Opinion: Why I Stopped Taking PrEP
PrEP (pre-exposure prophylaxis) has been blowing up in the news recently, from the Department of Health and Human Services suing Gilead Sciences (the producer of PrEP) over the patent rights to Truvada, to the Trump administration introducing a program called Ready, Set, PrEP that would serve free medication to uninsured patients; from Frank Ocean throwing a PrEP party, to Azealia Banks trashing Ocean in an Insta Story for promoting the drug.
It’s mind-boggling to think that a mere 7 years ago when the FDA first approved Truvada for PrEP, barely anyone knew about it. I certainly didn’t.
It’s also surprising to know that the research for the drug began over 30 years ago, in 1986, when a European scientist filed a US patent for tenoflovir, which is now being combined with emtricitabine to create the prophylactic drug that today is called Truvada (or PrEP).
The first time I learned about PrEP was 5 years ago, when I was potentially exposed to HIV. I hooked up with a boy I met at my gym, he took off the condom while I was ass-up, face-down looking for poppers, and came inside of me. He completely denied that he’d done either, and I only confirmed my suspicion once I was back in my apartment and a bucket of cum came out of me in the shower. After I confronted him once again via text, he finally admitted that he did that because he couldn’t get hard with a condom on. I thought that was incredibly shady and knew I needed to get some help ASAP. At that time I had insurance, so I went to see a doctor at Mount Sinai, which was recommended to me by a friend. “She is Jewish and trans, so you know she knows the tea,” my friend told me.
During my visit, she prescribed PEP (post-exposure prophylaxis) for me to take twice a day for 28 days. She encouraged me to stay celibate during that time, and during my check-up visit 30 days later the doctor asked if I had ever considered getting on PrEP. She explained to me that if I considered myself to be at high risk of getting infected with HIV, I might benefit from taking the pills. I concluded that it might be best for me, but stopped taking the pills after about two months, simply because I wasn’t as sexually active after this traumatizing hookup.
Fast-forward two years later and I am back on my slut spree. Even though most of the time my partners and I used condoms, there were some instances where indiscretions occurred and I would find myself sitting at a free testing clinic again and again. In fact, my visits became so frequent, that the doctors started commenting on it. “Hey, you were here only three weeks ago, you know that HIV infection won’t show itself in the first 30 days, right?” they would say. I knew it, but every time I had sex, be it with a condom or not, I would run to get tested right away.
Finally, during one of my visits a doctor asked a familiar question: “Have you considered getting on PrEP?” At that time I didn’t have my insurance any more, and I knew that the medicine cost over $1,000 for a month’s supply, which I couldn’t afford, so I wasn’t even thinking of getting back on the treatment. Besides, I have always been against the pill-popping culture of the US, oftentimes trying to find a more natural approach for remedies. I expressed both concerns to the doctor, to which she asked me if I would rather drink the pills for a short period of time – I guess she meant until I become less of a slut – or drink a drug cocktail my entire life if I were to contract an HIV infection. The doc assured me that there shouldn’t be any significant damage to my kidneys or bones if it’s a short-term prophylaxis (some of the side effects include possible liver damage and bone density loss) and that we would keep an eye on my blood work every 30 days.
As regarding me not having insurance, the clinic sent me to Project STAY that is jointly administered by NewYork-Presbyterian and by the Harlem Health Promotion Center (HHPC) within the Columbia University Mailman School of Public Health, out of the Vanderbilt Clinic in Washington Heights.
Project STAY mainly provides healthcare services for adolescents and young adults, while in reality catering to anyone who might need assistance with free testing, mental health, applying for insurance, or obtaining PrEP/PEP drugs.
I was shocked at how fast I was in and out of the clinic, with a bottle of free PrEP in my hand, which STAY helped me obtain through applying for a Gilead program on my behalf.
That was also the same day I (re)downloaded my Grindr app … and I noticed a new addition to the run-of-the-mill, robotic one-liners that the guys now used:
–You on PrEP?
That seemed to be one of the first questions asked now, instead of “top/bottom?” or “u host?” It also seemed that with the confirmation of both parties being on PrEP, came an assumption that raw play was on the table.
Shortly after, I found myself engaging in more risky behaviors than ever before in my life, while still being paranoid that I might be one of the 1% that the medicine doesn’t end up protecting from HIV. (According to CDC, the risk of contracting HIV is lowered by 99% if taken daily.)
Even though my risky sexual behavior increased, I didn’t feel any safer, knowing that there is a plethora of other STDs I could easily contract, like a new strain of untreatable gonorrhea. So yet again I found myself going to the clinic just as often as before.
During the last month of me taking the medicine, I became almost non-sexually active. My mom asked me at some point: “Maybe you should stop taking the meds already? You never know what side effects may occur from this in the future.” I couldn’t have agreed more.
So when I went back to Project STAY on the date when I was supposed to fill my new prescription, I told them that I wanted to get off the pills. I was asked if I would be okay talking to a social worker, who was doing a study on why people stop taking PrEP, to which I said “Of course.”
When the social worker asked me why I decided to stop the treatment, I asked her if she watched Game of Thrones. She looked puzzled, but said that she loved the show. “Do you remember when Khaleesi took control of Meereen?” I proceeded, “When she conquers the city she thinks ‘Ah, the hard part is done.’ Then one after another, bigger, more difficult problems start to arise that she didn’t anticipate, making it very challenging for her to rule. Well, it’s the same with PrEP.”
At a certain point I realized that I was looking at it all wrong. I wasn’t at a high risk of contracting an infection because I am a gay man; I was high risk because I am a gay man that willingly puts himself into unsafe practices. Truvada isn’t meant to be a substitute for a condom or abstinence, for obvious reasons, but of course, just like anything in life it is used for more than one purpose.
After the medicine ran out, I stopped sleeping around and decided to delete all of my dating apps, dedicating all of the time that I had into my work, instead of browsing the sea of bare torsos for hours and wasting my time being constantly stood up.
It didn’t come as a surprise to hear that Gilead has been hit with multiple class-action lawsuits, mainly for “intentionally continuing to promote the HIV medication tenofovir disoproxil fumarate (TDF), which was known to cause serious kidney and bone damage, so it could profit from the drug before its patent on the medication was to expire in 2015,” according to the Washington Blade.
There is no doubt that some people benefit from the use of the medications, whether to stay negative with an HIV-positive partner, or for work purposes. A good friend of mine, Caged Jock, is an adult performer, and he finds that PrEP is crucial in his line of work.
At the end of the day, everyone has to gauge their own situation and make a conscious decision on whether to get on the drugs, especially with the recent news of the Trump administration making them available for the uninsured. Just because something might be within the reach of your fingertips doesn’t mean you have to jump on the bandwagon with everyone else. Careful consideration, realistic expectations of self, exploration of alternative options, weighing of pros and cons and behavior pattern changes, might help you make the right decision for you.