada is a very well-tolerated drug. It is a medication that has been used as part of combination therapy to treat HIV-positive people since 2004. 

And then they ask me, why don’t you just use a condom? 

Well, I do most of the time, but sometimes things happen, sometimes condoms break, sometimes it slips off, and no one knows until it’s over… there are so many variables that can contribute to HIV transmission. Why would you discourage me from wanting to do something to keep me HIV negative? Wouldn’t you do the same thing if you were in my situation?

Instead of stigmatizing people who decide PrEP is right for them, we should affirm and empower them for taking initiative and personal responsibility for their own health. Positive messaging is what we need. After

I started PrEP 16 or 17 months ago, things changed dramatically for the better. I felt comfortable with
the sex I was having, I felt more confident negotiating sexual encounters, and I generally felt better about my life. I don’t know who I would be today if I hadn’t started PrEP back then. 

In order to create a better sense of community and belonging, I’m pushing for the re-appropriation of the term “Truvada Whore.” “Queer” used to be an insult? We happily took that word back, and it subsequently lost its power as a derogatory word. David Duran wrote a piece entitled "Truvada Whores" for the Huffington Post back in November 2012. In it he coined the term "Truvada Whore" and stigmatized PrEPsters. After learning more about PrEP, he changed his views, and  is currently a PrEP ally. And he’s a super cool dude. Read his latest HuffPo piece "An Evolved Opinion on Truvada."

Are you a “Truvada Whore” or an ally? Help me take the word back, wear it as a scarlet letter, be loud and proud. Follow me on Twitter, @pupbones. Search social media for #TruvadaWhore. Buy a #TruvadaWhore t-shirt and support AIDS/LifeCycle 2014. 

I’m tired of standing back and letting the world fall into complacency.

I’m ready to make a difference. I am a “Truvada Whore.”

EDITOR NOTE: Check out the new TruvadaWhore.com for links to helpful info on PrEP.  It is just a simple page at the moment, but the hope is to make it a bit more visual and fun. The domain name was purchased by an advocate early in the year, and when he found out about @pupbones and his fabulous  #TruvadaWhore campaign, it inspired him to get something online - yesterday! Stay tuned...

Buckle Up - Getting PrEP A Very Bumpy Ride

I got the impression that they thought I was just some gay pig bottom whore that wanted to party on the weekends.

Getting PrEP has not been easy for S. Among other challenges, he has faced grossly misinformed providers.

[Editor's note: S's experience illustrates, among other things,  the lack of knowledge about PrEP amongst a number of healthcare providers. He was told inaccurate information in a number of cases. We have highlighted in red the instances where providers gave incorrect or inaccurate information and provide a few editorial comments. After you read his story, check out this video that busts three common PrEP myths. And prepare yourself if you are interested in getting PrEP for yourself. Your doctor may need some education. Here is a handy brochure from CDC that can help you get ready for a PrEP visit to your doctor. Download and print or have it ready on your phone when you go. Do not assume your providers will know about PrEP. It is better to actually assume they know nothing. We are happy to help troubleshoot with you. Just email us.]

My journey to get PrEP started in June of 2013. Before that time, I had not even heard of PrEP.

 by S.

I was at a conference, and one of the speakers was giving a presentation on PrEP and TasP (treatment as prevention). Both of these were unknown to me, although I was aware of PEP (post-exposure prophylaxis).

At that time, I did not think Truvada was a viable option for me due to cost. But the seed had been planted.

In January of 2014, I read several articles praising PrEP from sources like Slate and Huffington Post. I started to do some research on my own, and decided to investigate this option further. I took two initial steps.

First, I contacted my insurance company to find out if my student health insurance would cover Truvada. It took several weeks, but they finally said it would be covered, but that I might need an authorization.

Second, I scheduled an appointment with my doctor on campus. Due to my student health insurance,

I need to visit the campus health center to be covered. My doctor was very friendly, and open to the idea, but was not familiar with PrEP. She agreed to allow me to get the kidney, liver, and HIV test I would need before starting Truvada, and said she would research PrEP and talk with the other doctors at the health center.

My test results came back, and I was HIV- and had healthy kidney and liver functions. Meeting with the doctor, however, did not go so well. She informed me that neither she, nor any of the other doctors on campus, felt comfortable prescribing this medication for the purpose I intended. She did refer me to an infectious disease specialist though.

