PrEP Is For Women, Too

[T-Minus 20 Days.]

Normally, I would write a long-form post, but I really think this article encapsulates the idea better than I could: women need to be a part of the equation when discussing PrEP!

HIV is not gender-specific. Nor is PrEP.

If the link above doesn't work, you can also find the article here: http://www.thedailybeast.com/articles/2015/12/19/the-hiv-drug-half-a-million-women-need.html

Thinking About Privilege and Stigma

[T-Minus 24 Days.]

There is privilege in being able to share this process openly, without too much fear of any reprisal...

• I work in a sex-positive, HIV-aware environment.
• I have supportive friends who are invested in my health and trust the soundness of my decisions (I hope).
• I have stable health insurance that allows me to pay for elective medications such as PrEP.
• I'm a white cisgender male. And yes, that does matter - frequently, people of color aren't offered the same opportunities for discussions about PrEP as white people. This can be even worse for trans* folk and trans* folk of color.
• Assuming my preliminary HIV test comes back negative (it did), by continuing this blog I'll essentially be shouting out "I don't have HIV, and I'm not going to!". I understand that this could make it seem like I'm stigmatizing folks who are positive, or minimizing the stigma against people living with HIV by discussing stigma against people taking PrEP. 

The stigma against HIV is far greater, and has lasted far longer, than the stigma against PrEP ever will. Period.

A few stories out of so many of the impacts of HIV stigma.

Prevention is an important topic, and one that people should be discussing more, but treatment is easily as important. TasP, or Treatment as Prevention, has been proved to be an extremely effective barrier to transmission. Just as with condoms, TasP in combination with PrEP can allow a serodischordant couple (partners with opposite HIV statuses) to engage in sex with near zero risk of HIV transmission. In fact there are some who've questioned whether the PrEP is even necessary, if the poz partner has an undetectable viral load (the amount of active virus in an HIV+ person's body - undetectable means there is virtually no active virus at all).

PrEP has seemed to be gaining in popularity in the United States in the past few months, and is beginning to be adopted worldwide, which is phenomenal. But the job of destigmatizing HIV falls entirely on HIV- people. I couldn't (and wouldn't) possibly demand that everyone on PrEP share their story. Medical care is a very personal, private thing. I want to share my story here, for whatever it's worth, to destigmatize PrEP, for sure, but I'm privileged to be able to do so relatively safely. 

Prevention is a huge aspect of awareness, but I think we have an obligation as a community - as several connected communities - to broaden the conversation not just about PrEP, but more importantly about HIV, whatever that looks like for you.

C'mon, let's #endthestigma

P.S. If you'd like to help impact the stigma and the hardship that can be a part of living with HIV/AIDS, think about volunteering for your local AIDS Project/Foundation. You can brows a list of resources from amFAR, and of course you can always Google for "AIDS Service Organizations" in your state. Lots of organizations need help, and it really can be a powerful experience.

Weighing the Risks - Side Effects and Such

[T-Minus 26 Days.]

There are risks to starting any medication. Of course there are. Starting any new medication means facing down potential side effects, not to mention adding a new routine to one's day or week or month. It means adding another visit to the pharmacist, and everything that entails (including potentially awkward conversations with the pharmacist about this medication or that). It means more frequent visits to the doctor.

I want to say that I spent a lot of time considering the side effects of PrEP, and other issues mentioned above, but I didn't. From the outset, Truvada (PrEP) was described to me as incredibly safe and reliable - even a couple of years ago, there was substantial evidence that PrEP was extremely effective. Besides, I already take a couple medications regularly, so adding another to the mix really isn't going to change my routine that much. The pharmacist still makes me a little uncomfortable, but not because of PrEP - it's just always felt like picking up or discussing medications should be a more private thing (but I deal with it). And I like my doctor, not to mention I enjoy being healthy in a general sense, so having a good reminder to check in more often isn't exactly a bad thing. And I'm fortunate to have good insurance and a good job, so the cost of the extra appointments and things isn't as big a deal for me as it might be for some.

As I've gotten a bit closer to starting PrEP, I have gotten a little more anxious about side effects though, so I did a little research into the specifics. Check out a section from Gilead's prescriber's guide for Truvada for PrEP below, as well as the company's website for individuals interested in PrEP.

For those taking Truvada for PrEP, the most common side effects were "headache, abdominal pain and decreased weight," and the incidence was incredibly low. It really seems pretty damn safe. I can deal with a headache or an upset stomach for a bit (in my experience, side effects from meds don't tend to stick with me for very long). Decreased weight is maybe something to consider, but of course I'll be going to the doctor every few months while I'm on PrEP anyway, so I can always talk about diet if my doctor or I ever feel like I'm losing too much weight - not likely!

