Two Weeks Into Using PrEP

After I returned prematurely from Europe in early August (because I had been fired from my remote job), I inadvertently got involved in the “debate” surrounding the use of Truvada as Pre-exposure Prophylaxsis (PrEP). I put debate in scare quotes because those against PrEP don’t seem interested in having substantial debates. Name-calling is their primary tactic, and it’s helped create a lot of unnecessary animosity among gay, bisexual, and queer-identified men. But I got into the debate because I knew it was time for me to seriously consider whether I should use it for myself.

Before August, I had never really been a huge PrEP fan. Not necessarily because I didn’t think it was valuable prevention tool, but more because I was opposed to Gilead’s price gouging tactics, and the overall expense of this prevention tool when basic educational and testing services have been underfunded at local, state, and federal levels. Nevertheless, after meeting with my clinician at the now unblinded (and unsuccessful) HVTN 505 vaccine trial, she recommended I seriously consider PrEP and offered me a chance to connect with the S.H.I.N.E. Project, a NYC organization that offers free HIV/STI testing, sexual health counseling, and other services free of charge to uninsured LGBTQ individuals in the area.

A few weeks later, I went to the S.H.I.N.E. Project and had some serious discussions with them about using Truvada. I was worried about cost. Without insurance, and at the market rate, the drug costs about $1,200 a month. However, the program coordinator directed me to the link about Gilead’s patient assistance program, which ultimately allowed me to access the drug free of charge after filling out five pages of information and faxing over last year’s tax return. I also learned about HIV testing every three months, and bi-annual oral, rectal and blood testing for other STIs and kidney/liver functions.

During this process, I decided that Truvada was something I needed to do for myself. I was taking a drug that would lower my risk of getting HIV at the same time that I was receiving more thorough and regular sexual health care than most of the other guys I know. Because this was being offered to me at no cost, I recognized that there are a lot of support systems and programs out there that could make the most vulnerable populations have access to PrEP, and I could now be someone who could educate others in this process. With all these factors considered, it seemed like a win-win situation.

Within a week of submitting my patient assistance application, I received the drugs through the S.H.I.N.E Project. The first few days I experienced some mild fatigue and days three to five featured nausea and stomach pain/cramps, but since then, all of the symptoms have vanished, and taking the pill has turned into a routine. For those worried about side effects or taking the pill regularly, I’d recommend getting an app on your phone that sends a notification at the same time every day. I’ve found taking the pill in the evening, a little before bed, is the easiest. I haven’t missed a pill yet, even when I took a week long trip to Montreal.

PrEP has it challenges, and some of the long-term effects of the drug are not yet known, but I don’t think it’s fair to place blanket descriptions on those who use the drug. Some use it without intending to use condoms, yes, but others use it for added peace of mind, whether they always use condoms or use them a majority of the time. For me, two weeks into using PrEP, I feel some of the heaviness of stigma and fear over my sexual practices being lifted, which has allowed me to focus more on creating stronger sexual and romantic relationships. It’s also allowed me to direct on energy at empowering others to be more aware of their sexual habits.

PrEP is definitely not for everybody, but if you’ve thought at some point, “Maybe I should be on PrEP,” then it’s worth considering. I think that particularly for my generation, this younger generation that’s internalized the negative emotions and historical grief of HIV/AIDS, PrEP can make a huge everyday difference.  If you thought, like I once did, that cost is necessarily a barrier, know there are assistance programs and low-cost/free sexual health services that can make PrEP accessible. If you are worried about the long-term effects of the drug, talk to your doctors and read the CDC guidelines based on study results. If you are concerned about the political implications of Gilead and drug companies profiting from HIV/AIDS, reach out to me and we can chat.

But please don’t use name-calling tactics to denigrate others have chosen PrEP. Nobody benefits from this tactic, and HIV will only continue to spread the more we shame people into believing their bodies and sexual health ought to be silent.