Cheers, Israel!

Israel formally approved Truvada for PrEP yesterday!

Just a quick post today, to shout out the awesome news that Israel just approved Truvada for PrEP. Cheers, Israeli friends!

Please Don't Forget Women!

[T-Plus 38 Days... I counted]

So this is a topic that I am not going to drop: PrEP is absolutely, unequivocally for women as well and as much as it is for men. Throughout this blog, I tend to focus on the male (and specifically gay male) lens, but only because that's my own perspective; it's the one I know best.

But the fact remains that PrEP information, and ads, and discussions, are all severely lacking. Women are often ignored and forgotten by agencies advertising PrEP. Some might argue, and it's true, that men make up the largest portion of folks at highest risk for HIV infection, but this doesn't excuse the invisibility of women in these areas, and particularly women of color; the same statistics from the CDC show that straight Black women are the fourth most at-risk group for HIV infection.

Some cities are doing better than others at addressing this. Chicago's PrEP4Love ad campaign and website have done a wonderful job of busting up that tradition, with beautiful photos of a spectrum of couples, both gay and straight, with primarily models of color.

http://www.prep4love.com from AIDS Foundation of Chicago.

The San Francisco AIDS Foundation has an entire site dedicated to women's questions and concerns about PrEP; their site is also focused on communities of color, and has a selection of resources in Spanish as well.

Certainly those two sites and ad campaigns, and the few others out there, don't make up for the horrendous lack of resources for women; every sexually active person can potentially benefit from access to PrEP, and we're hurting ourselves and our communities terribly by ignoring whole groups. This has to stop. 

One-Month Doctor Visit

It actually happened about a week after the one-month mark, but I went in this past Monday for my first check-in with my PCP since beginning PrEP. This visit was really just for two things: a kidney panel to make sure that my kidney function hasn't been impacted by the Truvada; and the next booster for the Hep A/B vaccine that I needed.

The kidney labs came back yesterday (according to my PCP, my kidney function "looks great"). Unfortunately, so did a swift kick from the vaccine. Normally vaccines don't cause me any side-effects, but I've been sleeping badly for the past week, so I'm sure I wasn't at 100% to begin with. Anyway, yesterday and today I've been feeling run down and just sort of overall crummy. A little better today but, well, it sucks.

Two more months til my next PrEP check-in with my doctor. That visit (which will take place three months into my PrEP prescription,) will cover a lot more: full-panel HIV/STI tests, liver and kidney labs, cholesterol check, and my yearly physical. Not all of that is required to stay on PrEP (just the HIV test and liver/kidney labs), but it's a handy opportunity to cover more ground anyway, so why not take advantage?

Still at 100% adherence.

Cheers, folks!

PrEP IS Love | Happy Valentine's Day!

This weekend is Valentine's Day, so I'm gonna keep this short, and just share a picture this time. I know it sounds kinda cheesy, but whether it's PrEP, condoms, or some combination, protecting yourself protects others, too. There's not much more lovely than that. Happiest Valentine's Day, folks! Stay safe. <3

One Month!

[T-Plus 30 Days. A Month!]

Yep, you read that right (and if you've been following the blog, you've maybe been waiting for it)... As of fifteen minutes ago, I took my 30th dose of Truvada, on the 30th day of my prescription. 100% adherence, folks! 

Finished my first bottle tonight!

Looking back, it's been a hell of a month: the first few days with my prescription were completely smooth, followed by about a week or so there with some pretty constant, low-grade nausea (which, to be fair, I could have gotten a prescription for, but really it was never bad enough to ruin my days or interrupt my work, and I tend to be the type that avoids extra prescriptions when I can). That nausea went away pretty quickly after that though, and since then it's been wonderful.

I've had to use my travel meds bottle repeatedly, which makes me really glad I made the thing. I think I've refilled it a half dozen times so far.

My prescription refills automatically until my doctor or I cancel it, so there's never a lapse in doses, but I do still have to go in to see my PCP this coming Monday so that I can get labs drawn (an HIV test and a liver function test this time). Assuming that goes well, I won't have to go back again for another two months.

People have asked me a lot of questions about PrEP (online and elsewhere). They've also asked me a lot of questions about me, which I definitely brought on myself to a degree by being so vocal about going on PrEP (I'm "out" to friends and family about being on it), but which I still find kinda uncomfortable sometimes (I told you I was on PrEP, not that I wanted to share my detailed sexual history with you...).

Oh, and I got my next bottle of Truvada last night (you can see it above), and with it, a big reminder about how important the copay card and insurance are. You can see it in the picture below (I made a meme out of a part of the pharmacy receipt):

Yep, that's a bit of my actual pharmacy receipt.

After insurance and the copay card, I paid nothing for my Truvada. Before? That one bottle of 30 pills would have cost nearly $1,800 retail, which works out to about $60 per pill. There might be some folks who can swing that totally out of pocket, but I am definitely not one of them (they don't pay Case Managers/Social Workers much here in the US). Cost is definitely a consideration when it comes to medications (though ideally it never should be); it's a big deal that there are options to make the safety PrEP affords accessible for many people. There need to be more options now, for everyone.

