Looking for PrEP: Part 7

 

 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. 

Has PrEP has gone mainstream? The CBC can’t seem to stop talking about it; Shonda Rhimes has written it into How to Get Away with Murder and most guys I talk to have at least heard about it by now, even if they’re still not sure how to get their hands on it, or how it works. As far as awareness is concerned we’ve reached peak PrEP. Now the scapegoating can really begin.

A number of concerning figures were recently released out of the U.K[1]. showing an increase in the number of STIs in men who have sex with men, and some in the gay media along with those against Truvada are already clamoring to place the blame on guys taking PrEP.

Is PrEP to blame? It’s worth noting that the link between PrEP and this increase in STI rates wasn’t formally established. Sad to say, but it’s largely a scare tactic used to generate headlines and shame people for the unspeakable crime of daring to enjoy having raw sex.

In truth, STI rates among men who have sex with men have been climbing for some time now, long before the advent of PrEP. It’s also important to note while awareness of PrEP might be at an all-time high, there are significant barriers to accessing it, especially for those that need it most. Not to mention the actual number of people taking PrEP is actually quite low.

Something that I’ve mentioned before, but may not be widely known is that in order to keep getting prescriptions for PrEP the CDC guidelines recommend screening for STIs. In other words, someone on PrEP is in constant contact with their doctor, and is regularly getting tested for bacterial STIs like gonorrhea and syphilis, whereas someone not on PrEP may choose to never get tested, or may only do so infrequently. The statistics on just how much barebacking is going on varies wildy, but the reality is the number of people who can say they use a condom every single time is low.

I’ll admit, this whole thing hits a bit of a sore spot for me. Why have gay men been saddled with this responsibility of being the paragons of condom use? After all, if you’re reading these words it’s safe to say your parents liked it raw. I’m not ignorant to the devastating impact HIV has had on our community, but we now have a safe, effective method of prevention that can work in tandem with condoms.  The real possibility of an HIV free generation is within our grasp, if we could only get over our petty squabbling and our fanatical devotion to respectability politics.

Perhaps it’s time to stop thinking about PrEP as just a pill, but rather a comprehensive protection strategy. It’s time to frame the discussion of PrEP as more than taking medication daily, but also a system for detecting STIs early, and supporting queer guys in harm reduction and safer sex management.

Taking PrEP is a safer sex strategy much as using a condom is, all we need to do is start looking at it that way.

[1] LINK 

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 6

 

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. 

 

For my first few weeks on PrEP, I had a hard time silencing the nagging pessimistic voice in my head that kept telling me the side effects would never go away, and I would have to stop taking it if I wanted to start having sex again. Although they eventually subsided, my self-imposed celibacy was clearly beginning to reach its limits.

In other words, I was horny. I needed to feel the weight of a man on top of me, and I needed it sooner rather than later. After I started feeling better, my next step was to check in on my Grindr account and find someone that was up for some fun. Shortly after logging on, I received a message from a guy whom I had spoken to in the past. Our conversations up to that point had mostly consisted of mild flirtation, and exchanging naked photos of each other. After some chit-chat about our HIV status and if he was cool with using a condom (which he was), he was on his way over.

He showed up at my front door looking more attractive than his photos. We kissed, went to my room and fooled around for a bit until he started to give the hint that it was time to move on to the main event. Reaching over to grab the condom and lube off the nightstand, I heard it.

“You’re neg right?”

“I am,” I replied.

At this point, I figure this can go one of two ways. Either he’s super nervous about becoming HIV positive, and is just making one last check to make sure, or he wants to fuck raw. As it would turn out, it would be the latter. He couldn’t really feel much with a condom on, and it was hard for him to maintain his erection he then told me.

I was a bit angry that he had chosen this moment of all times to reveal that information, but it just felt too hard to say no. We were mere inches apart and seconds away from fucking, and now was the time he would choose to make this revelation. Was he just embarrassed about the fact that he has a hard time keeping it hard, or did he never have any real intention of using a condom and only said that he would use one to make me feel better?

We had sex and afterwards he got dressed, kissed me goodbye and left. My dry spell had ended, and I had gotten what I wanted out of our encounter. Still I couldn’t help but wonder, why is negotiating condom use such a struggle for a lot of queer men?

Well, there’s the fact that we’re not allowed to talk about it. As with a lot of issues surrounding sex, there’s an awful lot of the blame game going on.

