John - "I feel more in control of my prophylactic decisions than I ever have before"

Not preaching or trying to convince anyone, just thought I'd share my PrEP story...

via John Sewell
Seattle, WA

I'm 46, which means I became a teenager the year we first got news of the "gay plague." I went to a military college, then spent 5 years in the Navy following that. I had a very few, discreet sexual encounters during those years, but mostly shied away because: 1) being gay was not socially acceptable, 2) I would have been kicked out of the Navy in disgrace if I had been called out, and 3) there was a mysterious killer affecting gay men with not much information about how it was transmitted or controlled.

Fast forward to 3 years ago.

I found myself head over heals in love with a man who was HIV+.

I had been infatuated with a few HIV+ men over the years, but had never before had to consciously decide if I wanted to be in an ongoing relationship with one. Love won out, and I made an agreement with myself that I'd be okay with a life of continued, consistent condom usage with this man. (I had been in the habit of regular condom usage until a monogamous partner and I had been together for six months, at which point I switched to condomless sex paired with continued regular testing.) At the time my boyfriend and I met, he was positive, but not yet on ART (as per CDC guidelines and his doctor's advice at the time.)

A year later, the CDC changed their recommendation on when to start ART. My boyfriend, on the advice of his doctor, started taking Atripla and, within 3 months, had an undetectable viral load. Once he reached that point, he and I stopped using condoms with each other. A year or so after that, I started on Truvada.

We are not monogamous, and I myself have enjoyed going to bath houses in the past and currently.

I get tested almost monthly as the result of a PrEP study and an HIV vaccine study I participate in. This winter, I tested positive for gonorrhea. This was the first time I'd ever tested positive for an STI. I was treated immediately and followed the advice of the STI clinic in regards to notification and temporary abstinence. Because I had discussed this possibility in advance with my partner and health care providers, it did not shock me or destroy my ego. I felt equanimity about it.

Where am I at mentally today?

I feel good about my choices regarding my sexual, mental and social health (if I can be so bold as to make those three categorizations). I feel more in control of my prophylactic decisions than I ever have before.

I think I've done a reasonable, informed job of preventing myself from becoming infected with HIV, but I'm also not afraid that my life will end if I do become infected. That's a welcome change! I would like to avoid other STI's, but I also understand that I should balance that with finding joy and pleasure in life, not hiding in the closet.

I'm sure not everyone would agree with my approach. I know there are both individual conscience and community responsibility angles to this discussion which are complex and sensitive. I'm happy with my current choices, and I continue to try to remain both well informed and open to modifying my strategy as we learn more about both HIV, other STIs and gay health in general.