Of course, there's a cost aspect to taking PrEP, too. I'm choosing to voluntarily take a daily medication that even on my decent insurance is a bit pricey. Still, relative to a lifetime of medical care for HIV, I think PrEP wins financially, too. Besides, there are programs all over that can potentially help subsidize the cost of Truvada for PrEP. I'll talk more about this in an upcoming post, but if you need cost assistance now, Gilead has a fantastic copay and prescription assistance program.

Ultimately, my decision to take PrEP has been about deciding how much risk (physical, social, financial, etc.,) I'm willing to accept in taking it, versus my risk for HIV infection. It's no small thing - taking it or not, either could have a major impact on my life.

For me, the choice feels easy (I feel that in my case, it's a fairly cheap and very effective way to enhance my protection against HIV,) but for you reading this, maybe that's not the case. That's okay, too! There are loads of other prevention options, if PrEP isn't right for you. If it is, and you're just not sure how to talk about it (or a bit scared to,) there are lots of fantastic resources to help start that conversation - and lots of great doctors that are willing to have it, too!

For resources about PrEP, HIV/Testing, and HIV/AIDS in general, click on the Resources tab near the top of the page.

More soon. Happy Winter Holidays, folks!

Layers of Protection - Condoms (and PrEP)

Condoms are a really big issue, no matter one's sexuality. They certainly have been for me, though not always in the best ways.

I think the first time I really thought about condoms was early in high school, during one of those really awkward, way-too-late "birds and the bees" conversations that we're stereotypically expected to have as kids. One frigid morning in the middle of winter (probably late January), my dad got me up reeeeeally early in the morning. He told me we should go for a drive (cue teenage apprehension). We got on the road, and got going a ways, before my dad tossed out the (basically expected) reason we were going for a drive. He asked me if I had any questions about sex (I didn't), and then told me if I ever needed condoms and was too embarrassed to buy them, to let him know. I got really nervous and mumbled some sort of thank you. To that point, I had never really thought about condoms at all - I was a nerdy kid who wasn't dating, and besides, was struggling to accept his sexuality.

Many of us don't think about condoms much, for a long time. Sure, we might hear about them awkwardly form our parents, or perhaps in Sex-Ed in school if we're lucky (I didn't, much), but in general discussing condoms is something we're really bad at in the United States. Worse, frequently when we do talk about them (at least among men), it's to rationalize why we should't/can't/won't wear them. I've had dozens of male friends who refuse to wear condoms for one reason or another. I'll admit (a little ashamedly) that all through my twenties I did that, too. I had a hard time finding ones that fit me, from the little bit I tried, and so pretty quickly I stopped bothering to even look. I just came up with excuses.

So yeah, for a long time, I didn't use condoms. Maybe the act "felt better", a little, but I didn't. Every time I had sex without a condom, I ended up going through a good week or two guilt period afterward. Sometimes that guilt would last even longer - until my next HIV/STI panel. Not knowing if you just got syphilis is not a happy place to be!

Working on stepping up my condom usage is something I've spent a lot of time on over the past few years or so. I started doing my research. I read articles, perused websites, but most importantly, I got small packs and samples of a bunch of different condoms and then tried I them on. Yep, I probably tried a dozen over the course of a few months, until I found a few brands and types that work really well for me.

Watch a really cute guy prove that you absolutely can't be too big for a condom.

I thought about a few big things - pros and cons, desired attributes, etc., - to condoms when I was making my decisions:

Risks and Rewards

Condoms aren't 100% fool-proof when used alone. They can break. They can come off. Other things can happen to them to make them unreliable (this is NO EXCUSE not to use them!)

Some people have latex allergies that make it difficult to wear typical condoms. Condoms made of natural materials can be more porous, and frequently only protect against pregnancy, but not HIV or other STI's.

Condoms need to be put on the moment you plan to start any sort of penetration. This is easily forgotten. And yeah, I get it, it's pretty gross to give a blow job on rubber (and sure, oral sex is less likely to transmit some Sexually Transmitted Infections,) but honestly, if you don't know your partner well, it's best to use a condom then, too.

Condoms can be really freaking hard to put on when drunk!

But on the flip side...

Condoms are pretty damn effective - they are among the cheapest and most effective forms of prevention against unwanted pregnancy and STI's around.

There are numerous alternative synthetic materials that condoms can be made of, ensuring that there is a safe, comfortable condom for nearly everyone.

Keeping a reasonable supply of non-expired condoms in different places (that aren't too hot or cold), such as by your bed, makes grabbing a condom easy.

For me, this one has become easy, since I've resolved to give up drinking for a while, but more importantly, if you're drunk (and particularly if your prospective partner is), you should probably reconsider having sex anyway, as consent can't be given by a drunk person.

