The Case for PrEP, or How I Learned to Stop Worrying and Love HIV-Positive Guys

Published: November 12, 2014

the Stranger
Evan J. Peterson
Original Article:

The pills are sky blue. Large, but not horse-sized. The corporate stamp, GILEAD, is printed on them in all caps.

Holding the bottle, I wonder if I’m ready to take it. I’ve read the list of potential side effects—mainly liver damage and bone density loss. My friends who’ve been on the drug for over a year have experienced neither. I’ve heard the rumors that taking this will influence me to stop using condoms and start screwing the whole touring cast of The Book of Mormon. It has taken me several months to get these pills—for free, thanks to a combination of insurance and Washington State’s drug-assistance program—and there’s something unreal about finally holding them. Holding the "miracle" HIV-prevention pill, Truvada.

My daily Truvada regimen is called PrEP, or Pre-Exposure Prophylaxis. That means I take it now, while I’m HIV-negative, and it prevents infection if I’m exposed to the virus. A single Truvada pill is actually a combination of two drugs, tenofovir and emtricitabine, which block reverse transcriptase, an enzyme that allows the virus to multiply. They essentially stop the virus from reproducing in the body. Truvada is also commonly prescribed as part of PEP, or Post-Exposure Prophylaxis, for people in the immediate aftermath of HIV exposure who want to prevent the virus from taking hold in their body. And it’s effective at treating people who are HIV-positive, in combination with other drugs. My neighbor has been on Truvada to treat his HIV for 20 years. He’s healthy and strong and grateful to be alive. This is not a new drug with unknown side effects.

There’s been far more controversy about Truvada than is warranted—most of it speculation, superstition, and sex shaming. The term "Truvada whore" gets tossed around ironically among gay men, and unironically among people who like to criticize gay men. For PrEP, Truvada is prescribed to be taken daily. Naysayers have claimed that the daily dose is an unreliable expectation because they know gay men, and we won’t take it every day. They also claim that it’s on its way to being treated as a sex-binge drug alongside meth.

To these folks, I can only offer my most considerate "Fuck off."

Everyone I’ve asked takes it every day, and I know a lot of people who take it. But even this daily regimen is now in question—just a few weeks ago, news broke that you may not have to take it every day. According to research conducted in the French IPERGAY trial (which also studied participants in Canada), Truvada is highly effective when taken just 24 hours prior to exposure to HIV and then again in the days following exposure. So effective, in fact, that researchers canceled the blind portion of the trial early and put everyone who was on placebos on Truvada.

This is an amazing development. The daily regimen is fine for people who are frequently sexually active, especially those in relationships with an HIV-positive partner, but not everyone is. And what about when we surprise ourselves? A sudden encounter with a still-affectionate ex-lover? A brief sign-on to Grindr, just to "see who’s around"? For heaven’s sake, Halloween?

The point is, whether you’re taking PrEP vigilantly every day or less frequently, it’s highly effective, and even more importantly, it’s nobody’s business how you take your medicine, other than perhaps the people with whom you’re having sex.

I grew up at a time in which HIV was every bit the "death sentence" that we now affirm it’s not. This is why I’m staring at the bottle of Truvada, still in mild disbelief after several months of waiting to get it. I’ve told my new HIV specialist, Dr. Kathy Brown, that I’ve dragged my feet on getting the preliminary blood tests to clear me for my prescription. I’ve done this because part of me still doesn’t believe that I can take one pill every day and be protected from HIV. It still feels like science fiction.

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