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!

Dating on PrEP

[T-Plus 22 Days.]

So, I'm closing in on nearly a month on PrEP now, and the side effects have all but completely faded; add to that the snow day that I ended up with today, and I figured it was time to update my online dating profile. Mostly that involved tidying up bits that were old and outdated, like where I'm working, what my big goals are, that sort of thing. But I decided to add something to my profile that I hadn't had there before: my PrEP status. Check out the paragraph I added below (click the picture for a larger view):

I spent a lot of time thinking about it before I decided to do this; knowing the stigma around PrEP, I worried (I still worry, a little) that it might turn some people off of my profile. Across the community, there's still a really persistent myth that people on PrEP are promiscuous, unfaithful, irresponsible, etc.,... not things I want people to think about me when I'm looking for a date.

Except that picture is the furthest thing from the truth. If you've been reading the blog for a while, you've heard me say this before: I'm not an especially big risk-taker when it comes to my sex life. I've had plenty of partners, but I'm not spending all day every day on Grindr or SCRUFF, or out at the bar or bathhouse. To me, taking PrEP (and telling people that I'm on it on my dating profiles) is a really important part of NOT being risky. Sure it means that I can explore my sexual tastes and fantasies a little more freely, because I don't have to fear that I'm exposing myself to a very serious virus in the process, but it also means that I'm taking the fullest control of my safety and that of my partners that I possibly can. I think that's a really important thing to tell potential dates/partners/spouses: I care about my health, I care about your health, and I'm willing to be honest, even though that means being pretty vulnerable. I don't know about anyone else, but to me, that's the core of any good relationship.

So yeah, I put it up on my okCupid profile. Already, some people have responded, including one cute guy who happily even mentioned that he had no problem with me being on PrEP, and that he'd been thinking of getting on it himself.

Cheers, friends!

Busy Week, But Still On Track

[T-Plus 19 Days.]

I can't believe it's been nearly a week since I last posted! What a week it's been, too; between work, starting another semester of grad school, and adulting the crap out of my day to day chores and stuff, I haven't had a lot of time to post. I have been keeping up with my adherence thoough. Check it out:

Keepin' on track.

Bam! Okay, so the "monthly" adherence bit is a little misleading, since I started PrEP on January 12th, but still, even with a super busy week, I've managed to keep on track with my daily dose every single day so far. Being this busy has made me pretty thankful for that emergency pill bottle I put together, though! I refilled it twice this week; four out of the last five days I've taken my Truvada away away from home, whether at class, at work, or out with a friend. In class, I talked to my professor in advance, and just let her know that I had a medication I have to take at 7pm each day. She was totally fine with it, and I was able to take my pill in class on a break she offered right around dosing time (you can see it there on Thursday, in the picture above). So, pretty proud of myself for keeping on schedule. 

The funny thing is, getting myself organized around taking my PrEP every day has helped my adherence to my Lisinopril (a blood pressure medication) tremendously. Maybe it's just that the app is making me more aware of my dosing times, but I think there's more to it than that; I think that the motivation I've had to get and stay on PrEP has encouraged me to be more engaged with my health overall. It's a good feeling. So is having a consistent, guaranteed appointment for HIV/STI testing and labs - I've always been a fan of knowing about my health... and TERRIBLE at scheduling... so having something mandatory and predictable is fantastic.

Hey, and my side effects are just about completely gone! I gotta say, it was kinda crummy those first couple weeks, building up protection but not feeling good enough to, um, use  that protection. Look, I know what you're thinking, I can hear the "Truvada whore" comments starting to bubble up, but I'm being honest here; I want to get laid. Um, duh. Not crazy, run-to-the-bathhouse and f*ck ten guys kinda laid, but something. And it sucks not feeling like it. But two weeks worth of feeling a little off is nothing compared to the alternative. So, I'm not complaining.

Cheers, friends.

Calculating Risk

[T-Plus 13 Days!]

Normally I save these sorts of things for Truvotter PrEP School's Facebook page, and in fact it's up there too, but the tool I'm linking to below is really worth a look.

Gaily Grind Sexual Exposure Calculator

What is it? It's a calculator that estimates the number of people you've been sexually exposed to in your life. Remember, most partners that most people have been with have themselves been with some number of people before them. It's not shameful, it's a fact of human sexuality! It's an important thing to be aware of, though, because it says something about sexual safety and risk; namely, the more partners you've had, and the more partners they've had, the more likely you are to have been exposed to sexually transmitted infections.

