PrEPEverything you’ve ever wanted to know about that other pill

Chances are you’ve heard of PrEP.  Maybe you’ve seen the #PlaySure advertisements on a subway or billboard near you.  You may have even heard about it on primetime network TV.  Jack Falahee’s How to Get Away with Murder character Connor weighs the option of taking the HIV prevention drug after finding out his boyfriend Oliver has HIV.  PrEP is getting as much press in the gay community as the newest season of RuPaul’s Drag Race.  But that doesn’t mean people are taking it.

As determined by a 2016 Gallup poll, there are almost 13 million gay people in America.  However, only 79,000 of us (less than 1%) are taking PrEP as part of a modern gay wellness regimen.  Drugs like Truvada have been touted as the biggest development in HIV prevention in decades.  Why aren’t more people asking for prescriptions?

Perhaps it’s due to a lack of information.  There are a lot of misconceptions floating around out there.  No offense to ABC but it takes more than a single scene to dive into the complexities of the drug.  Whether you’re a skeptic of the drug or you’re actively weighing the option of taking it, there’s some information you need to know.

What Is PrEP?

On the surface, it’s clear that PrEP helps prevent HIV.  Most gay men know what it does but don’t understand how it works, let it alone what the acronym stands for.  PrEP is short for Pre-Exposure Prophylaxis.  It’s a medication that you take before being exposed to HIV.  If it’s taken daily, studies have shown that it significantly reduces your chances of contracting the disease.

PrEP shouldn’t be confused with PEP, Post-Exposure Prophylaxis.  PEP is the cocktail of pills that doctors prescribe to patients who think they’ve been exposed to HIV infection.  Take PrEP before infection; PEP is for after.  However, if you’re taking PrEP, you won’t need PEP.  Easy enough, right?

Image source: Wikimedia Commons

How Does PrEP Work?

PrEP is classified as an antiretroviral drug, or ARV for short.  ARVs exist in multiple forms to fight various stages of HIV infection.  PrEP is the only one used on the front end.

In a sense, PrEP works the same way as medication you’d take to prevent malaria.  According to research conducted by AIDS Map, it builds up high levels of the ARV in your body.  This includes your bloodstream, rectum and even your genital tract.  In the event that you’re exposed to the virus, PrEP stops the virus from infecting and replicating itself in your cells.  Basically, it’s like the big, burly bouncer of your body, and it determines that HIV’s name isn’t on the list.

The most popular PrEP drug is Trvuada.  Truvada is actually a medication made from two different drugs—emtricitabine and tenofovir.  There won’t be a quiz after so don’t worry about remembering or pronouncing those correctly.

Also, though they’re less common, some types of PrEP are administered in topical form.  There’s a microbicide gel that can be used on the rectum but Truvada seems to be the reigning champ for most doctors.

Is PrEP Right for You?

Now that you understand a bit more about what PrEP is and how it works to keep you healthy, you’re probably wondering if it’s right for you.  There are still some other aspects to consider such as the drug’s wide-ranging benefits, possible side effects and real-life stories of gay men who’ve taken it.  But first, let’s talk about recommendations for men who should consider it.

First and foremost, you must be HIV-negative.  As discussed above, PrEP is a drug that only works for someone who anticipates exposure to HIV.  It doesn’t work for someone who has already contracted the disease.

If you’re not in a “mutually” monogamous relationship, you’re a prime candidate for Truvada.  Even if you’ve been with your boyfriend for 5 years, you should still consider taking it if you and your man have opened up your bedroom to third parties.

If you regularly engage in unprotected sex, you’re at the top of the priority list.  Also, if you’re sexually active but safe, you should still think about it.  Slip ups happen and PrEP helps you prepare for that unexpected moment of indiscretion.

So, you fall into one of these categories, but you’re still not sure.  Let’s dive a little deeper.

PrEP Benefits

Obviously, the one huge benefit of taking PrEP is preventing HIV.  While it’s not necessarily a free pass to engage in reckless behavior, it is an extra aid in your sexual health toolbox.  You’re preparing your body to fight off a virus that doesn’t belong there.  However, there are other benefits beyond the physical.

Gay millennials have grown up during a time when HIV treatment and prevention have advanced to new heights.  Far removed from the AIDS crisis of the 80s and 90s, many of us have grown up more aware of the dangers of unsafe sex.  Though that doesn’t stop some guys from taking gambles with their health, it has forced many of us to enter sexual activity with caution.  PrEP can offer that additional peace of mind.  As part of a gay wellness routine that includes condom use, you can relax and enjoy intimacy with your sex partner without worrying about the “what ifs”.

Also, PrEP encourages a positive conversation about sex in the community.  With preventive behavior, we can boost our community, prolong our lives and remove HIV from our future narrative.

PrEP Risks

We’ve all seen the commercials for various skin or heart medications.  The benefits sound nice but the side effects read like an encyclopedia of every affliction known to man.  “Side effects of this medication may include runny nose, diarrhea, vomiting, nausea, death, death, death.”  Like any medication, Truvada has side effects.  However, you’re highly unlikely to experience them.  One of the main reasons Truvada was approved by the FDA was for its low occurrence of serious complications.  There’s no need to worry.  Yet still, you should know what they are.