It took a week to get the appointment, and the appointment was for six weeks later. So I was back to waiting.

Finally, the day of the appointment arrived. I was meeting with the Director of the Division of Infectious Disease for the state I live in. I waited 45 minutes to go back, and then, after meeting with the nurse, a resident came in. She verified that I wanted PrEP, and then started asking me questions.

"Do you have sex with men, women, or both?" she asked in a staccato manner. "Men" I replied.

 

"Do you have anal or oral sex, or both?" "Both" I replied.

 

"Umm .. do ... " "I'm the receptive partner" I answered for her.

 

"So your partner is HIV+?" "No" I replied. "I don't have a steady partner."

 

At this point, she put her pen down and stated "We don't prescribe this to people like you." [Ed: She is totally wrong. You do not need to have a steady partner, HIV+ or otherwise, to be prescribed PrEP.] 

 

Huh. Two months of waiting, and a flat-out no. I asked her "Just like that? No?"

 

 She said that her boss would come in and I could talk to him, but that they don't prescribe PrEP for people like me. And she left to get her boss, who is the Director of Infectious Diseases.


I was blown away. First, someone who I can only imagine deals with gay men on a routine basis, and she can't even get the words out to ask the questions she needs to know. Second, what the fuck did she mean by people like me? Men who have sex with men? Someone who is not fortunate enough to have found a partner to share their life with? Someone who wants to protect them self? I felt like she had already labeled me as "whore" and as far a she was concerned, the appointment was over.

Well, the head doctor came in. He went through a lengthy spiel that PrEP is not a solution, only condom use 100% of the time is effective, there are side effects, and that the studies were not done with people in my situation, but rather with monogamous couples where one partner was positive, the other negative, and the HIV+ partner did not have a drug-resistant strain of HIV. [Ed: The doctor seems to be confused with studies regarding the use of treatment as prevention which showed that HIV-positive people on treatment  with undetectable viral loads, and HIV-negative partners, were very unlikely to pass on HIV. PrEP studies have been completed with thousands of HIV-negative gay men, heterosexuals, and injection drug users. Some of these people in the studies had partners, some had POZ partners, but plenty were single.]

 He said that they tried some trials with male and female prostitutes [Ed: This is misleading. The trials certainly included men and women who were sex workers, but there was no trial that only recruited sex workers], but then literally shrugged that off. I don't know if he was referring to me as a prostitute or not. He said that taking Truvada as PrEP would actually put me at a higher risk of getting infected with a drug-resistant strain of HIV and that I would be screwed then. [Ed: The data does not back up this assertion.]

Also, this was a daily medication, not something I could take on the weekend and go out partying. That I wouldn't be protected from other STD's, that there were terrible side effects [Ed: In fact, most people taking Truvada as PrEP have no side effects, and a small percentage have minimal], that they don't know the long-term results [Ed. It is true we don't have long term data on Truvada use among HIV-negative people, but we have more than a decade of data with HIV-positive people using this drug for treatment, and it is considered quite safe], and so on. Everything except being at a higher risk for contracting a drug-resistant strain of HIV was already known to me. I had been researching PrEP quite extensively.

Later that day, I got very angry when I considered my appointment. Never once did either doctor ask WHY I don't use condoms 100% of the time.  Perhaps if they understood me or my situation, they might have been more caring.

My experience has been this:

- I've had two boyfriends in monogamous relationships where we had both been tested and decided not to use condoms. Both of them cheated on me.

- I've had condoms break during sex.

- I've had tops sneak the condoms off during sex. (Sorry, but when your'e ass-up, face-down on a bed enjoying the sex, you can't see when they slip the condom off.)

- Condoms typically irritate my skin.

- I've been the victim of an act of sexual violence, and the perpetrator did not use a condom.

 

Taking all of these together, I need to do something to protect myself and not have to rely on the top to do what he says to protect me.

But the doctors didn't care about that. I got the impression that they thought I was just some gay pig bottom whore that wanted to party on the weekends.

