Looking for PrEP: Part 4

By: Alex Aviance, Guest Blogger

Disclaimer: The views expressed by guest bloggers are solely theirs and do not necessarily reflect that of Dosti, Snehithan, Lassi, or any programs and services of ASAAP. 

The truth is my family doctor and I have a good relationship. She’s known me since I was at least 9-years-old and is privy to some of the most intimate and personal details of my life. She’s been given a front row seat to my sexual escapades and is somehow always surprised when I don’t gag when I get my throat swabbed.

Still it’s strange not to mention awkward to have this conversation because of the unspoken implication that once I’m on PrEP I’ll be the courtesy bottom at every circuit party from here to San Francisco. I had brought up the subject of PrEP on an unrelated visit before, and her response was sort of what I expected: I’d be better off consulting an infectious disease specialist. Education amongst doctors still seems to be a huge bump on the road to PrEP, but it wasn’t a “no” so much as it was a “go ask someone else.”

Let me contextualize a bit. My doctor’s office is out in Scarborough, located next to a Caribbean restaurant, in a shady strip mall. The nearest guy on Grindr is about 4.5 miles away, and when I made my appointment to see my doctor again I had to repeat to the receptionist that I needed a prescription for PrEP about 4 times and she still had no clue what I was talking about. The Gay Village this place isn’t. After being told I was now on a waitlist for 8 weeks this was unfortunately my best (and fastest) shot.

At our appointment despite going over it in my head how I thought the conversation would play out she threw a barrage of verbal curve balls I could only hem and haw my way through. Why was I having unprotected sex? Why was negotiating condom use so hard for me? Why didn’t I want to have safe sex? She wasn’t holding back, and the truth was I didn’t feel comfortable, nor was I sure I had the time to explain the various intricacies and nuances of the power dynamics between tops and bottoms in the age of Grindr through a lens I thought she might understand.

I didn’t have answers for all of her questions, but I knew why I wanted to be on PrEP. I want that added layer of protection. I’m working through my own stuff, I’m starting a new career, and I’m doing my best to navigate the queer dating world, but it’s not enough. I’ve had guys take the condom off without telling me, I’ve had condoms give out to the friction from an overly aggressive fuck, and if I’m being completely honest I’ve also been so caught up in the moment the condom never left the nightstand. These are the realities of my current sex life.

I do use condoms; I do everything they tell you on the posters in the clinics, but is sex ever “safe”? Anyone having safe sex is doing it wrong I’ve been told because sex is inherently messy and prone to unforeseen circumstances. Why is it that PrEP isn’t considered part of my safe sex strategy?

She seemed satisfied with my response, and expressed genuine concern for my well-being. I suddenly remembered I had printed the CDC guidelines for prescribing PrEP to bring with me. I would need some blood work to confirm that I was HIV negative and that I was otherwise healthy enough to take Truvada on a daily basis.

Thankfully that was exactly what she needed to see, and she agreed to write the prescription for me. I could have my little blue pill, but not without some parting words of warning: To seriously reflect on why I have a hard time negotiating condom use and to consider what it might mean to become and live in this world as an HIV positive gay man.

And I do, every single day.

 

Alex Aviance is a young, queer man who lives and blogs in Toronto, Ontario. His interests include theoretical physics, cooking, World of Warcraft, and Ru Paul’s Drag race. Alex currently holds a B.A. in Journalism from Ryerson University and has plans to return to school to study social work. He hopes to pursue a career working in the field of queer men’s sexual health. His idols include Naomi Campbell, Anna Nicole Smith and Tammy Faye Bakker. You can often find him consuming far too many carbohydrates, destroying the patriarchy, and very likely engaging in a Twitter war @AlexAviance. 

Looking for PrEP: Part 3

By: Alex Aviance, Guest Blogger

Disclaimer: The views expressed by guest bloggers are solely theirs and do not necessarily reflect that of Dosti, Snehithan, Lassi, or any programs and services of ASAAP. 