Now on to month two... Cheers, folks!

February 7th is National Black HIV/AIDS Awareness Day

http://nationalblackaidsday.org/

Communities of color are still disproportionately impacted by HIV the US, and until recently, very little has been done to change that. February 7th is National Black HIV/AIDS Awareness Day. The best way to celebrate is to make a plan: get tested, ‎know your status‬, talk to your doctor about risk, and talk to partners and friends about prevention.

Learn more at: http://nationalblackaidsday.org/

PEP, PrEP, and TasP

[T-Plus 26 Days... Almost a month!] 

26 days and 26 pills into my first prescription for PrEP. I can't believe it's been nearly a month already! Sure, it was rough at first, but it's been great for the past couple weeks now. There have been some really interesting social side-effects to getting on it that I didn't expect, though.

The first of these is that many people seem to feel a lot more entitled to ask me questions about my sex life. That isn't a problem for me, since a lot of my work involves talking about different aspects of human sexuality, but it's still surprising. A lot of those sorts of questions ultimately come down to asking me why I'm getting on PrEP: do I have an HIV-positive partner? (I don't, but I could!) Do I want to have sex bareback? (Sure, sometimes, but that's not really why I'm on PrEP.) How risky am I, exactly? (Depends on a lot of things.)

The other thing that I've found is a lot of confusion about PrEP versus other medication-based prevention methods (when people have even heard of them). There are a lot of ways to prevent HIV transmission, but there are really only three major types that use medications at the moment: PEP, PrEP, and TasP. To make these a little easier to tell apart, I made a chart, which you can take a look at below (I'll describe the three prevention methods in more detail in a moment).

PEP, PrEP, and TasP - Three Medication-Based HIV Prevention Methods.

Alright, so the one thing that all three of these prevention methods have in common is that they all involve getting a prescription for one or more HIV medications (anti-retroviral therapies/medications, or ART's). The medications work exactly the same way inside the body no matter why a person is taking them, though different medications prevent the virus' activity in lots of different ways. Each method is intended for a different stage in HIV's "life-cycle".

Please forgive me in advance, but for the sake of making these prevention methods a little easier to understand, I'm going to use the analogy of hormonal birth control. I know it's drastically over-simplifying things, and I'm not trying to compare pregnancy to illness except very, very loosely. Okay...


PEP - Post-Exposure Prophylaxis - PEP is a method of HIV prevention for emergencies; a person who believes they're HIV-negative (a doctor will confirm this before prescribing PEP) and thinks or knows that they've just been exposed to HIV can get a prescription for one or two ART meds to stop the infection from taking hold before it can get started. PEP is a short-term prescription, normally lasting for about a month. PEP is usually prescribed by an emergency room doctor (because it has to be prescribed within 72 hours of the suspected exposure), but it can be prescribed by a Primary Care Provider as well.

You can think of PEP as being like the morning-after pill for HIV: you get it right after sex (or blood contact, in the case of PEP) to stop things right after the fact.

Strict adherence to a PEP regimen is necessary to ensure it is most effective.


PrEP - Pre-Exposure Prophylaxis - PrEP is a medium- to long-term prevention strategy that involves getting a prescription for a single, daily ART pill (presently Truvada, which contains two medications - tenofovir disoproxil fumarate and emtricitabine) in order to prevent HIV infection in people that are confirmed to be HIV negative. Going on PrEP is a commitment, because as with PEP, strict adherence ensures that PrEP is most effective, but taken regularly and on time, taking PrEP can prevent HIV infection even through repeated exposures over an extended time.

People get on PrEP for a lot of reasons: yes, some because they absolutely hate condoms; but also for some because they have an HIV-positive partner (or might not want HIV to stand in the way of possible future partners); because they use IV drugs or have a lot of anonymous sex; or because they simply want to reduce their risk for contracting HIV. Most people take PrEP for some months to years during periods of higher risk for HIV infection.

You might think of PrEP as being a bit like going on the pill - it's a daily dose of a medication that, if taken properly, stops things in advance.


TasP - Treatment as Prevention - TasP refers to people who are HIV-positive, who are adherent to their HAART regimen and virally suppressed (the amount of active virus in the person is "undetectable" - so little that it's virtually missing when a doctor looks at their blood). A person who's HIV is undetectable has a much, much lower chance of transmitting their virus to a partner regardless of any other prevention methods. Yes, you read that right - an HIV-positive person whose virus is well-managed can theoretically have unprotected sex, even repeatedly, and not pass on the virus to their partner. This doesn't mean a condoms shouldn't be part of the equation, too (that goes for PrEP as well), but it means that with good medical care, safe and active sex-lives are possible for and with poz folks.

The birth control metaphor kind of falls apart here. A better analogy for TasP might be taking medication to treat herpes - it's a lifelong regimen, but while on it, the risk of transmission is reduced.

As with PEP and PrEP, strict adherence to a HAART regimen is necessary to ensure the greatest risk reduction.

I hope this post has been helpful for some people. You're more than welcome to share the image above, as long as you don't crop or edit it in any way. You can find a shareable post - including the chart - on Truvotter PrEP's Facebook page.