PrEP

So I’m diving head first into a topic of news lately regarding PrEP. *This is a bit of a long post today so grab some caffeine*

If you aren’t familiar with the term PrEP, it stands for Pre-Exposure Prophylactic. ^[1]Not to be confused with PEP, Post Exposure Prophylactic. The same drug is used for both The drug Truvada has been on the market to treat HIV since the late 90’s. It was recently approved to help with the the prevention of HIV transmission for individuals that are HIV negative. This news has been received with some very mixed reviews from within the community and the fight over it rages on.

The disturbing part is not that the decision is contentious but that there have been attempts to silence or shame anyone who has embraced the option. I must say I don’t really understand the latter. Even worse, much of the criticisms are based on ignorance and baseless (so far) assumptions. I get the advice for caution and concern but the level of vitriol and condescending attacks is unnecessary and counter-productive. If you don’t understand something don’t ramble on about how awful it is because ‘you know someone will abuse it.’ As often turns out, you don’t know and that ignorance can cause real harm in this instance. You have zero right to demean anyone who would choose a path that may help prevent them from getting HIV, even if that path doesn’t line up with your personal preferences.

I blame some of it on our conditioning in Western culture to hate our bodies and/or any idea of sex outside of coupling. We are institutionalized from birth on 1man+1women=babies. Well, that social construct doesn’t apply so well for us same-sex lovin’ folks. And having moral apprehension to a method to prevent the transmission of HIV is perfectly fine for yourself. Sex is not dirty, wrong, or shameful. And this continual shame based approach to sexuality is reprehensible. Frankly, it should dispel any remaining allusions that we are in any way unique or more evolved than our straight brethren.

This particular argument isn’t about personal standards. It is about the prevention of HIV transmission. Infections are once again on the rise at an alarming rate. ^[2]Ironically, many don’t stigmatize the treatment of other STDs, like Gonorrhea or Syphilis, that used to be considered terminal. And while HIV may not be the death sentence it once was, it is still incurable. It is time to branch out and embrace more ways to combat the spread. The ‘you should use a condom’ argument has soundly failed, as evidenced by the continual rise in infections from a generation that missed the mass die-off in the beginning. And why we of all people continue to fall prey to this failed ideology escapes me. The ‘you should’ method has never worked. If it did, we wouldn’t have teen pregnancies, drunk drivers, continued HIV transmission, or even wars for that matter. You are right, people should use a condom. Many do but many more don’t. It is time to fight the transmission from a different angle and from as many angles as we possibly can.

There are some pros and cons to going on PrEP. It isn’t for everyone based on your risk-factors, health, eating/drinking habits, relationship status, etc. If you have questions or concerns, ignore all the hype and drama. Talk to your health care professional about it. At the end of the day, what I or anyone else thinks you should do is irrelevant. You should act to protect yourself and if this would help you, then you should consider it.

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For my own view, I support the approach to limit the spread based on sound statistical evidence. So far, the studies are showing that PrEP is truly effective in preventing the exposure and spread of infection.

One big argument I hear has been people will use condoms less. Statistically, so far that proves to be inaccurate. Two of the studies (which use blind testing – meaning you never know if you are getting the real drug or a placebo) showed that overall condom use did not decrease. But let us assume for a moment that people did. How many times have you trusted a complete stranger to be honest about their status? And how many times have you engaged in riskier sex based on that belief? The way I see it, we have several scenarios ^[3]excluding needle sharing where HIV transmission can occur:

Both partner’s know they are neg.
This is a fallacy. You should never assume someone who has sex with others besides you is neg. But let us assume for the moment, both partners think they are neg. You aren’t in a monogamous LTR and you engage in unprotected sex. Not being on PrEP means you are at the highest exposure rate for transmission. Being on PrEP would mean the ratio of transmission is reduced significantly (As much as 95% without a condom according to the efficacy rates of the studies so far).

One partner doesn’t know his status.
I would argue most of new transmissions via sex happen when one partner doesn’t know his status or assumes his status hasn’t changed. Again, if one of you are on PrEP, the exposure rate is reduced significantly.

Only one partner is neg.
Usually this means the poz partner is already on a drug regimen and undetectable. (You should still ask)  Plenty of sero-discordant couples already weren’t using condoms prior to PrEP. In an LTR or not, now the neg partner has an extra layer of protection and assurance he is not at risk. Not only does this reduce the transmission, it also de-stigmatizes the fear that comes from being with a poz person. Knowing you can be with a poz person and not put yourself at risk helps many who want to get past the mental mind-block, overcome their fear, and move forward.

Both partner’s know they are poz.
These are the least of your worries. These guys know their status and sero-sort on purpose. Primarily, to avoid the afore mentioned stigma that comes with being poz. I’d argue the only time this becomes an issue is when you get into assuming again. “We’re barebacking so he must be neg”, meanwhile, the other guy is thinking “We’re barebacking so he must be poz.” Never assume anyone is neg.

So which category do you fit in?

There are some cons and real concerns to consider. The biggest concern so far is the idea that guys will go on it inconsistently and cause resistance. Keep in mind resistance is only relevant if you sero-convert to being positive. Adherence to the daily regimen is key to the drugs efficacy. But think on this for a moment. The drug is already used for post exposure. Say you aren’t being very consistent with taking it daily. Then you have an exposure. How many of you reading this wouldn’t, out of that same fear, start taking it every day after an a possible exposure?

So far, the medical community is much more worried about resistance from folks that are using it as treatment, not preventative care. And let’s be real, people who spend the time, energy, and money to get on it as PrEP aren’t being cavalier. I’d argue they are doing just the opposite. It isn’t just a simple prescription. You have to visit your doc every 3 months, at least for the first year, for regular checkups and blood work. That decreases over time but you see my point. And when has a doc ever given you a prescription with an unlimited refill amount? See, when you think it thru you start unraveling some of the preconceived notions.

Another issue is cost. Fortunately, most large insurers already cover it so if you have insurance, chances are higher they do cover it vs not. I won’t even entertain the conspiracy theories I’m heard on this one.

And then we get to side-effects. The are some rare but sometimes very serious side-effects that can come from long term use of the drug. That again, is why you discuss it with your doctor and get regular blood work. Almost two decades of use show overall it is well tolerated by most. Even still, you are not given a prescription and never return. The hype over some of the more serious side-effects has been quite dazzling. I encourage you to go to WebMD.com and do a search for both Truvada and the little blue pill. ^[4]I don’t want to attract the bots so I’m not spelling it out. lolol No one is up in arms over the side-effects of the latter, which by definition aren’t much better. You can choose pretty much any drug site of choice to do a comparison.

In the end, you have to decide for yourself if this is right for you. If you are someone who uses a condom without fail (pun intended) then it may not be the choice for you. However, if you find that you aren’t 100% consistent and/or just want an extra layer of protection, then it might be for you. Talk to your doctor. Talk to others who are on it, regardless of their status. Decide for yourself if PrEP would be an additional way to combat the spread of HIV for YOU.

/rant