Taking Control with PrEP

107091581truvadacropThree months ago I started the steps of claiming further control over my health and my life by starting on PrEP (pre-exposure prophylaxis). I had been discussing my interest and intent to start with friends, family, and co-workers for a while. Before calling to schedule my appointment, I was made aware that I could qualify for co-pay assistance through Gilead, via truvada.com. Since I already had insurance I could apply for the HIV Co-pay Assistance Coupon Card, but if I didn’t I could still apply for the U.S. Advancing Access Program.
Scheduling my PrEP intake appointment with the AIDS Resource Center Ohio Medical Center was simple enough. First I met with a PrEP counseling intake specialist, in which I underwent a risk measure assessment. Basically, I covered past medical history, family history, social history (including sexual activity, any drug/alcohol use, etc.), and current medications being taken. I then moved on to meet with the physician who gave me a brief physical and prepared me for the labs I needed to have done. The rest of the visit was listening, answering questions, talking about Truvada and the risks specific to HIV, emphasizing the importance of medication adherence, along with connections to other related services. And then the waiting game for my lab results and medications began. A friend suggested to me to make sure I asked if a 90-day supply was available rather than a standard 30-day supply, as a way to potentially save a couple hundred dollars in the long run.

There’s a lot more to PrEP than just taking one pill of Truvada every day. PrEP would allow me to have sex without fear for the first time in my life. It would remove that month long hangover of psychological anguish after sex, worrying about whether or not I might have put myself at risk of HIV and looking for the slightest sign. If I get a cold or a rash my mind will instantly jump to conclusions because of the anxiety I have around HIV.

I know it’s a completely irrational fear in many ways. Even when I know there’s been no risk and I know the statistics, I should feel comfort but don’t. Even though I use condoms I still have anxiety. For me, wanting to use PrEP isn’t about not wanting to use condoms, it’s about wanting to have that extra layer of security, both physically and psychologically, to not have to worry about it for the next month, which is what I tend to do.

The entire gay community is affected by this kind of anguish and it only fuels the epidemic because when people feel anxious they don’t talk about it. When I try to talk about PrEP, people make assumptions about me and try to turn the conversation into a moral debate about personal responsibility, but doing this won’t stop the HIV epidemic. Empowering people to take control of their HIV risk with a range of tools is what’s going to help.

While condom usage remains the gold standard of HIV prevention, this shouldn’t stop us trying to understand that people might struggle with them. I think a lot of the concern around PrEP comes from the thought that “well you’re taking PrEP to have sex without a condom,” which people see as a problem. But really I think that’s missing the point; you don’t need PrEP to have sex without a condom—people do this all the time. The only reason to take PrEP is to prevent HIV infections. And that’s a pro-health choice at its core.

For anyone on the fence I ask:  If you were a woman would you take birth control pills to prevent pregnancy? If we had a vaccine for HIV, would you take that? You may not be at risk for pregnancy, and we may never have a vaccine, but for now we have an effective bio-medical strategy that reduces risk of HIV by up to 99 percent if taken daily. If you feel it’s for you, talk with your doctor.

-Evan Robinson