Sizes and Shapes

Condoms come in a variety of shapes and sizes. I personally tend to need slightly smaller condoms for comfort and to make sure they fit snugly, but of course people are a variety of sizes, and ultimately the goal is to find a condom that fits properly and feels comfortable. According to some research, much of men's discomfort and trouble around wearing condoms may stem from using the wrong size on our... stems. For guys who are a bit larger, there are of course XL varieties of condom.

Where to Buy

I prefer to buy my condoms from Amazon (yes, Amazon sells condoms!) The advantage of Amazon is that you can buy from a variety of sellers, frequently in varying levels of bulk (and typically for very cheap), and if you're concerned about privacy, remember that your condoms will come in a smiling Amazon.com box. People are as likely to think you bought a new Blu Ray. I have Amazon Prime, so my condoms ship with free Two-Day Shipping, meaning if I get low, I can restock quickly and easily. It's super efficient!

Condoms and PrEP

As I move forward with starting a PrEP Truvada regimen, I absolutely have to continue my condom use. Just as condoms aren't 100% effective, nor is PrEP! Not to mention, PrEP only prevents HIV transmission, but not any of the other STI's out there. 

Just taking PrEP is NOT going to keep me from getting a nasty case of gonorrhea, or chlamydia, or syphilis. One major fear that many doctors still have in prescribing PrEP is that condom use will decline once patients are on it. Research is mixed (see here and here,) but in general, men seem to still continue to use condoms after beginning PrEP. There may be some decline, but condom use among men in the United States is drastically low to begin with - a much larger issue that needs to also be tackled.

PrEP, It's Not Just For Gay Guys!

[I'm taking a really brief break from my personal reflections here, to put out sort of a PSA about PrEP for anyone reading this who doesn't identify as strictly gay or male. I myself identify as a queer man, and though I'm generally looking for other men, I have been with women as well, and it may happen again (sorry boys, no gold star here). Anyway, straight or gay, I think this information is important. Thanks, folks!]

That's right! PrEP isn't just for gay men... it's for bi and straight guys and women. Take a look at this slide from a Truvada for Prep training quiz (assembled by Gilead, the makers of Truvada):

Truvada (for PrEP) is indicated for any adult who is "at high risk for sexually transmitted HIV-1 infection".

This absolutely doesn't mean that every single person should be on PrEP. Not even every person at high risk should be. Every medical decision you make should be made in collaboration with your doctor and other relevant care providers; there are lots of great reasons not to take PrEP that your doctor can explain to you. The most important thing to do is to have an honest conversation with medical professionals that you know and trust. The process of beginning any medication or treatment should always be taken seriously, and only with proper information.

Part of busting down the stigma against HIV and PrEP is being informed: we know that HIV is not restricted to the LGBTQ community; though marginalized communities are certainly disproportionately affected by HIV, as the linked article points out, "(t)he majority of people living with HIV worldwide are straight (heterosexual)."

Regardless of your sexuality, and whether or not PrEP is right for you, it's always important to #knowyourstatus, and to look out for your sexual health.

If you're interested in learning more, Gilead has a fantastic website detailing PrEP for HIV- (negative) individuals. It's a bit text-heavy, but it's packed with a lot of useful information. Another resource to help start the conversation about PrEP.

If you'd like to get tested, virtually any Planned Parenthood can conduct tests for HIV and other STI's, not to mention most family doctors. For more resources, the CDC has a fabulous site dedicated to HIV testing, as well as a testing site locator. 


Myths About HIV. (2015, April 7). Retrieved December 12, 2015, from http://www.thebody.com/content/art58887.html 

Test Anxiety

It's been a few days since I started the process to get on PrEP (T-30 days, hopefully!) If you're familiar with PrEP or read yesterday's post, you know that part of the process is getting tested for HIV. I'm a Case Manager at an AIDS Service Organization and I'm mostly good about my HIV/STI risk reduction (I use condoms most of the time, try to talk to every partner about safety, and know what I can do in bed that's more safe or less). Still, there's always risk, and so every time that I get tested I get a little nervous.

It's not nearly as bad as the very first time I got tested. Then, I was in my early twenties, and at the time living in a tiny little town in a tiny little rural part of New Hampshire (having dropped out of college for a bit). Everybody knew just about everybody back home, and I was absolutely terrified. Worse, there were no rapid tests then, and results had to be given in person, so I knew I was going to have to wait a while to get my results. In fact, it took a lot longer to get them than I expected - because of some sort of processing error, my result came in but I wasn't called until about a month later (when I called in myself, at that point basically frantic).

Getting tested since then has been a lot easier (not much can beat how rough that was); this is good, because really any sexually active person should be getting tested at least every six months. On PrEP, I'll be expected to be tested every three months, which seems very frequent, but has the benefit of forcing me to be especially aware of my status (and not just HIV status, either!)

