My Life On PrEP
How I Learned To Stop Worrying, And Start Taking The Pill
Jake Sobo
10/18/2012

Editor’s note: PrEP is an HIV prevention option currently available in the U.S. and Truvada is the medication prescribed.  PrEP can be a complex issue that raises a number of questions. I wanted to provide a column that captured someone’s authentic experience around PrEP. I wanted it to be honest and frank because issues of gay men’s health must be dealt with candor and sincerity.  This is not a prescription. This is simply one person’s experience with a safe and legal biomedical option for reducing HIV infection.  I hope this will be informative and we welcome your feedback. 


Over the past three years, I’ve noticed something about my sex life. For a host of reasons that this column will be exploring, I’d all but stopped using condoms. This set-in most clearly during a recent out-of-town trip when a guy who’s Manhunt profile lectured others about “wrapping it up” spit on my hole, shoved it in, and fucked me raw. I was absolutely ecstatic. In that moment – caught off-guard by expectations and overcome with pleasure – I realized just how much my desires had changed.

It occurred to me some days later that maybe this pre-exposure prophylaxis – or PrEP, as it’s commonly known – might be for me. I was clearly the ideal candidate: a bottom with lots of partners who uses condoms inconsistently (read: almost never) and who doesn’t want to test positive. That last bit is hard for some to understand, since many believe that guys who fuck raw must subconsciously desire to be infected. I care about staying negative and have made strategic choices about my sex partners to that end. Well, “strategic” makes it sound scientific. Let’s be real: some of those choices were more like hopeful wishes. But the desire that drove them was the same as any scientific measure: prevent seroconversion.

This column is about my life on PrEP. It’s about how I experience it and how it’s changing my sex. It’s also about the politics of PrEP, which are still being sorted out as we speak – who has access, through what organization, etc. I’m writing because I know there are other guys out there on PrEP who are probably going through the same kinds of experiences and are hungry for any real, down-to-earth talk about it. But I’m also writing because there are HIV-negative guys out there not on PrEP who are curious about it, but too afraid to ask their doctors. They want to know what it’s all about. I’m here to tell them.

I’m also writing because I’ve heard too many HIV prevention types claim that no HIV-negative guys are actually going to bother taking a pill a day to prevent infection. Well, I’m going to give it a shot. And I know plenty of other guys who are interested in following suit. Maybe these well-meaning folks don’t realize it, but talking publicly about taking a pill every day because you are getting fucked raw isn’t exactly socially sanctioned. Combine that with the general lack of knowledge about PrEP and it’s no wonder that guys aren’t lining up to publicly share their interest it.

In the next couple of columns, I’m going to start by talking about how I got access to PrEP. This is a serious question for many readers, especially those without comprehensive health insurance. I’m going to talk not just about my own experience, but trials I know that are going on in major urban centers where you can get access to PrEP for free. If you know of any going on in your area, please don’t hesitate to pass the information along so I can mention them (mylifeonprep@gmail.com).

Beyond access, I’ll be exploring a range of issues including my experience taking the drug and how its impacting my sex life. That will keep me busy for some time, but I’m eager to hear from guys out there who are interested in particular issues or have questions. This isn’t an advice column, per se, but it can nonetheless be a forum for me to address concerns guys have about PrEP anonymously.


Which brings me to me: Anonymous. I am going to stay anonymous and use the pen name, Jake Sobo. I’m going to be talking about getting fucked and taking loads in this column. That’s the kind of thing I talk about with my friends, but don’t tend to put on my job resumes. I’m not ashamed about my private life, but my career dictates that I be somewhat pragmatic. I’m a gay man in his late 20s who lives outside of the major gay urban meccas.  I’ll leave the rest to your imagination.

Between now and my next column, if you have thoughts for me, don’t hesitate to leave comments below or shoot me an email. I’m eager to hear from folks out there because I know this is a topic that hasn’t been widely addressed. Let’s start the conversation!

