I first heard the buzz around PrEP when I moved to San Francisco a few years ago. I overheard a spirited debate at a bar one evening about whether sexually active gay men should take it. One side said yes, with passion. Why not take a pill with no major side effects if it almost guarantees the user won’t contract HIV?
The counter-argument posited the pill would encourage more people to have unprotected sex. They also argued PrEP would bring back a wave of other STIs like syphilis, herpes, and gonorrhea.
But one thing both sides could agree on? Sexually active gay men committed to safe sex practices should take PrEP as a precaution.
Single in San Francisco
When I first moved to San Francisco, I chose to abstain from PrEP. I was in a committed, (mostly) monogamous relationship and didn’t feel the need to start. Earlier this year, my partner and I ended our relationship, and I found myself back on the dating scene and spoiled after a year of fantastic sex.
I went to my first sex party a few weeks later and quickly learned that nobody wanted to use condoms. Even if I explicitly told them it was a necessity. The reason seemed to validate the point made by the anti-PrEP contingent: PrEP was an excuse not to wear condoms.
A few hook ups later, a trend emerged. Almost none of my sexual partners wanted to use condoms. Most would say they didn’t feel they needed one since going on Truvada. I quickly learned that if I wanted to have sex with condoms, I had to be very clear and firm with my partners. I even had one guy stealth me by putting on a condom and then slipping it off when I wasn’t looking.
As time goes on, my thoughts on condom usage are evolving. I find a lot of the public awareness campaigns about safe sex channel Nancy Reagan’s “Just Say No” campaign against drugs. Technically, “just saying no” to sex without condoms is ideal from a safety standpoint. But it isn’t always realistic and doesn’t consider the many reasons and circumstances in which people have sex without condoms.
For the most part, I choose to have sex with condoms, except in situations where I have high trust and communication with my partner. In those cases, we both know with a reasonable degree of certainty we are free of any STIs.
My Bumpy Road to PrEP
Because I am a sexually active man in San Francisco, I decided that being on PrEP is the right choice for me. I feel empowered being more in control of my health and safety. Surprisingly, getting access to the drug wasn’t as simple as I expected.
When I initially reached out to my doctor, he wrote me a prescription for Truvada with no problem. However, the following week, the pharmacy told me my insurance company denied coverage. If I wanted to start PrEP, it would cost me $2000 per month. I received a letter from my insurance company a few days later with three pages of prerequisites I had to meet before they would authorize the medication.
I scheduled another appointment to see my doctor and worked through a very comprehensive lab to get the insurance company the info it requested. Then there was an error in processing my lab results, so I had to go in again. After the second lab results came through, my doctor sent in my new prescription. It was promptly denied again because my doctor had not submitted a prior authorization.
That step took another week to complete. Finally, almost two months after I started the process, I was able to pick up my first bottle for a $30 co-pay.
My doctor warned me about possible side effects, such as nausea, dizziness, diarrhea, weird dreams, itching, rashes, and pockets of body fat appearing in different places, but assured me that most side effects go away after a few weeks as the body adjusts to the medication.
Tracking My PrEP Journey
I took my first pill on April 9th, 2017, and have been documenting my experience day by day. In May, I’ll provide a full report of my first month on PrEP where I’ll be fully transparent about the experience.
So far, I feel good about my decision to start PrEP. Taking preventative measures to maximize my safety and health in a high-risk environment is the right choice for me. I hope that, as science and medicine advances, we continue to see more preventative measures that get ahead of illness and infections before they occur. I want to be part of helping to reduce shame and stigma around Truvada.
In writing this article and researching PrEP, I’ve learned there are lots of different perspectives on the issues involved. What’s your opinion? Are you on PrEP? Why or why not? Do you think PrEP is a good thing for the LGBTQ community or encourages riskier sex practices? Let me know your thoughts!