"I have a responsibility to volunteer in the Next-PrEP study"

My support for PrEP up until now has been solely offered sitting at this keyboard.

Now, it's time to step back into the street one more time.

 by Daniel MacDonald


I knew I was gay since I was 13.

This was back in 1977, so being gay wasn't as socially acceptable then as it is now, but I didn't care even then. I liked guys, that was that, and I didn’t care who knew it. When you knew someone who was gay, well, “gay” was always said in a hushed whisper. I lost my virginity that year to a much older man I would spend the next nine years with. The sex was a fantastic event with him every single time, and being a healthy teenager, my sex drive was nonstop. We would spend the day shagging like dogs, and because we were in an open relationship we would invite others to come join us for the naked festivities.

Things would take a dramatic turn when a scary illness and rare cancer began to show it's face before I hit 25 years old. The flow of information stunk at that time, and there was far more misinformation than actual fact being shared, and it would quite a while before the disease had a name (and we all thought it sucked back then, too.) Great. Now anyone in the family who didn't care for my being a big ol' homosexual now had ammunition. If you don't settle down and get a girlfriend you're gonna get that gay plague and die. It'll be God's punishment for what you're doing.

Please. I tried girls, and the only way I enjoyed them was if they brought their boyfriends along for the fun and we had a bisexual romp. I’ve given more than one curious couple a night to remember for both of them. Told you: I'm a total horndog.

The name of the gay plague changed to something a bit more acceptable, but it was no less scary. My friends were dying, nobody was helping us at any level, and the only protection we had at our disposal if we didn't want to become HIV positive was to wear a condom. Now, let me tell you a bit more about me: I'm a big guy. When I finally stopped growing, I landed on 6 foot 6 inches. Nature also blessed me with a nice set of muscles on this gargantuan frame, and an appropriately sized cock - a true 10 inches and 7 around. That made me the most popular guy at the dance - a fact that I used to my advantage in my personal sex life, as well as rounding up tricks I "escorted" and a brief career in porn. All the sex I want? For money? And how many people will be watching? Well, sure – what the hell. Count me in. My most memorable scenes are probably in that box in your attic.

Finding a condom that I could actually get on was a ridiculous lesson in futility. When I could find one that had possibilities, it felt like my cock was being mugged.

Need a picture? Think of stuffing five pounds of sausage in a three-pound casing. I got them on - barely. They were painful, hard to roll down, and slid off while I was fucking. So the fear of HIV dictated a very uncomfortable, unsatisfying sex life for years. And because I couldn’t get a condom to fit me, I went from being versatile to total bottom. Sex was losing that wonderful fascination and becoming more of a scary chore than anything, and I funneled all that pent up sexual energy into HIV/AIDS advocacy; a passion that's followed me to this day. If there was a demonstration, speech or action taking place that I could get to, I was going to be there. I'd watched too many of my friends die, and too many senseless seroconversions involving people who didn't know all the facts about HIV.

Flash forward a few years to the mid-1990s. The man who took my virginity is out of the picture and now I'm with a wonderful man who I love intently. He's HIV positive--a fact I knew about him before I could spell his last name. And I'm HIV negative.

Together we had to find ways of discovering a satisfying sex life without my seroconverting. The meds of the day weren't what they are now, and I knew from my boyfriend’s complete transparency around his HIV status that he was sporting a big viral load. The word “undetectable” in regard to his HIV didn’t come up much those days. While there was no reason for us not to have sex, it came with a lot of caveats. We tried mutual masturbation. We tried me on top wearing a rubber. We tried him on top, wearing a rubber, which totally killed it for him.

Could you stay in the saddle with the question of "what if the condom breaks?" lurking in the back of your head? He couldn't either; especially on the day it did break.

He pulled out, and as was his habit he’d inspect the condom and damned if it didn’t happen. We spent the next few days waiting for my HIV test results and my boyfriend was in a morbid funk, and understandably so. He was overwrought with guilt at the prospect of my contracting HIV from him, and I had resigned myself to getting my results and hearing that I was positive. It was nobody’s “fault” and if it happened, it happened; so be it. The test came back negative; as did all the other subsequent tests I took afterward as a safeguard. During every single wait period for results, my heart broke for my boyfriend and the self-imposed guilt he was swimming in. Finally, we tried him watching while I fucked with other negative guys, which was probably the worst, most alienating idea of them all. His participation in those romps wasn’t nearly what it needed to be, and it wasn’t satisfying for either of us.