  •      There’s the possibility of lactic acid buildup.  Lactic acid is a compound naturally produced by your body which can cause you to feel fatigued when you have excessive amounts.  It’s the same effect you feel after a heavy lifting session at the gym.
  •      Your liver could enlarge or become fatty.
  •      If you have Hepatitis B, PrEP could worsen your infection
  •      Kidney failure is a far-reaching but possible side effect.
  •      Loss of bone density could occur.
  •      You may see unexpected changes in your body fat percentage.

You’d be forgiven for thinking bone density loss or kidney failure are both big deals.  They are.  However, there’s no reason to freak out.  Take the experience of Damon Jacobs, for instance.  He shared his story about taking PrEP with the blog, My PrEP Experience.  In the piece, he expresses fear of losing bone density or possible kidney failure.  He was initially concerned that he was destroying an otherwise healthy body to prevent HIV.  He set up regular appointments with his doctor every 3 months for blood tests.  The 42-year-old reported that he was the picture of health after 2 years on Truvada.

Aside from his solid physical health, he reaped some other psychological benefits.  He wrote, “Feeling protected from HIV helps me to feel more affirmative sexually.  Feeling affirmative sexually gives me more confidence and energy.”  His newfound energy led him to exercise more, improve his mood and engage in more productive relationships.  For Jacobs, Truvada was a win-win.

If you’re one of those people who thinks you’ll be that one person in a million who ends up with a dud kidney, don’t worry.  You only stand to gain from taking Truvada.

The Curious Case of Joe

While the previous “one in a million” jab was in jest, there is one example of man who still contracted HIV while taking PrEP.  Until early 2016, PrEP’s record was spotless.  Patients who took the recommended dosage (one pill every day) did not contract HIV.  One man, referred to as Joe in a POZ magazine profile, adhered to the dosage but still became infected.  What went wrong?

Joe set an astonishing 10 reminders on his smartphone every day so he never missed a dosage.  Though other guys he knew only used Truvada when they felt it was necessary (disco dosing), he was always consistent.  It was surprising, to him and the community, that he still ended up HIV-positive.

In the interview with POZ, he details how his sexual behavior changed after taking PrEP.  He felt more sexually confident.  With that confidence came a disregard for condoms.  He felt he couldn’t enjoy sex if one was involved.  Fast forward to May 2015 and Joe had contracted a very rare strain of the virus that was resistant to HIV medication.

Though he understood the risk involved in condom-free sex, despite using PrEP, he still engaged.  Perhaps this is the biggest misconception about PrEP: that it’s a healthy gateway to unprotected sex.  Rest assured it’s not.  PrEP is only effective if used as part of a more comprehensive, holistic health plan.

How to PrEP

Though Joe’s lifestyle choices may not be the perfect model of good sexual health, his commitment to the PrEP dosage is important to note.  For maximum protection against HIV, one pill per day is required.  Officially, Truvada claims to reduce your risk of infection by 92-99%.  If you take the pill every day without fail, you’ll be one of the 99%.  But men who disco dosed, taking as few as 2 pills per week, saw their reduction rate drop to 76%.  Plus, the drug’s effectiveness doesn’t kick in until after at least 7 days.  So, consistency is key.

However, the goal here is to reach 100% protection.  The only way to do this is by practicing other risk reduction behaviors.  Condom use in conjunction with Truvada is recommended.  It’s crucial to remember that Truvada is an HIV prevention pill but it has 0% effectiveness against other STDs.  Avoid any type of recreational drug use in which you share needles with others.  And plan to get tested on a regular basis.

PrEP may be as close as we’ve gotten to a magic little pill that stops the spread of HIV.  However, as shown in Joe’s story, it still takes more than a magic pill to keep yourself healthy.  Just as you eat a balanced diet and work out regularly to prevent cancer, heart disease and diabetes, you have to engage in a regimen to prevent HIV.  PrEP allows you to get smart and put your health first.  It requires your consistency and your commitment to a full gay wellness lifestyle plan.  But if you can avoid contracting HIV and live a long healthy life, isn’t it worth it?

Why Men Take PrEP

Back in 2014, when PrEP was still a relatively new drug on the market, The Advocate interviewed several men who were taking it.  The profile sought to understand how it affected their lives and why they decided to take it.

Writer Christopher Glazek was one of the men interviewed.  He’d previously written about the gay community’s slow embrace of PrEP for The New Yorker.  His research convinced him to take it and in turn, he started convincing his friends to take it as well.  He offered a poignant view on the matter.

“I think people agonize a lot over the question, ‘Am I really at risk?’  We know that people systematically underestimate their risk, but risk also isn’t the whole story,’ he said.  He goes on to say that PrEP is the key to ending the AIDS epidemic once and for all.  “When you go on PrEP, you’re not neg or poz anymore—you’re ‘post’.”

If you’re sexually active and PrEP isn’t part of your health routine, it should be, plain and simple.  The risks are few and far in between.  You’ll reduce your chance of HIV infection and get involved in some productive sexual health conversations in your life.  What you stand to gain is far more than you could potentially lose.  So, why not?