I feel pretty good about what my results will be, but an important part of my own sexual health is to recognize when I am engaging in risky behaviors (though I haven't always been good about this by any stretch of the imagination), and to know the risk. For me that also means accepting that I may someday get a positive result (although of course, I'm going on this journey to PrEP to make that less likely). Of course I don't want a positive result, but I would much rather know than not, and frankly I owe it to my prospective partners to be as informed as possible.

So I'm a little nervous, but I'll deal with it. It's an important part of the process - not to mention being a sexually active adult!

Check out the video and website below for a quick discussion about HIV testing anxiety. It really is better to #knowyourstatus.

(From http://www.avert.org/hiv-transmission-prevention/worried-about-hiv)

Prepping for PrEP

Hello Friends!

So, in T-31 days, if everything goes to plan, I will become one of those cute little creatures pictured below. Well, metaphorically anyway.

Two days ago I started the process of getting a prescription for PrEP. PrEP stands for Pre-Exposure Prophylaxis, and consists of a daily regimen of Truvada, an Anti-Retroviral drug commonly used to treat HIV (by suppressing its replication in some specific ways), which in this case is prescribed to HIV- persons to prevent transmission/infection. PrEP has been an available option for a couple years now, and has thus far demonstrated a 95% or greater prevention of HIV transmission/infection WITHOUT other prevention methods - with proper hygiene and consistent condom use, that number approaches 100%.

The problem is that there is still a lot of stigma around HIV and around PrEP (which is why I'm sharing this), and often a complete lack of information. Many who know the LGBTQ community have likely heard the term "Truvada Whore", a person who supposedly takes PrEP specifically with the goal of being promiscuous, without using condoms. In reality, while a small number of people might do this, research and common sense have showed that this is almost never the case (remember PrEP only prevents HIV transmission, not any of the numerous other harmful STI's out there - don't be stupid, ya gotta wrap it up, too). Because of this biased perception, there are still many doctors who refuse to prescribe PrEP on "moral" grounds. That said, I'm fortunate - I live in a major city, with access to broad options for medical care, and I work in an industry that affords me more education and connections around PrEP than most people.

So I am going to document my process as I get myself on PrEP. I am NOT A DOCTOR (obviously), so I am only sharing my own experience, and the knowledge I've built in my field. I am in no way trying to give medical advice, and others may have a completely different experience getting on PrEP for themselves. What I'm trying to do in sharing a piece of my process publicly is, hopefully, to raise awareness, and reduce stigma at least a little bit.

So, all that said:

Step one was to go to the doctor and bring up PrEP. This means being willing to talk to your doctor about your sexual health, which may be uncomfortable for some. My doctor then asked me some questions about my sexual habits, and then described the process over the following months.

Step two was to get a few major blood tests: an HIV test, a Hep B test, and liver and kidney function labs. The HIV test is obvious - if I have HIV, then prevention is basically a moot point. The Hep B test is done because it remains incurable, and because Truvada is a potential treatment for Hep B infection. The liver and kidney function tests are to ensure that my body can handle the medication - Truvada is an incredibly safe medication, but it is still very potent, and can have an impact on liver and kidney function. If that is already compromised, PrEP can put unnecessary strain on those organs.

Step three is where I am now: the waiting game. After the conversation and panel of tests, I have to wait for roughly 30 days while the results come back and I reflect on if I want to go forward with PrEP. After the waiting period, I'll be back in to the doctor for another round of confirmatory labs, and I'll get my first one-month script for Truvada.

There is so much shame around PrEP (and HIV!) still, and there shouldn't be. I'm PROUD to be getting on PrEP - if there is a thing that I can do to both prevent being infected myself, and thus anyone else, then I'll do it. We can't ‪#‎endHIVandAIDS if we're not informed and active participants in our health.

If you want more information, I can point you in the direction of good, professional resources around PrEP, but if you're comfortable with it, then the best place to start is with your doctor. And remember, PrEP isn't just for gay people - straight people can get a prescription, too!

Keep an eye out for my next post!

Intro to the Truvotter PrEP School Blog

Welcome to the Truvotter PrEP School Blog!

The purpose of this blog is to document my process as I get myself onto PrEP (which is explained in detail below). I am not a doctor, and this blog is in no way intended to provide medical advice to anyone, nor am I advocating that everyone begin taking PrEP. Instead, what I hope to do is to broaden the conversation (one that is so often hidden, or never had) around PrEP. There is a lot of shame associated with HIV, PrEP, and sexual health in general, and I hope that sharing my process encourages others to take a more active role in their sexual health, no matter what that looks like. Remember, the first step to any safe medical process, procedure, or treatment is to speak with your doctor, and to develop a care plan that works for you.

So once again welcome, and thank you for letting me share a little piece of my journey.

This may be the Truvotter PrEP School blog, but I'm definitely the one being schooled.