As much as it’s touted as an effective prevention strategy, actually getting your hands on that expensive, blue pill is a giant pain. I first heard about PrEP years ago while the first trials of it’s use as a preventative measure were underway. I had always considered taking it, but it seemed prohibitively expensive and was I even ready to divulge the most intimate details of my sex life in order to get it? In 2016 it’s no longer relegated to the pages of obscure medical journals. PrEP had become kind of a big deal – at least in the queer community – and perhaps all that momentum could propel me into actually getting it.

My story begins a while back. Through serendipity alone I saw an ad on the subway for a pharmacy that was connecting people to PrEP in the village. If there was ever a time to believe that the universe was sending me a message this was it. Hastily, I snapped a pic on my phone with the contact info on it while avoiding some shady glances from a guy nearby. His stare seemed to say “Oh, you’re interested in that.” Clearly, word is getting out about PrEP, and by association I’m already a Truvada whore regardless of whether or not I’ve swallowed the pills.

Later that week I was referred by the pharmacy to a nearby clinic so that I could meet with a doctor who knew how to prescribe PrEP only to be told there was an 8 week waiting list. I knew this wouldn’t be easy. Call me a masochist, but I enjoy the thrill of navigating bureaucracy and red tape so I was up for the challenge.

So how does one get PrEP anyway? There are a number of pretty large hurdles to clear. PrEP’s yearly cost is in the range of $12,000 – $15,000. For most of us that’s not an insignificant sum by any means. In fact, PrEP was only approved by Health Canada in February of this year. It’s up to the provinces at this point to decide if it’s worth making it widely accessible to at risk groups. For many economic, social, and political reasons I wouldn’t hold my breath on that decision. I’m lucky that my current insurance plan will cover the cost of the meds at all.

Secondly I need a doctor that:

A) knows what PrEP is and the associated protocols for prescribing it

B) believes I am “high risk” for contracting HIV, and is

C) sex positive, not homophobic, and won’t use their own prejudices as a reason to deny me

A doctor can refuse to give a prescription for any reason. For instance, if she is part of the camp that believes I will go straight from the pharmacy to the nearest bathhouse sling to become the power bottom I always dreamed I could be it will be entirely up to me to convince her otherwise.

It’s created a bit of an odd situation where I now have to simultaneously prove that I’m at an ongoing, high risk for contracting HIV, but not so much so that it paints me as a horny party boy with an unquenchable thirst for cock. At this point I’m no longer navigating logistical hurdles, but I actually have to change the way people think. And that may very well be my breaking point.

I’m originally from a “third-world” country, so healthcare was at times a bit of a luxury. I still have to regularly remind myself that coconut oil won’t in fact cure every disease known to man. But 8 weeks is an awfully long time to sit on my hands. It really shouldn’t be this hard to access something so important in HIV prevention. I understand the concerns, but do I really need this many gatekeepers to secure my own sexual health?

Alex Aviance is a young, queer man who lives and blogs in Toronto, Ontario. His interests include theoretical physics, cooking, World of Warcraft, and Ru Paul’s Drag race. Alex currently holds a B.A. in Journalism from Ryerson University and has plans to return to school to study social work. He hopes to pursue a career working in the field of queer men’s sexual health. His idols include Naomi Campbell, Anna Nicole Smith and Tammy Faye Bakker. You can often find him consuming far too many carbohydrates, destroying the patriarchy, and very likely engaging in a Twitter war @AlexAviance. 

Response to Orlando

Hello Everyone,

As the Interim Executive Director of the Alliance for South Asian AIDS Prevention, the news of yesterday’s violent act against the LGBTQ+ community in Orlando was shocking – for lack of a better word. It is an unfortunate reminder that homophobia/transphobia/biphobia and racism are alive and well all over the world.

Our thoughts and prayers are with the families and friends of all those who have lost their lives.

Our best wishes for a speedy recovery for those who are wounded.

ASAAP is an organization that works closely with those living with and affected by HIV and the LGBTQ+ South Asian community. We offer our ongoing support to the LGBTQ+ community as we heal and come together in solidarity to advocate for change.