But, after all of this, the doctor did consent to writing me a prescription for Truvada. As he left, he said that this particular medication was usually tolerated very well. (So much for the part of his spiel going on about the terrible side effects.) Curiously enough, they didn't require an HIV test since I had just had one - two months ago. [Ed: This is problematic. The doctor prescribing PrEP should have done an HIV test. A confirmed HIV-negative test is absolutely necessary to start on PrEP. And people on PrEP need to get re-tested for HIV four times a year.]  (I did get one done by my regular doctor though, for my own peace of mind. It came back negative.)

The adherence nurse came in, and this is when I found out that I was the first person that has been prescribed Truvada as PrEP there. I live in a large town of 130,000 in the south. This just astounded me. I never thought I would be the only one or the first one.

But I had my prescription and I went to the pharmacy that the adherence nurse recommended. Then came the biggest surprise. My insurance did indeed cover Truvada, but the co-pay was $371. That is more than I pay for rent. That is more than a car payment. That was more money than I had. And I was devastated.

I called the adherence nurse, and I found out the second problem. Their office had lots of programs to help cover the costs of medications, but they were all for people who are HIV+, and I am not. She would look into it for me, she said. I told her that I would contact my insurance company and look at things on my end. But I really expected that PrEP was no longer a viable option for me.

I found some interesting things out, though. If I filled my prescription on campus, it would be at least $130 cheaper. When I went to retrieve the prescription from the first pharmacy, the pharmacist there gave me the number for a program that would cover $200 a month of my copay. I called, and was immediately enrolled.

PrEP was starting to look feasible again.

Then another hiccup. The campus pharmacy didn't carry Truvada. They would have to order it. And until they ordered it, they couldn't tell me what the cost would be. So I had to wait at least another day. Of course, after two months, what is another day or two.

After even more waiting, the campus pharmacy (which was suppose to save me money) was more expensive than the first pharmacy. I had decided that the $71 a month was a cost I could live with. I called the adherence nurse back to see if there were other options, but she was out for a four day weekend. I decided to just pay for it, and I started taking the pill today.

We will see what the next few days, weeks, and months hold for me.

[VIDEO] Busting 3 PrEP Myths

Our friends at San Francisco AIDS Foundation and their BETA Blog partnered with Youreka Science on this fantastic, short video which provides great info on PrEP and busts 3 myths at the same time.



Myths busted:

1. PrEP doesn't work - busted.
2. PrEP causes bad side effects - busted.
3. PrEP is impossible to get - busted.

Watch! And look to the right for links to more info, resources.
 

[PRESO] PrEP Community Opportunities and Challenges

Last week, My PrEP Experience's Jim Pickett spoke at the PrEP Forum in San Francisco, with University of California San Francisco and other partners. His focus was on some of the opportunities and challenges associated with PrEP that communities, particularly gay men in the United States, are dealing with.

Take a look.

PrEP Community Opportunities and Challenges from Jim Pickett

If you would like to check out some slides that have more complete information on PrEP - how it works, side effects, adherence, what it doesn't do, how to get it, etc - check out slides from our Project Ready, Set, PrEP! training here.

Any questions about PrEP, feel free to email us.
 

[VIDEO] PrEParing for HIV

Despite really herculean efforts with condoms and condom education, we still have a stable rate of HIV infections in the United States every year, according to the CDC approximately 50,000 new infections annually... Clearly, we need something more, and it was out of that realization that PrEP was born...

 

This (12 minute) educational video takes a look at PrEP, a prevention strategy for people at high risk for contracting HIV. Researchers at the University of California explain how pre-exposure prophylaxis (PrEP) works as they describe a four-year, multi-pronged demonstration project with gay men in Los Angeles and San Diego.

 

"It's like a monkey wrench that gets thrown into the gears that is HIV, and prevents HIV from reproducing itself in a person's cells." 

Participants agree to take a Truvada pill daily to reduce their risk of getting infected by up to 99%. But will they follow through?

Methods to increase adherence among the participants are being tested, including daily reminders via text messages and tracking usage of the medication with special "Mems caps" for the pill bottles.

 

Watch below. Learn more here. 

 

PrEP provides peace of mind and relief... and I don't want to be on it forever

by J.

 

 Like most people I have talked to on PrEP my sexual habits haven’t really changed. 
I’m still a hopeless romantic looking for the right guy, sometimes in the wrong places.
I’m still not perfect with condoms, but I also have
confidence that I am still protected. 

