When I first heard about the introduction of the use of Truvada for PrEP (pre-exposure prophylaxis) in 2012, I did not give it much thought. I had been cured of HIV in 2007, and had been told by my doctors that I am immune to the virus. Therefore, I did not think that PrEP was something I needed for myself. Since the whole reason for all of my work is to help the HIV-positive community and their loved ones by giving hope that HIV can be cured, I eventually decided that PrEP is an important tool in preventing new infections and this is an extremely large part of my mission. This article will explain why my mindset toward PrEP for sexually active individuals and injection drug users has been transformed dramatically.
When asked by a leading HIV scientist at a conference in Marseille, France, in July 2012 what my thoughts on PrEP were, I said that since so many HIV-infected people were unable to access HAART, we needed to take care of them first rather than using precious resources to prevent further transmissions. Despite the fact that preventing HIV through “safer sex” did not work out so well for me, I thought that we already have prevention methods for HIV, and that those having receptive sex could just insist that their partners use condoms to prevent HIV.
However, I have since changed my mind.
In November 2013, my partner, Tim Hoeffgen, and I attended a PrEP debate in West Hollywood between a good friend of ours, Aaron Matthew Laxton, and the CEO of the AIDS Healthcare Foundation, Michael Weinstein. Weinstein had made public inflammatory remarks against people who choose to use PrEP to prevent HIV. Aaron supported the use of PrEP. I found that in contrast to his media opinion, Weinstein strangely admitted that PrEP does work if taken daily as prescribed. He also seemed convinced by the opposing argument that people on PrEP may have less of a tendency to spread other STDs because of the recommended quarterly medical checkups with HIV and STD tests. To me, his views seemed less hardline in that setting than his publicly broadcasted views. My mindset was beginning already to evolve at that point. Shortly thereafter, in order to learn more about the subject, I joined Damon L. Jacob’s Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, which offers in-depth discussions on PrEP.
Although I have been cured of HIV, I sincerely wish that PrEP had been available during my early years of sexual activity. I was diagnosed in 1995; I wish that I had never had to deal with the fear of thinking I only had about two years to live, or with the fear of judgment and stigma from friends, family, and the general public. I also had to take many pills daily for 11 years while being HIV-positive. For most people it means a lifetime of taking daily multiple medications, unless they are able to “join” my cure club. With PrEP back then, I never would have had to go through any of this. I wish this for all people who are currently at risk for HIV.
My partner and I in October attended the U.S. Conference on AIDS in San Diego. One of the sessions we attended was the PrEPare for Life workshop. Its speakers included several of NMAC’s (National Minority AIDS Council’s) Youth Scholars, all of whom were young, gay men of color. Their knowledge and ability to speak about their reasons for choosing to use PrEP impressed me greatly.
A good example is Devin Barrington-Ward, who was already an advocate focusing mostly on black men and methods of HIV prevention. He was looking at ways to protect his clients from HIV infection. This led him as a black HIV-negative gay man to take his own advice and begin using PrEP himself at the beginning of 2014. When discussing changes in relationships, once he realized that he could date and have sex with positive people without worrying about HIV, dating had become much easier. He felt he had more freedom since he could share in the responsibility to remain HIV-negative himself. He had a few mild side effects at first, which went away. He has experienced virtually no stigma and says that it has even opened conversations with people who did not know about PrEP. For those on the fence on the subject, he said that people should ignore all of the arguments on both sides and seek more of the facts available on websites such as PrEPwatch.org or the National Minority AIDS Council’s PrEPare for Life education and awareness program.
All of these influences have led to a change in my thinking about the use of PrEP to stem the rise in new HIV infections. If taken as prescribed, which means one pill daily, PrEP has been shown to be highly effective in reducing the risk of HIV transmission. The World Health Organization, Human Rights Campaign, and many leading HIV/AIDS organizations strongly endorse PrEP, and the Centers for Disease Control (CDC) has issued guidelines on its use. This ushers in a new wave of HIV prevention. I feel that if we are able to reduce the number of new infections, we could get closer to the objective of ending AIDS. The people who are not infected obviously cannot infect others.
While my ultimate goal is to see the end of AIDS, and a cure for HIV is extremely important, we also need to curb the rate of new infections. I believe that the use of PrEP is one of several methods now available to do that. Therefore, I have gone from feeling ambivalent about PrEP, to becoming a strong advocate for its use.