In solidarity,
Haran Vijayanathan

Looking for PrEP: Part 2

By: Alex Aviance, Guest Blogger

Disclaimer: The views expressed by guest bloggers are solely theirs and do not necessarily reflect that of Dosti, Snehithan, Lassi, or any programs and services of ASAAP. 

At this point I suppose we should get to know each other a little better. I’m a twenty-something, queer, racialized guy. I’m a mostly-bottom, a journalist, and amateur Martha Stewart all in one. I have multiple partners; some of them are ongoing and some are casual hookups, or one-offs. I get tested roughly every 3 months, and I usually bring a condom with me when I’m going out, invite a guy over or otherwise think there’s a chance I might have sex. However, I’d be lying if I said I never have unprotected sex. I like to establish connections with a guy before the condoms come off, but the truth is so many of us are unaware of our status.

I also feel as though too often I get pressure from tops that want to fuck me raw, because it’s hard for them to maintain an erection otherwise. I can negotiate the use of condoms all I want, but at the end of the day the top does a lot of the work surrounding the condom. He has to make sure he’s put it on properly, it’s not slipping off, and that it hasn’t ripped or torn. When it comes to safeguarding my own health that’s an awful lot of responsibility to put on someone else.

So I guess the big question is why now? I’ve been meandering my way through my twenties, and as I know it I’m HIV negative. Why go through all the hassle of taking a pill every day if what I’m doing already seems to work? Well first off the logistics are right for it to happen. PrEP can cost as much as $900 a month and requires a physician’s prescription. At this point I think I may just finally have that part down. Secondly, I want to take an active role in my sexual health. I want to be able to have sex and be secure in the knowledge that even if by chance a condom breaks, it comes off, or whatever – I’ve taken the steps to protect myself and my partners. Finally, too many of the guys I seem to meet are rather adamant about not using a condom the first time we meet. “I’m neg, u b 2” is a familiar but inadequate prevention strategy for me at this point in my life.

Negotiating condom use is still a huge problem that I haven’t completely worked out yet. If a guy tried to back out of using a condom at the last minute I could definitely get up and leave, but when our clothes are on the floor and he’s almost inside me telling him to sashay away is tremendously harder in practice.

That’s not to say there aren’t a few things I’m worried about. PrEP is a drug, and despite the good it can do there are side effects. It’s also not perfect. So far no methods of HIV prevention are 100% effective, and PrEP won’t protect me from other infections. Is it worth it? Well the way I see it, intestinal upset and nausea are small prices to pay to enjoy the stress free sex I want to be having.

 

Alex Aviance is a young, queer man who lives and blogs in Toronto, Ontario. His interests include theoretical physics, cooking, World of Warcraft, and Ru Paul’s Drag race. Alex currently holds a B.A. in Journalism from Ryerson University and has plans to return to school to study social work. He hopes to pursue a career working in the field of queer men’s sexual health. His idols include Naomi Campbell, Anna Nicole Smith and Tammy Faye Bakker. You can often find him consuming far too many carbohydrates, destroying the patriarchy, and very likely engaging in a Twitter war @AlexAviance. 

Looking for PrEP: Part 1

By: Alex Aviance, Guest Blogger

Disclaimer: The views expressed by guest bloggers are solely theirs and do not necessarily reflect that of Dosti, Snehithan, Lassi, or any programs and services of ASAAP. 

There are thousands of queer men in this city, and we’re all looking for something. Some of us are looking for sex, some are looking for acceptance, and some I assume are looking for love. I was looking for a man that knew what he was doing, respected my boundaries, and could keep it hard with a condom on. Little did I know that man is practically mythical.

Welcome to the age of Grindr; your the next orgasm is only a tap of a smart phone away. In a society that can’t seem to get anything fast enough it’s only logical sex would be the next step. Now in our eternal quest for sex, acceptance, and love we look for masc4masc and neg only, never having to acknowledge anyone we may for whatever reason find undesirable.

Unlike the generations of years past my friends and loved ones aren’t dying all around me, and HIV has lost much of its mystery to become a chronic, manageable disease. It’s a strange age to witness much less navigate. I come across so many guys who want to fuck raw, but as soon as someone tests poz that’s it. They’re suddenly no longer “clean,” and to the sex-shaming puritans among us they’re promiscuous meth addled drug addicts that got what was coming to them. 

