We Need Every Tool to End HIV
I'm a PrEPer.
I am HIV-negative, but I am taking an “AIDS” drug. In November 2013, I started taking Truvada, a drug that is used to treat HIV but is also used for pre-exposure prophylaxis, or PrEP, to prevent HIV transmission. I did this to reduce my chances of becoming infected with HIV. Yes, I know that I would be better off if I practiced safer sex 100 percent of the time. But it is called “safer” sex, not “safe” sex for a reason.
Condoms are not always used correctly. On occasion, they break. And on occasion, I may not use one or insist that one be used. I am human. Just like everyone else, I don’t always do what is best for myself. I am sure most everyone reading this op-ed can identify themselves in that sentence, based on something they do or don’t do (such as smoking, overeating, not getting exercise, aggressive driving, alcohol/drug abuse).
When I first went to my primary care physician and asked about PrEP, he said he did not know enough about it to feel comfortable prescribing it. He referred me to an infectious disease doctor. Despite the fact that the infectious disease doctor was a leader in HIV and AIDS care and treatment in the area, he said I was the first person to ever ask about PrEP. The intake nurse was amazed, that in his words, I was the “first person to ever admit that you don’t have safer sex 100 percent of the time.”
One week later, after some paperwork and several calls to verify that the medication was being sent to the correct address, I had my first prescription. My cost was $90 for a three months’ supply. A few months later, I had to have my doctor pre-approve my continued use, which is good for five years. I have to call in a prescription refill every three months, just as I have to go in for blood work every three months.
Some prevention experts have expressed concern that by adding PrEP to our prevention efforts, PrEPers (a.k.a. "Truvada Whores"), will feel that we don’t have to worry about becoming infected, that we are protected and thus we will increase risky sexual behavior. However, it's clear that folks interested in PrEP are already engaging in risky behavior, or else we would not be in a high-risk group. Interestingly enough, by having to take a pill every day, I am reminded every day of my obligation to try to stay HIV-negative.
If, as a community, we truly believe it is our responsibility to end the epidemic, the use of all tools at our disposal must be encouraged. I am fortunate; I have a job that has health insurance that covers most of the cost of PrEP. As someone who worked in the HIV and AIDS arena for nearly 18 years, I know this is not the case for many. Some people cannot access this drug, but that isn't a reason for those of us with access to skip it. And just because some people won’t remember to take their pill every day, it does not mean that the use of PrEP by others should not be encouraged. That would be the equivalent of saying no one should have access to condoms, because some people don’t use condoms every time.
As an HIV-negative man, I have a role to play in ending the epidemic. I have a responsibility to reduce my risk in whatever way I can. For me, practicing safer sex has not always occurred. By taking PrEP, I am reducing my risk of becoming infected with HIV. It is one more step for me.
As I explained to one friend, I can take anti-HIV drugs now and greatly increase my chances of staying negative, or ignore this new preventive measure and face a lifetime of anti-HIV drugs if I do get infected. The former option seems wiser.
The research is clear. When used correctly and consistently, PrEP can help reduce new HIV infections. The question is why more are folks not using it.