All this doesn't necessarily mean that you have to have fewer partners! You can have as many happy and consenting partners as you'd like, as long as you're taking the appropriate precautions for the level of risk you're taking. In general, if you're engaging in riskier behaviors and/or with more partners, it's best to use more layers of protection - whatever options work best for you (and your partner). Regular testing should always be part of the equation, but beyond that, it's up to you.

This was a big part of my decision to go on PrEP, but also a big aspect of the stigma that's still attached to both HIV and PrEP, especially among the gay community. Many of you may have heard the term "Truvada whore" - a gay guy whose supposed sole goal for getting on PrEP is to go completely nuts and f*ck every guy he can find with no condoms. I'm a generally pretty quiet guy, but more than a few people have asked me outright if some version of that is why I got on PrEP.

The reality is that sure, there are probably a few people who get on PrEP mainly so they can spend all day at the bathhouse without packing a stack of rubbers. But so what? Sure, it's not the smartest move - PrEP only prevents HIV transmission, it doesn't touch syphilis or herpes or gonorrhea - but that person is still taking some responsibility for their sexual health and that of their partners. If they're being adherent to their Truvada, and getting their regular tests, then they can be pretty darn sure they aren't becoming positive, and that means that their partners aren't either.

Besides all that, though, the reality (at least that I can say anecdotally) is that the majority of people who get on PrEP are already looking out for their sexual health in one way or another, and are simply looking for a greater degree of security. I personally don't take a whole lot of risk in my sex life (I've had plenty of partners, but I generally insist on condoms, I talk about safety with them, etc.,) but for me, PrEP is still important. The risk of becoming HIV+ is a reality in the world today, especially for sexually active folks. I chose to get on PrEP because to my mind, my level of risk was enough to make it worth it. Given that it's free (for me, so far), and that there's work still to be done before we reach a cure, I feel an obligation to take this level of responsibility to look out for myself and whoever I sleep with.

Thanks for humoring my little soapbox here - I knew the myths surrounding PrEP going in to this process, but it's been fascinating and a little frustrating sometimes to encounter them face to face.

Cheers, folks!

Day Twelve - Protection Up, Side Effects Down

[T-Plus 12 Days.]

Twelve days in now, which means I'm getting close to half way through my first month on PrEP. I've taken my doses on time (well, within about 45 minutes of my alarm) every night so far, and at this point I should be very, very protected from infection; for the most part, things have gone smoothly, but the nausea I was experiencing at first lasted a bit longer than I expected, and I've gone for about a week with some mild indigestion. Not fun, but not debilitating at all, and my appetite has been fine. On the upside, it's been getting better daily, and my doctor explained that most side effects pass within a month.

In terms of adherence, I've been digging into the MediSafe app I've been using a little more. There are several handy features that I've found beyond the ones I described in my previous post; you can see a lot of those features in play in the picture below:

MediSafe adherence app.

There are a few things going on here. The app tracks my medications in a virtual "Pill Box" each day. If I click on a medication, I see a box like the one pictured above, displaying the next scheduled dose of the medication that day, dosing instructions/preferences, the number of remaining pills (which I've set in the Profile portion of the app), and when I have my refill reminder set (in about two weeks as of this posting). The app also lets me enter my prescription numbers, which is handy when I get texts from my pharmacy for automatic refills, since that's the only identifier I gen in them.

I haven't had to use a pill from my emergency stash yet, but I expect I will soon; I'm taking an evening graduate course each week this spring, and it generally runs past my dosing time. I could wait until I get home afterwards, but I'd rather stay as consistent about my timing as possible, so my plan is to speak with the professor and ask permission to step out for a moment each night. I don't need to tell her what specifically I'm taking, but I can explain that it's an important, time-sensitive medication. Schools in the United States are generally expected to make minor accommodations for health and wellness, so this should be adequate. If you're a student as well, don't be afraid to ask for permission to go take your PrEP when it's time! It only takes a moment, and by speaking with your professors, you should have no trouble keeping your dosing schedule punctual and consistent.

Cheers, folks!

Day Eight - First Week of Protection

[T-Plus 8 Days.]

Eight days and eight pills in, and I think I'm starting to get myself on a routine - I've been using my app to track my adherence (it's actually kinda satisfying to be able to look back at see "100% Adherence" on my medication report), and so far I've managed to take my meds within about 30 minutes of the reminder I set (currently 7pm, or right around dinner time so that I have something in my stomach when I take my dose).

