Sex and the H.I.V. Morning-After Pill

Published: June 28, 2013

I RECENTLY had a serious H.I.V. scare after an episode of unprotected sex. The next day, at Whitman-Walker, a clinic in Washington that specializes in treating gay patients, I began a monthlong regimen of the drug Truvada, a form of post-exposure prophylaxis, or PEP. It has to be taken within 72 hours after potential contact with the virus that causes AIDS. The price tag would normally be $1,200, but I was able to get a subsidy the manufacturer gives to low-income earners.

“You can only get this deal once,” my doctor warned.

“Jeez, I hope so,” I said. “I mean, it’s not like there are PEP regulars, right?”

She sighed. “Oh, there are.”

More than 30 years since AIDS emerged, and two decades since antiretroviral drugs transformed that epidemic into a chronic but manageable disease, conversations about H.I.V. remain awkward, especially for gay men.

When were you last tested? Did you test only for antibodies, or was it a full polymerase chain reaction test? What have you done sexually since you last tested negative?

It can be tough to rekindle any bedroom passion after such questions come up.

Two recent developments could make these conversations less awkward, or even render them moot. But they also raise troubling questions about promiscuity and responsibility that are reminiscent of debates from the 1980s.

The first development was the approval, last summer, by the Food and Drug Administration of an over-the-counter rapid-response at-home H.I.V. test kit. The test, called OraQuick and available nationwide since October, gives results 20 minutes after an upper and lower gum swab. The second is the increasing availability of PEP and of pre-exposure prophylaxis, or PrEP.

PEP — the medication I am taking — has been called the H.I.V. morning-after pill, and PrEP, to follow the analogy, is akin to birth control. A study in the British medical journal The Lancet this month found that drug-injecting addicts who took PrEP were half as likely to become infected with H.I.V. as those who did not; other studies have shown that the drug reduces transmission of the virus from mother to child, and transmission among both gay men and heterosexuals.

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