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HIV Equal Survival Guide: To PrEP or Not to PrEP

In most ways, sexually active men and women in the 90s had it worse than we do today. You couldn't just swipe right to meet someone; you had to write down the directions if you were going to pick up a date for the first time, and HIV medications weren’t nearly as advanced as they are today. Yes, sex and dating in the 90s were a little trickier than they are today, but at least one question was a little easier to answer. If you wanted to practice safe sex, condoms were your only option. There was nothing to debate; you either wrapped it up or you didn’t. But today, if you are a gay man who is HIV-negative and sexually active, that question has become quite a bit more complicated.

 PrEP is the pre-exposure prophylaxis pill that, when taken on a daily basis by someone who is HIV-negative, prevents the transmission of HIV by up to 99 percent. The drug, known as Truvada, has been available as PrEP since 2012, and research has continued to show its overwhelming success when taken correctly. Although doctors recommend that PrEP be used in conjunction with condoms because it does not protect against other STIs, people who use PrEP will experience the same efficacy rate of HIV prevention from Truvada whether they wear a condom or not, although condoms do provide an added layer of protection.

 The introduction of PrEP into the discussion of safe sex has led to a fierce debate about who should be on PrEP and who should not. Some people feel that PrEP will only encourage risky practices and promiscuous behavior. This group believes that a person interested in PrEP may not be responsible enough to take the prevention pill every day, leading to a false sense of safety and an increased risk of infection, not to mention an increased risk for STI infections.

 Others involved in the discussion believe that every gay man who is sexually active should be on PrEP. This group believes that the widespread acceptance and use of PrEP could lead to a dramatic decline in HIV infection and the elimination of HIV stigma.

Both groups have strong opinions about PrEP and whether it should be wholly accepted or fundamentally rejected by the masses. Most likely, you are part of the majority who find yourself somewhere in the middle; a little unsure of PrEP but fascinated by the introduction of such a novel form of HIV prevention. For this group, here are the only things that you should do: Get the facts, evaluate your own sexual behavior, speak to your doctor and decide for yourself.

 Here are some basic PrEP facts that you need to know.

  • PrEP does work when you use it. Make sure you are ready to commit to taking a daily pill without too many slip-ups or forgetful omissions. The less you comply with your daily dose, the greater the risk of HIV transmission
  • Taking PrEP isn’t as simple as filling a prescription. You will have to meet with your doctor on a regular basis to undergo routine blood work.
  • Not every doctor is up to date on the facts about HIV and HIV treatment. It is best to find a healthcare worker who is knowledgeable on HIV so that you can get all of the facts and be confident about your choices.
  • PrEP can involve side effects, the majority of which are mild and go away after a few weeks, but about 1 in 200 people using PrEP experience changes in kidney functioning. But there is no need to be concerned. This is why you work with a doctor and undergo regular check ups to make sure everything is functioning properly.

And here are a few of the most popular myths about PrEP that you may have heard:

  • Your body can develop resistance to Truvada as PrEP – It is impossible for your body to develop a resistance to PrEP. For people living with HIV and taking PrEP, the HIV virus can develop a resistance with inconsistent compliance.
  • You will have to take PrEP for the rest of your life. – Wrong again. You can start PrEP and stop PrEP depending on when you determine you need it. Just remember, it takes seven days for PrEP to become fully effective.
  • People who take PrEP are promiscuous and only want to practice unsafe sex. – The truth is, even the most ardent of gay men fail to use condoms every once in a while, with many forgoing a rubber more often than they care to admit. People who take PrEP are taking responsibility for their behavior and are doing something to protect themselves and others.

The decision to take PrEP is a big one and it shouldn’t involve blanket assumptions, idealistic views of sex or false information. You owe it to yourself to find out all that you need to know about your safe-sex options so that you can make the right choice for you. It doesn’t matter what you decide, as long as you have made up your mind based on the facts and the truth about your behavior, and void of any social pressure.

To learn more information about PrEP, visit www.prepfacts.org.

(Illustration by: Clarione Gutierrez)