 

Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade, and is eager to share his experiences taking PrEP. Having closely followed the development of PrEP from early trials to FDA approval, he was excited to give it a shot when it was approved for use among MSM for preventing HIV.He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV, and started taking PrEP as a way to help him stay negative. He is well aware that the drug is not 100% effective and that he could test positive; while he hopes that does not happen, he knows that he can rely on his numerous HIV-positive friends to deal with that situation should he seroconvert.


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  • 13
  1. Gary in Nashville posted on 10/20/2012 09:36 PM
    PrEP has the potential to be beneficial to many potential suitors, especially serodiscondordant couples. However there is one thing I can't quite understand. I am poz and have been on the HIV meds Truvada/Intelence in the past. Having this experience with these meds drives the question that puzzles me. My stint with this regimen ended after 8 months when I started skipping treatments due to the way I felt when taking them. It was rough, the weakness and lethargy, nausea, and the 2 lowest CD4 (immune cells affected by HIV) levels that I ever had in the course of my infection despite having an undetectable viral load each measurement I was on treatment. Why should I continue taking these treatments if I was skipping doses played a major role on deciding to halt it. I can understand why a serodiscorant couple would be committed to this method of prevention. But with my experience and knowing it is similar to what many, many other poz guys med experience, I don't understand how a single gay guy who is so obsessed or committed to remaining HIV negative is going to commit to take these medications when the number 1 benefit to being HIV negative nowadays is not longer life (HIV drugs have changed the life expectancy of HIV+ persons to normal -1 or 2 years) but not having to take these potent and powerful drugs and deal with any side effects they may cause. That is now the number 1 benefit to being negative, not having to take these life saving drugs in the first place. I know my experience is not like everyones who has ever taken HIV meds. Some have side effects temporarily but they dissappear or leave within the first 3 or so months and their body gets used to them, but not to say these drugs still are not causing silent problems that develop over time such as liver/kidney/heart/pancreas/brain problems some of which have been blamed on Viread (in Truvada) and other meds. My opinion is if you are that obsessed to remain HIV negative, then don't share needles and don't have bottom sex without a condom. If your not that committed to staying negative, barebacking is more important that wearing a condom. Then go out have bareback sex, do what makes you happy realizing you may or may not get HIV by doing so but you won't have to worry about HIV meds until the day arrives that you are HIV+. At least then you won't have to worry about taking these meds until they are needed, saving wear and tear on your internal organs from the drugs. Anybody else feel the same about PrEP usage for single gay men?
    1. martin posted on 11/30/2012 03:09 PM
      @Gary in Nashville Read your Blog and you hit it on the nail. My meds make me so ill I wish I would just die. These that I take are my last option. So I agree with your statements 100%. I got infected long before we even knew what it was and have worked my ass off to stay well. 58 pills a day. I say make SURE you stay Negative. I appreciate your post
  2. Jake Sobo posted on 10/21/2012 10:32 AM
    Thanks, Gary, for these insightful comments! I have friends who have said the same thing: "Why would I take a pill a day to avoid having to take a pill day?" This is any interesting question that deserves consideration, but I'm not quite ready to equate potential complications related to HIV with the potential side effects of Truvada. Here's why.

    I'll talk about my experience with side effects in a later column (probably the third installment), but I'll give you a preview now: I haven't had any.

    As for speaking more broadly, these are the results directly lifted from the iPrex study findings. As I think becomes clear, side effects were generally mild when experienced and the vast majority of participants experienced none (like me):

    1. Nine percent (9%) of individuals who received the PrEP pill reported nausea in the first month, compared to 5% of those who received placebo. After the first month there was no excess nausea among those who received the active pill. Similar rates of nausea are also reported by HIV infected people starting antiretroviral treatment. As with treatment, providing reassurance that the nausea resolves after the first few weeks may help encourage longer term use of PrEP.

