Did you know that as a gay man your chances of contracting HIV are 1 in 6? If you you are a gay man of color, your chances are even greater- 1 in 4 if you are latino and 1 in 2 if you are black. But, HIV is no big deal anymore, right? I mean, it’s a manageable disease. It’s the cards we have been dealt in life as gay men; the proverbial “shit sandwich” we have grown used to eating. We must except it… I beg to differ. We have a choice. We can accept the status quo or we can stand up as gay men, take responsibility, and #ENDHIV as a gay disease.
PrEP stands for pre-exposure prophylaxis. It is not indicated for post exposure prophylaxis. (In other words, it is not a “rescue” medication to be taken after unprotected sex. If you fall into this category, click here.) It is yet another tool we have in the arsenal of HIV prevention. It consists of a daily medication called Truvada along with safer sex practices. In clinical trials, PrEP has been shown to be 92-99% effective in preventing the transmission of HIV. Truvada is actually the trade name for a combination pill consisting of two medications (emtricitabine and Tenofovir), which have been used as part of the cocktail to treat HIV and AIDS.
PrEP is a commitment. It starts with a whole slew of blood tests. It’s very important to make sure you don’t already have HIV before you begin PrEP. This is to prevent partial treatment of HIV which could lead to resistant strains of the disease. It is also important to check for hepatitis B. Those with hepatitis B who stop taking Truvada could get worse. Additional lab tests prior to starting Truvada include:
- hepatitis C
- kidney function
When you start PrEP, you are committing to taking a pill every day. You are also committing to following up with your medical provider every 3 months for an HIV test, kidney function tests, and other sexually transmitted infections that could increase your risk of contracting HIV. Like any other medication, Truvada has some side effects, some of which can be severe. Most of my patients complain of mild nausea, or stomach upset that gets better after they have been on the medication for a while. Also, Truvada has certain interactions with other medications which your medical provider can discuss with you before starting.
Truvada can be pricey too. A thirty day supply costs around $1800. Gilead Sciences, the company who makes Truvada, offers the “Gilead Advancing Access Co-pay Program” which can help those who have insurance with a high co-payment. They also offer medication assistance for those who have no insurance.
Truvada for pre-exposure prophylaxis, is indicated for men who have sex with men who fit in any of the following categories:
- 5 or more partners annually
- Poor condom compliance
- Any prior sexually transmitted infection
- Serodiscordant couple ( one pos/one neg)
- IV drug users who share needles
So, it’s a big decision. It takes courage. It’s acknowledging that their is some inherent risk in our lifestyle and being willing to take steps to mitigate that risk. It’s not for everyone. But if you fit into any of these categories, it’s worth a trip to you medical provider to see if it’s right for you.
Do you have experience with PrEP? What made you decide to start or what keeps you from starting? The conversation starts here. Please leave your comments so others can benefit from your story.