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4/30/2013
So much has changed since when I began writing this column last October. When I started “My Life on PrEP,” most people were wholly unfamiliar with the concept and its implications for HIV prevention. Apart from the spiteful attempts of AIDS Healthcare Foundation director Michael Weinstein to do everything in his power to kill it, there was a deadening silence that seemed poised to strand PrEP on the island of misfit prevention toys alongside the female condom and post-exposure prophylaxis.
I began writing “My Life on PrEP” to break the silence and shatter the Pollyanna narrative that PrEP was only for good gays who used condoms or had poz boyfriends. Like most of the guys that PrEP is going to help keep negative, I’m not a good gay. I’m a Truvada whore. And I’m proud of it.
I am thrilled to say that this column has reached mission fulfillment. The national – perhaps even the international – conversation on PrEP has changed. Community forums abound. Guys on PrEP are starting to come out of the woodwork and talk about their experiences, and those curious about it are better able to find reliable, sex-positive information. I’m not the only troublemaker ...
My Life On PrEP
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4/3/2013
PrEP, STIs, & Sexual Networks
One of the most consistent criticisms of this column over the past six months has been that some perceive me to be taking STIs other than HIV for granted. Like the birth control pill for women, Truvada doesn’t protect against anything but HIV. So if PrEP promotion is correlated with condomless sex, wouldn’t it necessarily lead to a rise in STIs?
There are some hefty assumptions implied in this argument – namely, that PrEP promotion is correlated with condomless sex. While the clinical trial found that guys on PrEP were more likely to use condoms, critics suggest that guys on PrEP in the “real world” and not in a trial won’t be as motivated to use condoms. But, perhaps by focusing purely on behavior, this question may be framed entirely wrong. Could there be implications for STIs with PrEP, even if you’re not using condoms more or less often?
I haven’t written about this topic yet, in large part because I’ve been mulling it over. My initial reaction was to write it off completely, but that seems reactionary and not particularly fruitful. Needless to say, when I was diagnosed with syphilis a couple of weeks ago, my mind immediately wondered ...
My Life On PrEP
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3/22/2013
A couple of months ago, I wrote about the question of when somebody taking PrEP might consider discontinuing its use. A few readers e-mailed me to ask a related but different question: what if you stopped taking Truvada when you weren’t having sex, and started taking it again later? Scientists call such an approach “intermittent” use of PrEP.
The idea makes some amount of sense – especially to someone like me who rarely has sex in the town in which I live, in the middle of effing nowhere, in the frozen tundra of the Midwest. The bulk of my sex happens when I’m on the road, either for business or just simply for sexual tourism. Could it make sense for guys like me to only start taking PrEP before their next vacation, and stop taking it a few weeks after you get home?
Whatever you want to call this approach – intermittent, stop and go, on demand – the first thing to know is that we don’t have clear answers yet. The biggest PrEP studies were intended to test whether it was effective to take the drug every single day. There is a French clinical trial aimed at testing ...
My Life On PrEP
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3/7/2013
Part 16 in a Series on PrEP by PositiveFrontiers.com
Dearly beloved, we gather here to say our goodbyes. For over thirty years, condoms have been our only lifesavers in the face of HIV. Gay men invented their promotion at a time when death was the only seeming alternative. When treatment did not exist. When Kaposi’s sarcoma was a visible reminder of the epidemic. It was a different world. To quote Mr. Kushner, “You can never make that crossing that she made, for such great voyages in this world do not any more exist.”
Weep not, dear friends, for the passing of our friend. For a new era is dawning in HIV prevention.
If we needed any additional evidence of the need to turn the page, it came in the form of a seemingly banal conference presentation this week in Atlanta at the 20th Conference on Retroviruses and Opportunistic Infections. While CDC staff scientist’s Dawn Smith analysis of data from two previous HIV clinical trials seems at first glance to be of little import, its findings scream a different truth. (You can watch her presentation here – it’s the last paper in the session.)
The study’s aim may seem modest to many readers: to estimate how effective condoms are at ...
My Life On PrEP
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2/27/2013
Part 15 in a Series on PrEP by PositiveFrontiers.com
If you had asked me back in September when I started writing this column what I thought the biggest obstacles facing PrEP would be, it would not have immediately occurred to me to add doctors to the list. Of all the various parties that need to be onboard for PrEP to actually do much to mitigate the number of new HIV infections nationally, I would have expected doctors to be an easy sell. I would have thought insurance companies—those paying for private coverage—would be much more difficult to get on board. Doctors love pills, after all. And insurance companies hate paying for them.
Truth be told, the reality is precisely the opposite of what I expected. So far, there have been no reports of private health insurance denying coverage. Meanwhile, stories of doctors stonewalling their patients and denying prescriptions abound. I was recently visiting Los Angeles and gabbing to my friends about PrEP, as one does, and my friend who has been HIV-positive for years relayed a very telling story to me. During a recent, regular check-in with his HIV specialist at Kaiser Permanente, he told his doctor that he and his HIV-negative partner were curious about PrEP. They’ve been ...