   

Growing up in the 80’s and 90’s HIV/AIDS was everywhere.  The news consisted of periodic death updates just like during the Iraq war.  Because I have always been a person who devours any type of knowledge I knew all about the disease but didn’t think about it in relation to myself.  Health class told me more, but I didn’t really pay attention because it was the standard fear mongering talk which said any sex was going to kill me. 

 

It didn’t hit home until my junior year sociology class where my teacher brought in a speaker who had AIDS.  He talked about the treatment he endured at the time including things like injections in his eyes to try and stave off blindness.  For the first time I with my eyes what the disease could do, and for a guy questioning his sexuality it was shocking.

 

 

After I came out sex for me was always varied, top, bottom, oral, it didn’t matter I loved it all.  Like most men I can’t say that I was always safe.

Despite the vision of the man in my soc class, and my better judgment, a hot man could still make me
do dumb things.  Soon I met the first guy I dated who was HIV+.  We usually used condoms, but when he told me not to put the condom on as he laid on my living room floor I complied.   Despite being educated I thought I was going to end up positive from that encounter.  I dated him for over two years before it ended.  It was only then that I had the courage to get tested. I had resigned myself that there was a good chance that I was positive from the occasional lack of protection, despite him being on treatment.  Again it was negative, but this time it had a lasting impact. 

From that moment I forward I always got tested 3-4x a year, but I still couldn’t say my practices were perfect, I am human.  As I grew up I gained knowledge, and wasn’t afraid to get tested anymore, yet it was always a nerve racking experience.  I still wasn’t perfect with protection, and I knew it wasn’t foolproof either.

The inevitable “promises to myself” would come on testing day that if “I’m just okay this time I won’t do that bad thing again”…

 

Bad boy!  This coming from an exceptionally rational person, it didn’t make sense even to myself.  Hoping and praying is not a substitute for real prevention based on science. 

HIV still one of those topics that people still talk about in hushed whispers saying things like “you’re clean right? okay, just don’t cum in me”  While recognizing the sheer idiocy of such flawed logic, I was not immune to this method of “prevention”.  The complete failure of this method of prevention hit home in 2012 when two good friends tested positive.  The emotional side of me was shocked, the logical side expected it.  Looking at the stats, I figured I was eventually going to be a statistic.

I don’t remember where I originally heard about PrEP, but what stood out more than anything was the figure 99%.  With that I devoured every article I could find on PrEP and Truvada.  I have a healthy skepticism about many articles about HIV treatment, prevention, cures etc.  You can only hear “a cure or vaccine is two years away” so many times before you become dismissive; yet in this case I was enthralled to find that PrEP was something that actually worked, and with that I knew it was for me.

I have always been open with my doctors because I figure there is no way they can help me if they don’t know the true story.   Because I was so honest the discussion was easy, I knew I was in a high risk group, and my doc agreed.  Within a week I had my prescription.  PrEP isn’t cheap, but luckily it’s covered by most insurance.  Also, Gilead the drugs manufacturer has an assistance program that covers much of the cost for many people. In my case it took a couple phone calls and faxed forms to make it cost me less than $20 a month.  Insurance or not, it is available. 

 

  

Before I started I was nervous about side effects.  Unlike many people I take very little medication, Aspirin for aches and pains, and Nyquil if I get sick is about as far as I usually go.  With that in mind I took my first pill on that warm July day in 2013.  After dating a few poz guys and reading up on the medications, I expected some side effects, but luckily for me I didn’t have any, even when first starting the medication. 

 

That first month I missed two doses. 

 

 

This annoyed me because I knew I needed to do this correctly for the protection I had wanted for so long.  That problem was solved with a $1 pill case.  A pill case would be my #1 recommendation for any “PrEPer.”  All you do look at the pill case and say, “Is the pill in there today?” take it, if not, you’re good.  I haven’t missed a dose since.

What PrEP has really allowed me is peace of mind and relief.  The testing anxiety that would come around every three months prior to PrEP is gone.  Before, I would get nervous even if I had done nothing dangerous. 

Like most people I have talked to on PrEP my sexual habits haven’t really changed.  I’m still a hopeless romantic looking for the right guy, sometimes in the wrong places.  I’m still not perfect with condoms, but I also have confidence that I am still protected.  Like myself when I was younger many people still don’t get tested enough.  It doesn’t matter how good the trade from the bar looks, if his test was a year ago, how can you be sure he’s negative?  Even if he’s not and you make a bad choice PrEP has got you. 

