to one man who takes PrEP
44, works as a scientific liaison officer and is a gay man who keeps himself
well informed about HIV. He has been using PrEP as protection against HIV
during sex for the last six years and so far has remained negative. He talked
to HTU about why he started, how he
does it, and how he thinks it could be used.
HTU: So how did you start using it?
I met my
partner James in 2003. I came out during the ‘Don’t die of ignorance’ campaigns
in the late 1980s and was very scared of HIV, but then I fell in love with
someone who happened to have it.
start the sex we had was very different from what I’d experienced with anyone
else. It was more intense and intimate and also rougher – we’re both into S&M
and fisting. He was very open about being positive and having an undetectable
viral load and also about not liking condoms. Before that I’d had 20 years of
safer sex but I felt ‘I’d really like to know what it’s like to be that
thought: What about PrEP? My job had involved reading up on the animal studies.
I knew we were likely to have sex every weekend so post-exposure prophylaxis,
PEP, wasn’t the answer.
How do you use it – and how do you get it?
I use my partner’s pills. We don’t have
sex so often that his clinic is likely to notice; in fact these days after six
years it’s down to about, say, once every two months.
tenofovir then switched to Truvada
when he did. I take one dose about two hours before sex then another 24 hours
after sex and a third 24 hours after that. We always plan sex because we’re
into quite rough stuff so I always know when we’re going to. I don’t think I’ve
had any side-effects; I got a slight headache after one Truvada dose but it might just as well have been caused by poppers!
Did you have any reservations about taking
loads. I felt guilty about barebacking anyway: why should a reasonably
intelligent person like me put themselves at risk of a life-threatening
infection? I went to counselling, hoping it would make me see clearly what I
was doing. But instead it just reinforced my decision about the level of risk I
was happy with. Having had intimate bareback sex with my partner, it just felt
like this dispiriting retrograde step to start using condoms again.
end I think the PrEP, as well as hopefully adding more protection, helped me
live better with the guilt of not using condoms. It helped me feel I was doing
as much as possible to reduce my risk.
Do you test regularly? And would you use
PrEP if your partner had a detectable viral load?
test every six months and so far I’m still negative. HIV isn’t that easy to
catch and it could just be luck, of course. I’m quite prepared for that
positive HIV test and I don’t think either of us will have a drama. But I’m not
going to relax PrEP because it’s much better not to have HIV than to have it.
James is pleased I’m taking it.
partner’s 100% adherent and has always been undetectable, but we both do play
outside the relationship sometimes and on a couple of occasions I have used it
with HIV-positive guys who were not on treatment. I’ve asked them not to cum in
me, though I’ve heard that doesn’t make a lot of difference. With HIV-positive
guys we always negotiate and they play to my level of safety or me to theirs,
whichever is safer.
we use condoms I will take PrEP. With the kind of sex I like, there’s plenty of
other transmission risks even if you do use condoms. I’m amazed at how guys will
use condoms but quite happily share pots of lube, for instance.
days I’m almost a ‘reverse serosorter’: I’d rather have sex with an HIV-positive
guy who knows he’s undetectable than a guy whose last test was negative but
could be coming down with HIV and have a really high viral load.
Do you still have doubts about it?
obvious thing is that it doesn’t protect you against other STIs [sexually
transmitted infections]. In fact I have caught an STI and had to get treatment
for it. Since then we’ve really tightened up on other precautions like not
me really, however, who’s had doubts about it. My GUM clinic was concerned I
was using it as a method of preventing HIV infection, and still [is]. Rightly
so in a way, as the evidence is still in its infancy. But I haven’t exactly
felt 100% supported in my decision and they keep on wanting me to talk it over
with the health adviser.
concern is worry that they’ll restrict it to heterosexual serodiscordant
couples who are trying to conceive. Just because gay men’s sex doesn’t involve
procreation, why should we be penalised?
If the current trials prove it works, who do
you think should get it, and how?
initially people in serodiscordant relationships should get it – even if they
use condoms. They should be willing to have counselling and contemplate
behaviour change; clinics might worry about being pressured to provide it if it
works and won’t want to be seen to condone unsafe sex. Maybe the clinic could
see it as a ‘stopgap’ pending other behaviour change. However I think it’s
important not to use behaviour change as a condition. Secondly, I think it
would be useful for clinics to identify people at high risk who are having
problems with condom use: maybe the doctor and the health adviser could review
patients together. Then it might be suggested as part of the solution.
Any last words?
helped me tackle my fear of HIV and my guilt at barebacking. I’m in a wonderful
relationship and am very happy with the sex I’m having. I didn’t want fear of
HIV to affect that and PrEP fell naturally into place as a strategy. I only
hope that the studies show it to be effective and that I haven’t just been
lucky so far.