Chris Tipton-King, San Francisco filmmaker, is changing the conversation around HIV prevention and condom use.

Chris Tippon-King
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the PReP Project

Why did you decide to make The PrEP Project?

When I started working on this film, it was originally about what was then referred to in hushed tones as “barebacking,” or choosing not to use a condom. When I started looking up statistics about HIV prevention, I learned some surprising things: fewer than 17% of gay men use condoms consistently, and less than 15% of the men who should be on PrEP (according to the CDC) are actually on it, despite it being available since 2012.

Living in gay culture, especially in any big city, you get the sense that everyone around you is using condoms 100% of the time because that’s been the drumbeat message of every gay and health organization for the last thirty years. To discover that the #1 method of prevention was so ineffective in terms of real-world adoption was really eye-opening.

It took me a long time to ramp up production on this because I was busy starting my own video production business, and I was a little worried that I’d missed the window of opportunity to make a difference, since PrEP with through an initial wave of being highly controversial, but then seemed to settle into normalcy.

But when I found out that 60-75% of guys have heard of PrEP but still aren’t on it, it really motivated me to finish this and get it out into the world. Whether it’s knowledge about the specifics or a cultural reluctance to talk openly about sex, there’s something in the way of getting us where we need to be, and I hope this project helps close that gap.

It’s been a little frustrating watching some of the well-intentioned but ham-fisted attempts to market PrEP so far; I saw this Queerty article with the headline “PrEP ads are finally homoerotic!” and their idea of homoerotic was two guys exchanging glances on the subway! I think to be successful, the target audience has to see themselves in the campaign, so that means young gay men of color who aren’t using condoms.

There’s a paradox in that the organizations tasked with getting the word out about this can’t really come out and say “we don’t care if you don’t use condoms!” so I think that’s where I come in as an independent filmmaker unburdened by the committees that usually review this stuff.

PReP Project behind the scenes
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You’ve invested a lot of your own funds in this project and you aren’t looking to make a profit. What are you hoping to accomplish with The PReP Project?

I’ve got three goals: teach people about PrEP, reduce stigma and shame for people living with HIV, and encourage sex positivity.

Grindr profiles now have “On PrEP” and “Undetectable” as HIV status options, and a quick glance around SF on the apps seems to give the impression that a lot of people are on PrEP, but I still encounter people on a regular basis who haven’t heard of it or don’t fully understand what it is. An unfortunate side effect of all the effort to get people to take sexual health seriously is that fear-based campaigns have demonized HIV+ guys, making us afraid of HIV+ people instead of HIV itself.

I have many healthy, happy poz guys in my life, and the chances are you probably do too and just aren’t aware because it’s such a shame-loaded thing to out yourself about. I think there’d be a lot more compassion and a lot more awareness of how important it is to take steps to safeguard yourself if folks were aware of just how prevalent it is: in San Francisco, it’s nearly one in three guys.

Think about that next time you’re out! But we can’t even begin to address HIV if we aren’t talking about it, and we Americans can be so puritanical when it comes to sex. I think judgement, stigma and shame have no place in gay culture.

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The stories you’ve shot are based on real people and real events. Tell us about the format you chose for The PrEP Project.

The format is a little unusual, I’m calling it “hybrid documentary,” because the primary source is an unscripted interview with a real-life activist (Mr. Leather LA, LA HIV Commission member, and Free Speech Coalition Executive Director Eric Paul Leue) but then we cut to semi-fictionalized scenes that illustrate what he’s talking about.

There’s only so many times I can show a blue pill, and looking at a talking head gets boring despite how fantastic and engaging Eric is to watch, so I drew inspiration from the series “Drunk History.” On that show, they get a historian drunk and then have them tell an important story from history, then they take that audio and do a full-blown period re-enactment, but the actors have to lip-sync all the lines from the drunk historian.