Now 8 months in, I can honestly say PrEP is one of the best things to happen to me.   I don’t want to be on it forever, but I REALLY don’t want to be on HIV medication the rest of my life for a disease that can kill. 

 

To me it’s one of the most important developments for gay men in the last 30 years.  We are no longer dependent on just condoms to prevent the disease that killed a generation of gay men.  I personally see it as the gay version of birth control.  Yes, you should still use other methods, but PrEP is there when you don’t.

 Three things have changed for me in the time since I have been on PrEP.  I am now much more comfortable talking about HIV, and prevention.  Coming from a person who used to work in prevention I always used to feel like a hypocrite because I didn’t use a condom every time yet that’s what I preached, PrEP empowered me to tell people to take a stand against HIV even if they forget the raincoat. 

Dating HIV+ guys has also become a non-issue, I had no problem with it before, but it was always on my mind.  With PrEP, I am more concerned about who is coming out for happy house. 

The third is that my wallet is lighter by $20 a month.  Even if it was $100 or more I would pay it.  Ask a senior, you can’t put a price on health, pay now or pay later.       
 
I’m open about being on PrEP with friends and acquaintances.  If they want to judge me, let them.  I would much rather let people know about something that can protect them against the cheating boyfriend, guy lying about his status, or person who never gets tested. 

There is no reason to be ashamed of protecting yourself.  HIV is still very much real, we can talk about it, and protect ourselves or we can ignore it, for me I will choose the 99% effective PrEP.   

 

I began taking Truvada on July 19, 2011, and haven’t missed a dose since

I learned as much as I possibly could, gathered up a stack of information, and decided this could be the right prevention strategy for me.

by Damon L. Jacobs
New York City

It was one thing to come out about my decision to take PrEP. After all, I have worked most of the past twenty years as a psychotherapist and safe sex educator in both New York City and San Francisco, and have discussed the complexities of condoms and risk-reduction with hundreds of individuals and couples, both HIV positive and negative.

But it wasn’t until I was sitting on the Huffington Post Live set with a surprisingly large camera pointed at my face that I began to panic: “Are you really going to talk about barebacking for the whole world to see? Do you really want everyone to ask if you’re taking loads from positive guys? Won’t this ruin your professional career and reputation?”

Believe me, I understand the importance of condoms.

My early education and training in Psychology took place in the California Bay Area during the early-mid 1990s. That was a time when loving people with HIV/AIDS meant losing people with HIV/AIDS. You would see friends, acquaintances, lovers...and then you wouldn’t. I was one of those volunteers that stood on the corner of Sanchez & Market giving out condoms, lube, and pins that said “100%.” The implication was that we could end HIV by 2000 if everyone used condoms “100%” of the time.

It was estimated then that half the men living in San Francisco carried HIV, so I had been prepared statistically to be fucked at some point by someone positive, knowingly or not. Instead of hiding from that reality, I learned the facts. Condoms, if used correctly, would protect me about 98% of the time. I was comfortable with a 2% margin of risk and set out to have a satisfying and healthy sex life.

Flash forward twenty years. In early 2011, I found myself newly single after the end of a six year relationship.

I was turning 40, and experiencing a loss of physical sensation down there, both as a top and a bottom. I was also finding that, unlike the 1990s, new partners didn’t want to use condoms. And to be honest, I didn’t want them to use condoms either! I found myself having more and more slips and near-misses, where condoms were only partially being used. I was, to put it clinically, becoming “very high risk.”

By happenstance I went to a forum at Gay Men’s Health Crisis where I learned about this new medication that could reduce one’s risk for becoming HIV positive by over 90%. There were some researchers from the iPrex study there, and some community leaders, but no one who actually had any experience taking this drug was on the panel.

I learned as much as I possibly could, gathered up a stack of information, and decided this could be the right prevention strategy for me.

I took this pile of data to my doctor, and we had a very frank and open discussion. We talked about my risk for HIV and my struggle to stay negative despite my recent behaviors. I explained that most people I knew who seroconverted had had a sense of fatalism involved, perceiving HIV as a “when” not an “if.” For the first time in my life I was beginning to experience that sense of HIV inevitability for myself, and it terrified me. With that information, my doctor determined it would be appropriate for me to begin using Truvada as an effective risk-reduction strategy. I began taking Truvada on July 19, 2011, and haven’t missed a dose since.

