Being prepared for unexpected moments

My journey to using long-acting injectable PrEP started in 2016. I’d been a longtime condom user as my mother educated my sister and me about the importance of safe sex at an early age. My mother was hopeful that by this age in my life, at least by the time I was 18, that there would be a cure for HIV. While she didn’t necessarily know what my sexuality was at the time, and neither did I, she wanted us to be thoroughly aware. Thankfully she had this foresight, because I began to have sex at a young age and had the knowledge of protection with me. Coincidentally, one of my first partners was very big into safe sexual practices as well—which further reinforced what my mother had been teaching us all along.

In 2016, I decided that condoms were really not enough because a part of me wanted to participate in condomless sex, but I was always deathly afraid of any sexually transmitted infections (STIs), viruses, etc. I was speaking to my physician during a routine checkup when I casually began to express my concerns around the issue. My doctor then mentioned PrEP as a preventive method. I was hesitant as I really don’t like taking pills of any sort, but with further consideration, I went into my local health department to further inquire about PrEP. It was there that I was introduced to Truvada. I used it for maybe a year or two but was experiencing some complications like head and stomach aches. So, my PrEP nurse switched me to Descovy. It was a smaller pill, and it was easier to swallow and had less side effects since it’s processed by the body a little bit differently. So, after finding a PrEP medication that worked for me, what made me switch to a long-acting injectable PrEP med, Apretude?

I was living in Los Angeles at the time and had been receiving PrEP care at APLA Health’s Charles Drew University/MLK Medical Campus. One of the PrEP nurses told me a few years ago that they were introducing Apretude. I was very apprehensive because it was fresh on the market, but it sounded like a better alternative. When you’re on oral PrEP, you are supposed to take your pill every day—and sometimes it’s just not possible. Sometimes you might stay out overnight unexpectedly, so you didn’t think to pack your contact solution, your contact case, your hair products or your PrEP meds. Between the potential of missing a dose or running out of your pills, taking a daily pill is too tedious a task for a fast-paced or everyday life. In fact, this has happened to me before where I’ve just gotten down to my very last pill and wasn’t paying attention. So, when Apretude was introduced to me, the idea of it sounded great because I did not have to remember to take a pill, and even though the alternative made sense, I was not entirely sold because I felt the research was still very limited. So, I sat on the idea for a while.

You never know when and where you may find yourself in a situation where you may ‘slip up and slip in.’

When I moved back to Baltimore, I continued my PrEP care through my city’s health department. Access is easy—it’s free and you don’t have to wait long to be seen. I was still on Descovy, but one of the nurses mentioned that they were going to start offering Apretude; however, I’d have to get on the waiting list as only a few people would be able to receive it per their health insurance. After my chat with her, I decided to try it. About a day or two later, the specialty department at my pharmacy called me with the news that my application had been approved. They shipped it out to the health department, and within a week, I was receiving my first injection. I always tell people, if you’re having problems getting access to PrEP, to check with your local health department as they may have a program to help you. Bonus: it might be at no cost to you.

I was still a little apprehensive when I went for my first dose, as there were still so many unanswered questions. My biggest concern was the time frame of when would I experience the full effectiveness of the medication. I rarely participate in condomless sex, so I didn’t necessarily fear the initiation process, but I was extremely curious, nonetheless. The bonus here is that I’d no longer have to remember to take my PrEP daily. No more running out of pills or traveling with a rattling bottle of Descovy. The injection itself was pretty simple. One intramuscular injection to the upper buttocks and it’s done! It didn’t hurt any more than a flu shot. But after the second or third day, I was extremely sore around the injection area. A day or two later, though, the soreness wore off, and I was back to business. All in all, I feel the convenience is worth the few days of pain. 

Injectable PrEP is administered by your physician and has a short window for treatments. Knowing that, somebody like me, who’s always on the go, might find trying to adhere to the window a little bit tricky. But just the ease of knowing that if I can make that appointment, get my injection and endure the soreness for a few days, then I can keep busy and stress-free—and no longer worry about keeping up with a pill.

As I began using Apretude, I thought it would be insightful to share my experience across my social media channels to create opportunities for conversation. My hope was to enlighten my people and my community who are unaware of this option or its accessibility. I wanted this to be impactful to those who were considering their PrEP options, either the long-acting injectable or the traditional oral treatment. After making a few videos, the comments started to roll in. Some commenters wrote things like:

Oh, you’re allowing yourself to be a guinea pig?

In five years, you guys will all be on a commercial talking about how it didn’t work.

I won’t call it hate, just maybe some misunderstanding and miseducation. Whatever their responses are, I’m satisfied in seeing the conversation around safer sex practices beginning. Personally, I don’t frequently participate in condomless sex, but there’s a comfort in knowing that if I decided to, that I’d be better protected from HIV transmission. That same sense of peace is present when, and if, my condom breaks or slides off during sex.  

So, if you’re considering taking the long-acting PrEP injectable, what’s my advice? Do it! What do you have to lose? You never know when and where you may find yourself in a situation where you may “slip up and slip in.” There may also be moments of impaired judgment—under an influence of your choice—where your actions could lead you down the road of concern and regret the following day. And so, I would just say, know that your options are there. If you can get it, get it, and it may even be free. 

Know your status and protect it. Your status is the only status that you can be accountable for, and you’re going to be with you until the end. Your happiness and your health are your priority. Your health is your wealth, so be good to yourself and trust your instincts. If you can avoid the infection with a pill or shot, and help put an end to HIV, let’s all do it together. 

Follow Lutfy Mandhiry on Instagram: @sincerely_lutfy.