Truvada doesn't have to be taken with food - Gilead points out that "food does not affect how Truvada works" - but upset stomach is one of the most common side effects of the medication, and I have a sensitive stomach, so I'm all about taking precautions - remember, if you throw up a dose you just took, that dose is lost. If you caught some of my previous posts, I had a couple of rough mornings a couple of days in (this past Friday and Saturday) when the nausea was worst, but since then that's passed, and this morning I felt pretty normal (for whatever that's worth...).

So now the trick is gonna be keeping up this new routine; I'd like to be able to go into my first follow-up appointment having taken every one of my pills on time. This has a couple benefits for me: if nothing else, it means I've been as protected as I can be for the entire past month, but besides that it also tells me that my kidney function labs (which they'll draw at that first follow-up) will be as accurate as possible. It doesn't seem likely at this point that the Truvada has been hurting my kidney or liver function (I'm not experiencing jaundice, or any other sign of renal failure), but ya never know until you check.

Week one of meds went great - here's hoping the first week of protection goes at least as well.

Cheers, friends!

Day Six - Achieving Protection

[T-Plus 6 Days.]

Took my sixth pill last night, which means today is the sixth full day of Truvada (PrEP) in my system. This means that sometime between today and tomorrow, I should reach the peak level of Truvada in my system, and thus peak protection from HIV infection (current research suggests it takes about 5-7 days for the body to build up enough of the meds to provide maximum protection). So, um, woohoo! 

This is why keeping up my adherence is such a big deal though. I know I said it repeatedly in my last post, but I don't think I can emphasize enough how important it is to take my PrEP every single day. Because a level of the meds persists in my system for a while, I can miss a dose here and there and still be well-protected, especially once I've been taking it for a while. This is a good reminder that I don't have to freak out if I forget a dose from time to time, but it's not an excuse to be bad about my dosing! It's really easy to get "too busy" or whatever, but if I'm missing too much, then I'm not protected.

So I've taken up a couple of habits to try to keep my adherence up:

First off, I downloaded an app that helps me track my meds and my adherence. The one I opted for is called MediSafe, but there are loads of others (perhaps sometime soon I'll start assembling a list of other apps in the Resources tab).

Pictured below, MediSafe allows folks to do a number of things that help stay adherent. When you first open it, it asks for a list of your medications, as well as their dosing instructions. You can edit this list whenever you want, and it also lets you add medications you take "as-needed", such as aspirin or antacids. After that, you have your daily "pill box", which displays all of each day's medications, quartered off by time of day that they're supposed to be taken. Each medication that you take on a regular basis comes with a reminder, and those reminders can be customized; I personally love the Star Wars-themed "medtone". Over the course of time, MediSafe tracks your adherence, and it can generate reports in a couple formats (including Excel spreadsheets) that you can export and email to, say, your doctor.

MediSafe adherence tracking report.

The second thing I did was to make an emergency to-go bottle of my most important medications, so that I always have some doses with me - there's always the chance that I'll spend the night at somebody's place... or maybe work really late or something. I used a small pill bottle from an old prescription, and taped my own label over it with a list of the medications in there and their colors (I suppose that's a little bit obsessive, but I want to be sure that the pills aren't mistaken for something else if it's ever found by, say, airport security or something). You can see a picture of it below.

  

My emergency to-go medication bottle.

So that's it for now. I've been spot-on with adherence for the past week, and hopefully I'll stay that way. I had a couple of rough patches in the mornings on Friday and Saturday (I got pretty nauseous both mornings, but both days it went away within a few hours, and since then it's been getting easier each morning). I'll check in again soon. If you're reading this, please feel free to post comments and questions - I'd love to answer what I can!

Cheers, friends!

Two Days In - Pill Three Mini-Post

Update - I took my third dose of Truvada tonight. So far I've taken it with food, but tonight I didn't think, and took it before dinner. That was definitely a mistake - the really mild upset stomach I had all day kicked up a notch or so tonight while I was having dinner with a friend. Don't worry, nothing bad happened, but my appetite dropped, and now my stomach's pretty twisted up. Boooo! So um, food before PrEP from now on, definitely.