Since beginning the regimen, more information has been learned about its efficacy, and it is now believed that daily use (ie, seven days a week) of Truvada may reduce risk of HIV transmission by 99%. That is higher than condoms!

And now the question they didn’t ask on the Huffington Post: "Are you knowingly taking positive loads?"

To that I return to the world of statistics. Twenty years ago, I knew that condoms could reduce the likelihood of becoming HIV positive by 98%. Those were odds I was willing to gamble with. Today I know that daily use of Truvada may reduce my risk of becoming HIV positive by 99%. Furthermore, if my partner is able to maintain an undetectable viral load then his probability of transmitting HIV is reduced by 96% or more. Given the escalation of gun violence in the U.S., it seems I am statistically more likely to get shot right now than to get HIV.

So yes, I have had positive partners, and yes, we are making decisions that are based in health, safety, and pleasure.

That being said, I must urge anyone reading this to make sure you only begin using PrEP in tandem with a doctor. Truvada is not a casual drug, you cannot stop and start it at will without the possible consequence of your blood building resistance. Please only use this regimen after a doctor has drawn your blood, determined your HIV negative, and healthy enough to begin using this medication. If you don’t have a doctor with whom you can discuss getting fucked up the ass, then you have the wrong doctor.

Have I experienced backlash from using PrEP? You know it. The hostility from a prominent service organization has been appalling. The messages and comments left on websites where I have discussed PrEP have been degrading and insulting. Fortunately, I am trained as a psychotherapist to recognize angry fear-based thinking, which is a natural consequence of growing up and living in a homophobic culture.

Many gay men have internalized such a deep sense of shame and guilt related to sex and pleasure, that they can only react to the idea of “PrEP” with automatic and irrational attack.

At the same time, I can honestly say that the majority of feedback I’ve received has been supportive, appreciative, and quite curious.

How do you know if PrEP is right for you?  Ask yourself: If you were female, would you take a birth control pill to prevent unwanted pregnancy ? Both PrEP and birth control involve a daily and proactive commitment to maintaining one’s sexual and physical health. Both involve adherence and consistency in order to protect from an unwanted consequence And both involve potential stigma from angry and ignorant outsiders.

I encourage you to learn more and make decisions that are based in integrity, respect, and compassion for yourself and your partners.

I am open to answering any questions at Shouldless@gmail.com
Damon L. Jacobs is a Licensed Marriage Family Therapist in New York City, who specialized working with individuals and couples in the GLBT community. He has spent 16 years treating issues related to HIV/AIDS, stress management, bullying trauma, grief/loss, suicide management, care-taking fatigue, substance abuse, domestic violence, and anxiety disorders. He is the author of "Absolutely Should-less: The Secret To Living The Stress-Free Life You Deserve."

To learn more, contact Damon at Shouldless@gmail.com, or visit www.shouldless.com.

Interview Part 3: Toronto Health Promoter Chooses PrEP - "Maybe I should get a t-shirt made that says 'Truvada Whore' on it"

via Positive Lite (Canada)

Part 3 of an interview with Len Tooley, an HIV-negative gay guy who is taking pre-exposure prophylaxis. He works in Toronto as a gay men’s health promoter, HIV educator, tester and counsellor.

Excerpt:

I wish that I could be 100% certain that even if I used a condom every single time I had anal sex I wouldn’t get HIV. I also wish that condoms could be made out of a magical material that didn’t have any texture, scent, colour or substance – but I know that not all my wishes can come true!

But I’ve had to admit to myself that I’m not perfect at using condoms 100% of the time, and, because I’ve been working as an HIV tester and counsellor for so long, I know that a lot of gay men that I provide HIV testing to aren’t perfect either. And that’s not because we’re not trying, it’s because we’re not robots. I can also admit that condoms aren’t some invisible barrier that doesn’t impact the quality of my sex life at all. Condoms aren’t easy to use, and for me (but not for everyone), they make sex a lot more difficult. I wish it wasn’t so, but alas, it is.

Read the whole thing. You can catch the first and second segments of this interview at this link too.