It’s the mark of a fine, upstanding homosexual to always be able to say no. To always demand that a condom be used, and to always make sure he uses one. It’s not something that’s really up for discussion in any way because coming out and saying that condom negotiation may not exactly be your strong suit is tantamount to admitting that you have some sort of massive personality flaw.

There’s also the feeling of not wanting to disappoint your potential partner. Many of us know the feeling. We’ve ended up hooking up with a really hot guy, but in the back of our minds there’s an unfortunate sense of “I don’t want to ruin this” that goes on. Sometimes we move out of our comfort zones to accommodate other people, including taking risks to our own well-being if we think it will make them happy. Sometimes that manifests in the form of forgoing condom use.

We also get caught up in the moment. The fact is, when someone at the last minute says they no longer want to use a condom, it takes an enormous amount of courage and willpower to say I’m not willing to do that.

The pressure to have complete mastery over our sexual experiences, regardless of our current mental state, past experiences or emotions is ever present. In those brief moments where we might forget, we’ll always have the upstanding homosexuals to remind us.
 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 5

 

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. 

I’m not coming to you as a Truvada virgin. I had a run in with the drug a year ago while taking it in combination with another HIV drug, Kaletra, as PEP (Post-Exposure Prophylaxis) after an encounter in which I thought I might become positive. My thirty days on the two drugs were basically a hot mess from start to finish.

In those 30 days I constantly felt the need to throw up for most of the day, every day. It eventually got so bad that I was prescribed an anti-nausea drug that’s usually reserved for people going through chemo. Diarrhea and upset stomachs also plagued me for the majority of my treatment. At the end of it all, I lost about 12 pounds without even trying.  I could stand to lose a little weight, but making myself so sick that I can’t keep food down isn’t a diet plan I was prepared to embrace again any time soon.  

Part of my agreement with my doctor to get on PrEP was that I would try to abstain for the first week to get my body accustomed, and so that enough of the drug could accumulate in my body to actually be effective. As I downed my first pill, my thoughts raced taking me back to the hellish experience of one year prior. If the side-effects returned there would be no way that I could realistically take my meds every day, and unfortunately, PrEP’s effectiveness starts to wane with missed doses. When I considered the lengths I had to go to in order to get PrEP in the first place, I realized I wasn’t prepared to give up yet.

As it would turn out, a lot of that worrying and apprehension was over nothing. Compared to my previous experience, this time around is a walk in the park. It’s almost certainly due to the fact I’m only taking Truvada, and not a combination of drugs as before. The nausea has returned, but it’s no way near as intense and life-altering as it was before. Unfortunately, the upset stomachs have also returned and it’s bad enough that abstaining hasn’t been a problem because my desire to get fucked is at the lowest its been in a while. Still, I can already feel the side-effects fading as my body adjusts. 

It’s impossible to predict how the medications might affect someone, but they’re usually minor and include nausea, vomiting, diarrhea, stomach pain, and dizziness. In about 3 months I’ll have to visit my doctor again since PrEP does have the potential in the long term to reduce bone mineral density as well as cause liver damage in a rare amount of situations. Those aren’t things I’d be able to necessarily asses on my own, so part of my PrEP plan includes getting them checked along with my HIV status.  

When it comes to both accessing it and adhering to it, I’ve learned PrEP isn’t for everyone. Side effects play a big part in that. Some guys have taken to a practice affectionately known in queer circles as ‘disco dosing.’  Or as the doctors call it, (the much less fabulously named) intermittent dosing. It means only taking PrEP shortly before, and shortly after an unprotected encounter.

It’s unsurprisingly not yet recommended by the CDC, since our current research shows that PrEP works best when taken regularly. I’ve previously viewed it as a pretty fucked up game of Russian roulette, but now that the shoe is on the other foot, I’m beginning to understand why some people might feel they have no other choice but to use it this way. The general ramshackle availability of PrEP in Canada right now, as well as the exorbitant cost may make disco dosing the only viable method of accessing PrEP for some. 

Given my past experiences, there is a sense of uncertainty I can’t seem to shake.  In the future there may be drugs that can be used as PrEP with fewer side effects, but for now Truvada is all I’ve got. All my eggs are in one proverbial basket. Despite this, I’m not quite sure I’m ready to use disco dosing as my preferred method of prevention. I can only sum up my feelings in the words of what may be the gayest disco song of all time, “I will survive.”

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.