So my friend calls me up on a random Sunday afternoon and his tone tells me this is more than a social check-in. I immediately go in for the meat of the issue: "What's wrong babe? Let it out."
"Oh my god, ok, listen, don't laugh at me but yesterday I broke out into a rash on my arms and legs, which honestly happens from time to time but usually goes away quickly, but today I woke up and it spread all over my body and even a little on my face."
"And yeah, well, about 2.5 weeks ago I hooked up with a fuck buddy of mine and we...."
"Dude, you are not having a rash outbreak from contracting HIV."
"Well, yeah, ok, but seriously, it's really freaking me out and I don't know why I have this rash and we didn't use a condom for like one minute and..."
"Seriously, immediately stop believing it's even within the scope of possibility that you got a rash from contracting HIV two weeks ago. Seroconverting isn't so fucking aggressive that you would have such severe symptoms after only two weeks. Seriously, take my word for it, stop freaking yourself out."
"I know, I know, but it's possible and..."
Sigh. The decades of fear and depravation and guilt that many of us have experienced in our lives have really taken a toll on our sexual psyche.
So yeah, you know about PrEP (Pre-Exposure Prophylaxis) yet? Here's a headline: "PrEP has been seen to be about 99% effective of preventing the transmission of HIV when taken as prescribed.
Ok, so now that's I've successfully passed the buck on all that, what else is there? Just my experience, no holds barred, no PC-word-policing, completely honest and unfiltered for your consideration.
How'd I hear about PrEP?
I was first introduced to the drug by some friends/sluts in San Francisco, where many major studies had been hosted long before the drug was endorsed by the FDA. One friend in particular told me that he had participated in various studies, and while on PrEP, had taken loads from undetectable poz dudes and was still negative. "Whaaaat?!? Are you crazy??," I thought. I'm leaving out a lot of context here, like how this friend is so amazing at hosting dialogue before jumping into bed, and how since this conversation happened it has been confirmed by the CDC that it's virtually impossible for an undetectable person to transmit the disease, but that's not really the point. It's that funny thing where you need to witness someone else survive your biggest fear in order to overcome it yourself. You want it to be true, and the best case in proving it is to hear someone has tested it in a way like that.
How'd I get on PrEP?
I've been on PrEP for about 3 years. I'd had poz sex partners before and didn't really have any qualms with it, but we definitely always used condoms. Then I started dating a poz guy. I reeeeeally wanted to shoot my load in him reeeeal bad, but alas, I think he was more worried about giving me HIV than I was. One night he shot his load all over my face (hot!) and some got in my eye (“it buuurrrrrnnnssss!”). We initially didn't think anything of it, but the next day I brought it up.
"Do you think I have anything to worry about from having your cum in my eye?"
"I was kinda wondering the same thing."
To make a long story short, my amazingly sex-positive doctor told me the likelihood of transmission was extremely low, like a percentage-of-a-percentage low. But still, better safe than sorry, so I went on a post-exposure regimen that included Truvada (a.k.a. the amazing blue PrEP pill). I talked to my doctor at the end of that cycle and discussed the pros and cons of PrEP. We agreed I was the ideal candidate to be on the drug, so I have been on it ever sense.
What about side effects?
I have never experienced any noticeable side effects from being on PrEP. The most common side effects you hear about are nausea and diarrhea, but when I say common, they don’t appear to be wildly frequent, meaning, most people I have spoken to on the topic have not experienced side effects at all. That isn't to say people don’t have them. One friend was on the drug for less than a month and couldn't stand the nausea, so he quit taking it. Six months later he tried going on the drug again and had zero side effects. Some people I've spoken to changed the time of day that they take their pill, which helped with any side effects they were experiencing.
Oh, and yes, you have to have lab work done roughly every 3 months to make sure your liver and kidneys are OK. I personally haven't met or heard of anyone who has had liver/kidney complications because of PrEP, and because you are tested regularly, your labs would give notice looooong before any permanent harm could be at stake. My latest lab results, after being on the drug for 3 years, read, "labs look great."
Drugs are going to effect different people in different ways. It's up to you and your body whether PrEP is right for you. With that being said, one side effect that every single person I've ever known to be on PrEP has experienced is significantly decreased anxiety stemming from the fear of contracting HIV.
