From professional to personal PrEP comes alive as a prevention option worth considering
I first heard about PrEP at a community meeting a couple of years ago, after it was shown to be an effective prevention method in human studies. I decided to look into PrEP further when the FDA approved the prescription drug Truvada as prevention for those who are at high risk for acquiring HIV. In yet another community meeting soon after FDA approval, I learned that some insurance companies were planning to cover most of the cost for treatment. I also learned that patient assistance programs from the maker of the drug, Gilead Sciences, have been extended to those taking Truvada as PrEP.
The decision
Though I have a background in public health (primarily sexual health research and direct prevention and care services), I found that the more I heard about PrEP, the more questions I had. If I was interested in actually taking PrEP, how would I afford it? Was I even truly at "high risk" for acquiring HIV? Would I have adverse reactions to the meds? How would I overcome my internalized fear and the stigma associated with actually reaching the pharmacy counter and receiving the prescription? What if someone I know sees the Truvada label laying around my apartment and Googles it? Would they think that I was HIV-positive?
After mulling all of these questions over in my head, I did a cost-benefit analysis to see if I should in fact start taking meds for prevention. After my brainstorming session, I took the conversation to my primary care provider. I shared that I was no longer in a committed, monogamous relationship. Though I had a couple of strong suitors, there were no obligations for exclusivity. I wasn't fooling myself; I knew that I was probably not the only sexual partner of theirs either. Even still, I know that I don't always use condoms with my main partners, especially after our sexual arrangements have long been established. After a thorough dialogue with my provider, I made an informed decision to start a pre-exposure prophylactic regimen. Before getting my prescription, I had to take a panel of blood tests, including HIV and other sexually transmitted infections (STIs). When I was cleared to take the treatment, my doctor sent an electronic prescription request to my regular pharmacy and, Voila! I had done it.
The experience
To date, more than 10 months later, I have not experienced any severe adverse reactions to the treatment. During the first few days on the medication, I noticed a drastic boost in energy levels. I was wired for the first couple of nights and found it very difficult to stay asleep or even to fall asleep, for that matter. I liken the experience to drinking a few cups of coffee late at night. By day three or four, I still noticed the rush of energy, but I no longer had difficulty sleeping.
Now that I have been on PrEP for nearly a year, taking my meds has become routine. I have not missed a single dose since starting the regimen! However, I have taken my meds a little later than my scheduled time, usually because I was away from home for an unexpectedly prolonged period of time.
I attribute my high adherence rate to knowing that PrEP will only work if you take it. I always carry a few doses with me and my iPhone alarm always reminds me to take my medication.
I believe that my adherence serves as a buffer against the risks that I may take, and it is a central component of my sexual decision-making process. I discuss PrEP with my sexual partners. Since being on PrEP, I've noticed that my risk behaviors have actually decreased. Specifically, I find it easier to discuss HIV status and preferred prevention techniques with my partners early on in the relationship. My open approach has allowed for conversation and a safe space for them to comfortably disclose their own HIV status, testing behavior, antiretroviral adherence, and in some cases even their CD4 and HIV viral load.
The future
Before writing this article, I had only shared my PrEP experience with my close friends and intimate partners. Most have received my decision warmly and are glad that I am readily available to discuss prevention from a sex-positive perspective. I feel that my coming out as someone on PrEP helps shine some light on the stigma, fear, and ignorance that far too often negatively impact my community. By no means am I saying that PrEP is for everyone, but it is one tool in the "HIV prevention toolbox" that needs to be showcased along with condoms, risk reduction, behavioral interventions, and the like.
When asked how long I actually plan to be on PrEP, my response is "not too long." In the next few years, I look forward to building a family while in a monogamous relationship with my very own "Prince Charming." On a bigger-picture level, hopefully a cure for HIV is on the horizon. Groundbreaking research and policy initiatives are making testing, treatment, and adherence more accessible for all. I see an AIDS-free generation in our future!
Alan Johnson received a master's degree in public health from DePaul University and holds a BA in psychology with a concentration in human development. Prior to joining the AIDS Foundation of Chicago as Linkage to Care Coordinator in 2012, he coordinated behavioral research grants and interventions with the Adolescent Community Health Research Group at DePaul.
Alan also currently serves as co-chair for the Policy and Advocacy committee of the Chicago Black Gay Men's Caucus.
Photography by Darren Calhoun
This piece previously appeared in Positively Aware magazine.
