This article was published on July 29th, 2015
In case you haven’t heard, there’s a pill out there called Truvada that reduces your risk of getting HIV by upwards of 99% or even more! It’s a strategy called pre-exposure prophylaxis (PrEP) where an HIV-negative guy take HIV antiretroviral medication to prevent HIV from establishing an infection. The birth control pill for HIV.
Having said that, PrEP is not an HIV prevention tool. PrEP is a tool to heal a community. That’s not the language of a scientist or a public health official. That’s the language of gay men traumatized by 30 years of fear, mistrust, anger, death, loss, and yes, genocide. HIV is often thought of by the medical community or the straight community as a virus. It’s more than a virus – it was a plague that tore through a community far worse than the black plague did in the 14th century. Some people lost nearly every friend and lover they had, while the other 97% of the population looked away and ignored, complicit in this genocide. And even when the deaths went down, the gay community was still left traumatized, fearful of one another and what lurked in each other’s bodies. And while HIV negative guys suffer(ed) from anxiety, HIV positive guys suffered from stigma. A wall emerged in our community between the negative and the positive. Yes, some reached over the wall towards their brothers but the wall was still there.
Treatment as Prevention (TasP) and PrEP are changing that. The wall between us is being chipped away at, one scientific discovery and one message at a time. And there are many reasons why that wall is crumbling.
First, PrEP reduces the risk of HIV transmission drastically and you’re in control. You don’t have to worry about being drunk and forgetting to wear a condom or putting it on properly. You don’t have to worry about whether the guy you are sleeping with is positive. And you don’t have to worry about whether the guy you’re sleeping with is taking his meds and maintaining an undetectable viral load. Just like when women first got their hands on birth control pills, this means you have a highly effective way to practically eliminate that risk yourself. At first, you still may be a bit scared. But when you start to realize that you’ve got a greater chance of getting hit by a bus than you do of getting HIV, the fear starts to evaporate. Have sex with that positive guy – touch him, feel him, enjoy him. That wall is gone when it comes to sex.
Second, PrEP means both HIV-negative guys and HIV-positive guys are popping the antiretrovirals – they’re all on the ARV train together. The biggest change in a guy’s life when he becomes positive is that he now has to take various pills. It’s a daily reminder that he’s got this virus. And how many guys who don’t want to disclose their status to everyone have had to hide these pills in their own home in case guests peek into the medicine cabinet. What’s great about Truvada is it’s both a treatment and a prevention medication; many HIV-positive guys have been on Truvada themselves. Negative guys and positive guys can talk about their pill popping routine, initial start-up side effects, if any, and the rules around their insurance plans. One of the things guys who take PrEP begin to learn is the world positive guys live in – regular tests by a physician, what a CD4 count is, what creatinine levels mean, the different drug interactions, etc. They now inhabit the same world and visit the same clinics. You’re a sexually active gay man? Positive or negative, you’re taking your pills.
Third, PrEP means every gay guy is responsible for their own health. The onus, and the pressure, is no longer solely on the positive guy to stay on his meds and keep his viral load down. One of the biggest fears for HIV-positive guys is passing on the virus. If both guys are sticking to their meds, this risk is virtually eliminated. The responsibility is now on both of them. And it’s about time. Positive guys have faced that responsibility alone for far too long and it’s a burden that can affect a guy’s mental health. And this is even more significant for serodiscordant couples. Each get up in the morning, go into the washroom, brush their teeth, and pop their pills. They’re in this together.
A lot is being written about how PrEP is a new HIV prevention tool and how effective it is and simple to take. But that’s the science talking. PrEP is a hammer. It’s helping tear down that wall in the gay community. PrEP is about healing the community and bringing guys back together. Over 30 years later, we may soon be whole again.