What about Condoms?
"All those Truvada whores are just looking for an excuse to bareback! PrEP is nothing but a party drug!" Such goes the outcry from the indignant masses who have been sold the propaganda that condoms are the only solution to decreasing HIV transmission, while at the same time wondering how HIV transmissions continue to rise.
My Opinion: Remove the bullshit politics. This is not an “Us vs. Them” situation. Both condoms and PrEP are part of an arsenal of personal options for deflecting HIV transmission, and it comes down to individual choice as to what behavior we think is best for ourselves. In making this choice there is no textbook answer for every individual, but the facts remain: PrEP alone is just as effective, if not more, at combatting HIV transmission as condoms.
Before I was on PrEP, I probably had a track record of using condoms 80% of the time. And every time I failed to meet that 100% standard I would lament and get depressed and scared. 90 Days later I would breathe that sigh of relief until I would slip up and start the cycle over again.
Today my track record is roughly 50% of the time and I've never felt more confident in my sexual health. Here’s the real difference: that 50% of condomless sex is comprised of undetectable poz guys and other guys who are also on PrEP. The chances of contracting HIV from those two groups of people, while being on PrEP myself, is virtually zero. I use condoms with dudes who prefer them (I would never try to coerce someone to do anything that makes them uncomfortable) and dudes who haven't a clue on their sexual health.
What about other STD's?
When I was a freshman in college, a kid in my dorm had his first hookup ever and had a herpes outbreak two weeks later. That guy from San Francisco who took poz loads during PrEP test studies that I talked about earlier? He had his first STD ever about a year ago, after 15+ years of being a sexually active hoebag. My point is that with the flutter of a butterfly's wings, any sexually active person can get a fucking STD at anytime. Yes, you can get gonorrhea, syphilis, chlamydia, and herpes just from a blow job, and I know y’all aren't using condoms for that.
I've had all the usual suspects at least once in the entirety of my sexually active life (about 15 years), but I haven't had an STD in the last two years. And I've been a total slut in that time, trust. PrEP isn't going to increase the risk of contracting an STD (studies thus far even prove as much).
Being uneducated, not being able to talk about sex with your partner, and not getting tested are the only things that will continue to increase the spread of STD's in the queer community. As it happens, people on PrEP tend to be very educated on their sexual health, and get tested on a regular basis because they have to in order to stay on the drug.
What about the costs?
PrEP is expensive and has a loooong way to go before it will be as readily accessible to the masses as it should be. Current estimates show that the drug costs roughly $1,500/month. Someone much smarter than myself provided this quote:
“Truvada as PrEP is covered by Medicaid in all 50 states. It is covered on all plans through ACA. If someone has NO insurance, then Gilead will pay for it. If someone needs help with co-pays, Gilead will pay $300 per month. If someone needs more help with co-pays, then the Patient Assistance Network (PAN) will help. And as of a few weeks ago, it looks like the White House will be eventually funding some type of Federal assistance program.”
As for me, my insurance plan covers all of it except for $80/month co-pay. And the aforementioned Gilead program covers that, so I literally pay nothing out of pocket to be on PrEP. You'll need to talk to your doctor, insurance provider, and local health clinics to figure out the most cost-efficient solution for you to get access. Many cities like San Francisco and Los Angeles are making it easier for anyone who wants access to get it regardless of income. Hopefully that trend continues and this drug becomes as accessible as condoms.
What about you?
I recently read an article from a local Atlanta sex columnist who spoke at length on why he doesn't take PrEP, and there seemed to be a lot of backlash from people on his point of view. Albeit the article coming off a bit self-righteous, I read it and thought, “Good for you man, I'm glad you aren't a high risk individual and don't need to take a daily pill to protect yourself. That's amazing for you.”
For those of us who aren't 100% adherent to using condoms, or want to confidently be in relationships with poz guys, or just have a ton of anxiety from the guilt that's been projected on us from the moment we realized that HIV awareness goes hand in hand with having a sexually active lifestyle, it feels amazing to know there is another option. So if you fall into that latter category, go to a local health clinic like Positive Impact or AID Atlanta, or talk to your doctor and learn all the facts. Be educated on all the pros and cons, and make the decision that is right for you.