As a twenty-something gay guy it’s fair to say I’ve done my share of partying, meeting other guys, and hooking up. I’m sure many queer guys can attest that while the boys, blowjobs, and apple martinis might be fun no matter how safe we’ve been our hearts are trying to forcefully escape our chests as we sit in a chair at Hassle Free waiting for the results of a rapid HIV test. It’s a process that I’m not sure I can really ever describe as getting easier the more times I do it. It’s usually nerve wracking and results in my brain going over every possible scenario in which I may have messed up (and how I really, really, shouldn’t have brushed my teeth just before giving that guy head).

Even as I write this there is a chance I could be poz and not even know it. Although that’s true for just about anyone that’s currently sexually active, living with this realization takes its toll on my mental health. We might like to think otherwise, but the truth is condoms are far from perfect. They can break, come off, – either by accident or on purpose  – and they obviously reduce the physical sensation of sex. Some guys just can’t keep it hard with a condom on and prefer to bareback instead of using one.

So you can imagine my fascination when I learned about PrEP (a.k.a. Truvada, Pre-Exposure Prophylaxis) a pill that studies have shown to reduce transmission of HIV by as much as 99% when taken daily. I hesitate to compare it, but some activists and health promoters have held it up as our version of the birth control pill. As you can imagine the very thought of queer men using a pill and having unprotected sex terrifies people enormously, and the drug is causing a huge amount of controversy.

It’s not just right-wing, religious types either. There’s also a vocal anti-PrEP group within the queer community. They believe that Truvada will fuel promiscuity, drug use, and unprotected sex among gay/bi/trans men or “Truvada whores.” Given that backlash and my determination to get my hands on PrEP I can’t help but wonder; am I the next Truvada whore?

 

Alex Aviance is a young, queer man who lives and blogs in Toronto, Ontario. His interests include theoretical physics, cooking, World of Warcraft, and Ru Paul’s Drag race. Alex currently holds a B.A. in Journalism from Ryerson University and has plans to return to school to study social work. He hopes to pursue a career working in the field of queer men’s sexual health. His idols include Naomi Campbell, Anna Nicole Smith and Tammy Faye Bakker. You can often find him consuming far too many carbohydrates, destroying the patriarchy, and very likely engaging in a Twitter war @AlexAviance. 

Pride Volunteer Call-Out

Interested in joining us this year for Pride month in Toronto?  Check out how to get connected below.

Please Note: Folks interested in participating in the Pride weekend outreach will need to attend a training session on June 19, 2016, registration is required asap.

Introducing: Looking for PrEP

Over the summer Dosti & Snehithan will be featuring a series of guest bloggers.  Alex Aviance is the first in this series with his blog entitled: Looking for PrEP.  Looking for PrEP is a blog mini-series focusing on Alex’s journey with PrEP as a South Asian man living in Toronto.

Disclaimer: The views expressed by guest bloggers are solely theirs and do not necessarily reflect that of Dosti, Snehithan, Lassi, or any programs and services of ASAAP. 

About the Author:


Alex Aviance is a young, queer man who lives and blogs in Toronto, Ontario. His interests include theoretical physics, cooking, World of Warcraft, and Ru Paul’s Drag race. Alex currently holds a B.A. in Journalism from Ryerson University and has plans to return to school to study social work. He hopes to pursue a career working in the field of queer men’s sexual health. His idols include Naomi Campbell, Anna Nicole Smith and Tammy Faye Bakker. You can often find him consuming far too many carbohydrates, destroying the patriarchy, and very likely engaging in a Twitter war @AlexAviance.

Useful Resources:

If you are thinking about PrEP please contact a physician for more information. Below are a few links that might help answer your questions, if there are any more contact us!

  1. One Step Closer to Accessing PrEP in Canada 
  2. What is PrEP and is it right for me?
  3. Oral pre-exposure prophylaxis (PrEP)
  4. What is PrEP?
  5. Pre-exposure prophylaxis (PrEP) resources