Also, Eric is crazy smart with all the relevant studies and numbers on the tip of his tongue, but one of my goals was to make sure to cover the basics as clearly as possible, so I needed a narrator to fill in some of the details he glosses over. So there’s two scenes that start out as a flashback to one of Eric’s stories, but then a character walks up to the camera and explains things directly to the audience.

I also thought it’d be fun if all the characters from the fictional side of the film knew each other, just like the close-knit family of the real life gay community. There’s also some really hot sex in it—I  hope it goes viral!

What are some of the biggest stigmas around PReP? Why haven’t we seen a bigger adoption of the pill in the gay community?

That’s a great question, one that I hope researchers are hard at work on figuring out. While the initial wave of slut-shaming seems to be over, there’s still this worry that promoting PrEP is dangerous, because everyone will stop using condoms and drug-resistant gonorrhea will spread like wildfire. The thing is, the people who are the getting on PrEP often weren’t using condoms in the first place! Remember that 17% condom use figure.

My activist comrade-in-arms Evan J Peterson had a really great insight into this: perhaps people judge it harshly because they worry that they’d judge themselves about it—they worry that being on PrEP would make them turn into sex-hungry monsters.

Research shows that PrEP doesn’t change behavior that much, but in addition, my reaction to that is this: so what if you’re a sex-hungry monster?

We should enable everyone to make good choices about their health, whether their values are like yours or not. I should also point out that being on PrEP requires you to get tested every three months, which is way more than most people, and will hopefully put a dent in community STI rates.

The elephant in the room when it comes to PrEP is cost and access. We’re currently embroiled in a huge national debate about healthcare, and PrEP is a good example of why we need better access. Things like HIV affect the entire community, so it’s in our interest to invest in prevention strategies like PrEP even if it’s not for you personally.

Between PrEP and Treatment as Prevention (also covered in the videos) are within striking distance of actually eliminating HIV transmission altogether—we shouldn’t let value judgments about other peoples’ sexual practices stop us from getting there.

Many other countries have viral suppression rates much higher than in the US (for example, the majority of their HIV+ population is on medication and not contagious). I think treatment-as-prevention is teaching us to take a more community-minded approach to health, where we don’t have to rely so much on individual behavior that’s hard to dictate.

gay men at party
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What was your own personal story with deciding to go on PReP?

I’m self-employed, so I pay for my own healthcare—and I couldn’t afford the high deductible on my original “bronze” Obamacare plan. So at first, I signed up for a clinical trial, and it involved testing PrEP delivered both as a pill and then as a “lube” (rectal gel). OMG, the gel was super gross and I could never get it to stay up there!

But the pill was easy, I had no side effects, and as someone who has always found condoms uncomfortable and awkward, and as a single guy in a gay-mecca city, I was a prime candidate. The next year I switched to a silver-level plan, got my copay paid for by the free-to-everyone Gilead assistance program, and I’ve now been on PrEP for two years.

chris and camera
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Where do condoms come into play?

Technically speaking, PrEP is a prevention strategy package (Truvada, testing, condoms). But since it’s proven to be very effective on its own, some people choose not to use them, or pick and choose when to use them based on risk assessment, like hookups vs partners, how recent your partner’s last test was, etc.

I think it’s important to remember that your body doesn’t necessarily work the same way someone else’s does, so their level of compatibility with condoms may be different; and what level of risk they’re comfortable with may be different too.

It’s very difficult to unpack where exactly we inherited all of our attitudes towards sex from, but many of them are deep-seated beliefs that aren’t easily swayed even in the face of clinical evidence to the contrary; as with politics we just interpret the data to fit the framework of our own beliefs.

Why else would the head of the AHF, who is definitely aware of all the data, dig in his heels so deeply against the advice of the CDC, FDA, and nearly every other HIV prevention organization?

What do you hope changes in the next five years with respect to PReP?

My number one hope is that the cost comes down. Until then, I hope that those at highest risk get the message and get on board, because the end of HIV is finally in sight.