My Life On PrEP
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2/13/2013
Part 14 in a Series on PrEP by PositiveFrontiers.com
Every year around the New Year, a friend of mine— we’ll call him Thomas—gives a presentation about the sex he had during the previous 365 days. It’s a geeky-whore mix of PowerPoint slides and statistics, as well as steamy photos and lurid anecdotes. Every year for the past six years Thomas has set aside time to pause and reflect on the dalliances, trysts and fleeting encounters that kept his libido churning during the year—inviting a close group of friends to share in the process.
I received my first invitation to hear Thomas’ annual state of the slut report this year, and I was entranced. Like a modern-day version of Samuel Steward and his “Stud file,” Thomas has a list of everyone he’s ever had sex with and can readily recount details of each of his several hundred partners. He described annual trends in his sexual practices, replete with line-graphs charting the number of partners and detailed descriptions of new and exciting episodes.
I felt like a gauntlet had been thrown. My friends know me for being something of an expert on the topic of sex. I talk a lot about it with my friends. I’ve had a lot of ...
My Life On PrEP
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2/6/2013
Part 13 in a Series on PrEP by PositiveFrontiers.com
I’m fast approaching the four-month anniversary of “My Life on PrEP,” a milestone that I imagine equal parts of you are either thrilled or disgusted to see pass. You've made your views about me and my ideas plain, which I have honestly appreciated. One of the wonders of the internet is that guys who would never dare to do so in public don’t hesitate to leave a comment calling me a whore online.
I think that’s great. It exposes the dirty underbelly that we often brush aside because of politeness or political correctness. Go ahead, call me a whore. It gives me fodder for more columns like this one. Feed me. Rather than take them personally and cry in a corner about how mean some of y’all can be, I think there is much insight to be gained from these accusations and slanderous, mean-spirited comments. While this verbiage came in a variety of ugly packages, perhaps the most common came in the form of questioning my tendency to fuck without condoms. This column isn't exactly about condoms, or sex without it, per se. I chose to sidestep those debates because gay men spent the past decade or so beating the ...
My Life On PrEP
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1/30/2013
Part 12 in a Series on PrEP by PositiveFrontiers.com
Author’s Note: When this column was written Wednesday, the study’s “Zero Feet Away” report was not publicly available. Jake received a copy of the report Thursday, just as this column was about to go to print. The link is included in the story below.
Last week, The Huffington Post did their usual job of fanning the flames of panic by running a “story” (more like a copy and paste job) on an alleged study that claimed to have found that a bunch of gay men “had engaged in unprotected sex.”
Before I tear that press release a new asshole, let me just relate to you what the study claimed to have found. Allegedly, two New York-based researchers conducted a survey of just over 700 gay men “who meet their sexual partners through the use of geosocial networking apps like Grindr, Scruff, Manhunt and Growlr on their mobile devices.” The big (allegedly shocking) finding was that just under half of the guys who responded say they had sex without condoms.
Eeek! Oh my God! Call the cops! Call the president!
Well, wait a goddamned second here. All we have to go on is a two-page press release from the organization that ...
My Life On PrEP
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1/23/2013
Part 11 in a Series on PrEP by PositiveFrontiers.com
When I first starting taking Truvada last October, I thought that I would finally be done with the incessant freaking out about HIV and self-diagnosing that many HIV-negative gay men go through on a regular basis. If you are (or have ever been) an HIV-negative gay man, you likely know what I’m talking about. You wake up in the morning with chills—or wake up at night feeling feverish. Almost by instinct, your hands fly to your neck to check your lymph nodes. The internal monologue begins. “Are they swollen? They feel lumpy?!? Is that normal?” Suddenly, you’re in the bathroom with a thermometer lodged in your mouth. “Do I have a fever? I feel fucking hot in this sweatshirt. Am I sweating? Jesus Christ, I’m fucking sweating!”
Of course I was sweating. The heat was on in my apartment and I fell asleep in a sweatshirt and under three blankets. But nevermind the facts. The mind is a powerful organ, able to repeatedly convince me that those beads of sweat are signs of something much worse than overheating—it’s gay cancer! Cue the horror music.
By the time I started taking Truvada, I had been fucking guys for 15 years. I ...
My Life On PrEP
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1/17/2013
Part 10 in a Series on PrEP By PositiveFrontiers.com
One of the things that I’ve always found somewhat maddening about the public discussion about PrEP is the downright reluctance—nay, pussyfooting—that colors so much of it. It seems nobody is allowed to speak about PrEP without adding a slew of conditions. PrEP “might” be right for you. PrEP “could” be a good option.
I don’t really recall AIDS activists being so hamstrung about condoms back in the '80s. Though it certainly took painstaking hours of fundraising, organizing and troops-rallying, campaigns singing the praises of condoms plastered billboards in gay ghettos from coast to coast. Where are the PrEP campaigns? Where is the excitement about the first new, highly effective HIV-prevention tool in 30 fucking years?
The genius Aussie academic, Kane Race, noticed this about PrEP last spring. In his cultural studies academic-speak, he characterized PrEP as a “reluctant object” that was terrifying for its possible utility as a gateway to “unbridled homosexuality.” While public health researchers love to categorize people as “high risk,” people don’t similarly enjoy thinking of themselves as being “risky.” PrEP, however, demands that you do just that. Every time I pop one of those pills, someone in the back of my brain I’m acknowledging the ...
My Life On PrEP
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