You get the idea? We loved each other but our sex life at the start left a lot to be desired
These days, meds are better if you're HIV positive, and condoms come in more varieties. And I'll tell you a secret: I don't always use them. I know that’s blasphemy for me to say as an HIV/AIDS advocate but there it is. Sometimes the waves of testosterone come crashing ashore, and common sense goes out with the tide. I still have some issues finding ones that will fit, and female condoms aren't as universally accessible as I'd like. I have no problems negotiating whether or not we use them when the time comes. If I'm with someone who says they're negative I expect them to prove it; I'm not naive enough to take someone at their word. It takes more than a guy giving me a hardon before the gloves come off - if you get the drift.

Enter PrEP.

What an out of the box thought, right?

 Lots of people aren't using condoms, and these medications - if taken as they're supposed to - have the potential to dramatically decrease the possibility of becoming HIV positive.

According to some studies, PrEP can be 94% effective--which makes it more effective than condoms. Now, imagine the efficiency in preventing HIV if someone is on a PrEP regimen and using condoms. I've read all the studies and I know that number is constantly in dispute depending on whom you talk to.

So I've signed up for the Next-PrEP study and I’ve been accepted. For the next year, I will be taking a combination of three pills but will have no idea which particular arm of the study I’ll be in, so there is a minimum of one placebo and a maximum of two active drugs as part of my daily routine.

I met with the study directors from day one, and every one of them has been wonderful. The flow of information is amazing; they really leave no question unanswered. I was given a full-on explanation on everything from how HIV works, to what medication is designed to do what, to a soup to nuts explanation of the study’s goals and my role in helping get their data to the finish line.

Will there be side effects? There just might, and I was given a ton of documentation on what I might have to work through. But that's not too much of a concern as they usually pass over time as you continue to take the meds. There are layers upon layers of people and boards monitoring the safety of all participants, so I know I won’t be thrown in the deep end all on my own, or that I won’t have any safety net if I do have something go awry while I’m participating in the study. There are also regularly scheduled doctor visits and tests that will keep an eye me at all times. All of the people I've met in this trial couldn't have been more friendly and helpful.

And my sex life during the study? I’m not expected to do anything different – so keep on, keepin’ on. Which means, well, usually busy. (I’m still that horndog that I was when I was a kid.)

I know these pills aren't going to make me 100% bulletproof against HIV--nothing short of complete celibacy will do that. But consider this: the HIV prevention message of "always use a condom" is over 30 years old. It’s the safe sex equivalent of a warning on a pack of cigarettes. Everyone knows the message is there, they know what it’s saying. They know if they don’t follow the directions, something bad will happen, but they will still buy a pack of smokes if they want one. Or they’ll have bareback sex knowing full well they might regret it when it’s time to get their next HIV test results – if in fact they are even testing. I can’t count the number of times I’ve been chatting openly with people about HIV and testing and I see that hang-dog expression on their face when they tell me that they haven’t tested in a long time - or at all. Or they can’t remember their last test.

People change, lifestyles have changed and there's a new generation coming up that hears the message of safe sex without the urgency that I did when I was their age.

My son, who's also gay, has been sexually active since he was 15. Up until the time I adopted him, he thought of HIV as a mythical beast that wasn’t a threat to his existence. He’d never heard of Hepatitis B or C, and didn’t know much about STD’s. As a father, the possibility of medications being readily available for him as an effective prevention measure against HIV is something I find very exciting and promising. And you better believe he knows how to put on a condom now, as well as where to find them free all over the city (if he’s not raiding my stash).

The very definition of safe sex is changing, and it needs to.

Gay men aren't using condoms, and it's not about finding a new message to make their importance more prevalent. My son had been having a rowdy sex life a year before I adopted him, and he had no clue how to put a condom on. The message needs to be changed to convey that, while condoms can be effective, there's another way to ensure your protection. There are those in power who preach that a pharmacological solution to HIV is a disaster and will try to make you believe that everyone who's got access to PrEP will toss their condoms away for good. They'll try to tell you that Truvada and PrEP is a magical pill solution that does nothing more than give up on gay men. I've written page after page making sure you don't buy their half-baked cake.

Consider this: I've had a very active sex life for the last 36 years, and I'm not even 50. I've been a male prostitute, gay porn performer, live sex performer, and I'm still an HIV/AIDS advocate. There's been tons of great sex in my life, and there's probably a ton more before I hang it up for good (hopefully when I'm in my 90's). There is also no logical reason why I'm still HIV negative. I have no explanation on why I've never contracted a single STD. I also know I'm not bulletproof either, buster. More than three decades after I watched my first friend die from AIDS, we still don't have a cure.

To me, I have a responsibility to volunteer in Next PrEP, even though I’m going to be one person among many who have stepped up for this trial. I need to be there, as a gay man, a father, an HIV/AIDS advocate, and as a journalist who’s got an active, fulfilling sex life.

My support for PrEP up until now has been solely offered sitting at this keyboard.

Now, it's time to step back into the street one more time.