Are we PrEPared?

I am a single gay man living in San Francisco. I am a former bartender, now turned nurse. Recently PrEP, Pre-Exposure Prophylaxis has become widely available, and it seems to be hitting the gay community by force. For the last 6-12 months, it seems as if every man that I went on a date with or happened to hook up with was on it. Unfortunately, I found this out because many of them did not want to use a condom and used the line: “It’s ok I’m on PrEP.” This was quite disturbing to me because Truvada (the medication used to prevent the transmission of HIV) ONLY protects against HIV, nothing else. Now I am no angel—I’ve have had many unpleasant trips to the clinic with the clap and have had a previous partner inform me that I might have been exposed to syphilis…BUT it’s precisely those experiences that make me want to use a condom. HIV is at the top of my list of things I don’t want, but along with HIV, there is hepatitis C, herpes, and antibiotic-resistant gonorrhea, just to name a few. Having worked in sexual health clinics in the past, I am very aware of the long line of lovely parting gifts you can leave for you partner after the horizontal mambo has finished.

Last year I dated an HIV positive person, not for the first time, but more seriously than before. Previously, I was definitely guilty of serosorting because I rationalized (only internally) that if I were to find a life time partner, I would eventually want to take the condoms off. The fact that PrEP has been shown to be more effective than condoms alone makes this a possibility, particularly with a positive partner whose viral load is undetectable and the risk of transmission fairly low. This allowed me to consider the relationship in a very different light from before.

Obviously since I am now single, that relationship did not work out, but that experience in conjunction with the fact that it seemed every gay man I know was on it, got me to look into PrEP as an option for me. I found out my insurance covered it, and after a little research, I decided to go on it. I just wanted to have that extra insurance because shit happens—condoms break, people get drunk, or find that super hot guy but don’t have a condom and try to rationalize it in their head: “well just the tip...” I had no intention of running around the city (as I had seen many others on PrEP) bare backing dudes left and right…but things have a way of going differently than you expect them to.

Removing that boogie man that makes every fuck for a gay man into a threesome does change things, at least at first. I am definitely one to usually use a condom, particularly when I’m not in a monogamous relationship, but reducing the likelihood that I will seroconvert does make it all that more tempting to “slip up” in the condom department. At first I could not resist the urge to engage in some arguably higher-risk behaviors with people that I felt I could more or less trust whom I probably wouldn’t have had I not been taking “the pill.” However, after a couple of STI scares, that quickly changed.

The attitudes of people that I do hook up with also seem to have changed since I started the program. Others seem to feel like since I am on PrEP, that it’s now fine to stop using protection. In one case, I was hooking up with someone I had hooked up with before. He’s positive, and the previous times we had hooked up, we had used condoms (and lots of them). This particular time when things were getting hot and heavy, I reached to my bedside table and handed him lube and a condom and turned back around. I heard that familiar crinkle of the condom wrapper and then he was inside me. After a couple minutes, I wanted to change positions and when I reached back, I realized he had not put the condom on. I asked where it was, and he pointed to the unopened wrapper next to me. In astonishment, I asked what he was thinking. He replied that since I was taking Truvada, that it was okay. Aside from the violation of trust, I was shocked at his attitude because he was in an open relationship and aside from my health, he was jeopardizing his boyfriend’s as well.

While that account is anecdotal at best, it does speak to the fact that because of PrEP, certain people are taking more risks because they think that the boogie man of HIV has been banished by a pill. The fact is that PrEP is not 100% and in order for it to be effective to its full ability, it needs to be taken everyday around the same time. To trust that the other person is doing this is quite a gamble, particularly if it is a new relationship or a causal hook up. This being said, I am a huge supporter of PrEP for people who are likely to be having sex with multiple partners, particularly if their partners are men who have sex with men (admitted or not) or IV drug users. If this slows the rate of HIV infections in any way, then in my mind, it is a success from a public health stand point and lessons financial burden on our already screwed up healthcare system. The worry that other sexually transmitted diseases will be on the rise is a concern, but I feel that after people start realizing that just because other STI’s aren’t seen in the same light as HIV/AIDS, this does not mean they shouldn’t be protecting their health as best they can.

- Anonymous- Drag queen / RN nurse

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