    2. The drugs used in this study are known to cause small increases in serum creatinine, a naturally occurring molecule filtered by the kidneys. In this study, 5 of 1251 participants (0.3%) who received the PrEP pill experienced mild increases in serum creatinine that persisted until the next test. All creatinine elevations resolved with discontinuation of the pill. Four of the 5 participants restarted PrEP without recurrence of the creatinine increase. Investigators monitored renal function throughout the study and found no serious kidney problems.

    3. Unintentional weight loss of more than 5% was reported in 2.2% of people using PrEP compared with 1.1% of placebo users (P=0.04).

    4. Sixty-six (66) headache events were reported by 56 (4.5%) of participants in the FTC/TDF group, as compared to 55 headache events among 41 (3.3%) of the placebo group (p=0.10)
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  3. David Patient posted on 10/22/2012 08:07 AM
    Bravo on your honesty... very refreshing and based on what I see, reality for more than not. I'm a poz man of nearly 30 years and while I am still undecided about PreP, I see value in it... I just have to undo 29+ years of HIV training and education to get my head around it... and regardless, well done! wish we had more of your kind of candor and honesty.
    David Patient
    www.davidpatient.com
  4. propperPrEP posted on 10/26/2012 01:22 AM
    Hola,

    feeling part of the same target group as you, I was also PrEPing myself that last bb summer - seemingly successful as my last test still showed neg.
    However, I was wonderung what drug you are taken (Truvada, Atripla?) as PrEP - and how do you get it? Black market or really paying the official price which then seems to be a quite exoensive hobby .. or from India .. or does the insurance even pay for it in the states?
    1. Jake Sobo posted on 10/27/2012 09:46 AM
      @propperPrEP Hi "propperPrEP" --

      See my latest column to find out how I got it covered by health insurance:
      http://www.frontiersla.com/mylifeonprep/Story.aspx?ID=1797617

      Next week, I'll have a column detailing clinical trials and free access programs outside of private health insurance.

      - Jake
  5. logical in melbourne posted on 11/30/2012 03:00 PM
    about time someone spoke out about it
    I researched for a few years and have accessed by my self PreP
    my doctor would not put me on it or steer me to a study as he didnt know of any.
    I went to the sexual health clinic, again they were surprised and some had not heard of it, but they steered me to where i could get the drug.
    I am over 50, I have a long term partner of 25years who has been poz since before we met
    I too also like to play around, Ive made this choice for lots of reasons but mainly for me.

    I have not read the rest of your article as yet but I will be
  6. electronic cigarettes posted on 07/04/2013 05:54 AM
    Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade
  7. bad credit motorcycle loans posted on 07/18/2013 04:31 AM
    PrEP has the potential to be beneficial to many potential suitors, especially serodiscondordant couples. However there is one thing I can't quite understand.
  8. Ian in Idaho posted on 02/06/2014 11:59 AM
    Jake, I was all ready to go ask my doctor about Prep when on the checklist for doctors I had it listed "go over the side effects" and one side effect I saw was "changes in body fat." I know this is a big deal for HIV positive people on meds but it scared me enough to not talk to my doctor about it.

    Can you comment about HIV negatives getting "changes in body fat" from Truvada Prep?

    Thanks@
    1. James Sullivan posted on 08/09/2014 09:58 PM
      @Ian in Idaho the FDA mandates that all HIV medications list "changes in body fat" as a potential side effect. Fat wasting "that look" principally occurred on the "T" nucleosides (AZT = zidovudine < D4T = stavudine) and on DDI = didanosine. Those drugs were cornerstones of therapy from 1990 until ~2000. Fat accumulation, around the neck and inside the abdomen (causing that pregnant with fat look) was noted early on with indinavir = crixivan, and to a lesser extent on other protease inhibitors. As a doctor w 20 y experience treating HIV, I can say you just don't see this w truvada. The thought is that the two drugs in truvada, both nucleosides, do not poison mitochondria like the older 3 nucleoside drugs did, and that the fat wasting seen with them came somehow from that effect.
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