Two Days In - Side Effects and Adherence

[T-Plus 2 Days]

Two days and two doses into my first month of PrEP today. I took my first dose the night before last, and yesterday was pretty normal - no headache, no nausea. I thought I might have gotten a little dizzy that first evening, a couple hours after I took my first dose, but it could have as easily been that I was just tired.

Today was a slightly different story. Took my second dose last night (no dizziness afterwards), and woke up this morning with a slightly sour stomach. It wasn't much, just a little a little extra rumbling and a little lower appetite (which came back fast a couple hours later). The indigestion has persisted through the day, but it's still low-grade, and doesn't seem likely to get any worse.

My doctor prepared me for this possibility (and of course I had done my research about side-effects in advance); my doctor explained during my most recent appointment that if I experienced any nausea after starting PrEP and was concerned about it, he could prescribe medications to help. So far, I don't think that's going to be a concern, but it's good to know that there are options. As it is, my doc and my research all explained that typically any side-effects don't generally last more than a month.

It's really important to note here that if you're taking Truvada (for PrEP or otherwise), you should always consult with your doctor before adding another medication, including over-the-counter meds and even for side-effects. This is because Truvada, as with many meds, has some potential interactions with other medications (though in the case of Truvada, those are fairly few). A doctor familiar with your health and medication history can suggest the best options depending on the side-effects you're experiencing.

Okay, so I'm coping with the minor side-effect. Next step is adherence.

[Adherence describes how consistently a person takes their prescribed medications or treatments on-time. In this situation, "on-time" is generally accepted as being within two hours on either side of one's regular dosing time - so if you take your medication at 9pm normally, then as long as you're taking your next dose between 7pm and 11pm, you're considered on time. If you're consistently taking your doses on time, without missing, every day (in the case of Truvada), then you're considered fully adherent.]

Adherence can be tough. Life gets freakin' busy sometimes... which unfortunately means that things get forgotten, including medications. I've been guilty of this plenty - I'm supposed to take a blood pressure medication every day, but for a long time, I'd miss or nearly miss as many as a few doses each week. Not good. For both the blood pressure meds and Truvada, I need to have what's called a "therapeutic level" of the medication in my system for it to be properly effective. In the case of Truvada for PrEP, the more doses I miss in a week, the less protected from HIV I am. So yeah, adherence is super important.

Right now it's early in the process - I'm still pretty excited to have gotten on PrEP (I think I will always be amazed that I live in a time when something like this is even available) - so my adherence is probably going to be great at first. It's fresh in my mind, too. The bigger deal is keeping that up, because as I said before, the more I miss, the less protected I am. Perfect adherence is the goal. That doesn't mean I can't miss sometimes (it's pretty likely I'll miss a dose eventually), but I've gotta try to take it as consistently as possible. As it is, my doctor explained that I won't have a protective level in my system starting off for somewhere between five and seven days, so I really can't miss early on.

There are lots of ways to help with this. One suggestion I've gotten repeatedly is to use a weekly or monthly pill box; this lets me parcel out my meds for easy access, but also has the benefit of letting me track missed doses easily. The problem is I'm terrible at keeping up with those, not to mention I like having my medications in their bottles so if I have to travel with them, they're right there with all of the important prescription information. Other folks have suggested using a calendar near where I store my meds, but I'm terrible with (paper) calendars, too (you should see my office at work - I think the wall calendar there is on September of last year...)

The best bet for me has been to use either a reminder in my phone, or an app that lets me organize my meds. Both work really well for me, especially since I keep my phone with me more than any other calendar. For me, the apps are best, because they allow you to track missed doses in the same way a real pillbox does, but of course you should find a system that matches your schedule and preferences; the apps offer the most detailed adherence tracking, and can even let you transmit that information to your doctor, but as with any digital medium, there are potential privacy concerns that might turn some people off of apps. Whatever system works, take your meds!

And that's it for now. I'll check in again in a couple of days - with any luck the upset stomach will have faded by then!

Cheers, friends!

T-Minus NOTHING!

[T-Minus 0. ZERO!]

Cheers, friends!

So, in many ways this post is long overdue; I even considered splitting it into parts briefly. A lot has happened since my last post!

Alright, so last week I snagged a Gilead copay assistance card (you have to get one and activate it beforehand, so that when you go to pick up your script, they can apply the additional assistance). Of course, I promptly forgot that I took one, and so it lived in my bag, totally inactivated, until yesterday. Yeah, I'm a horrible procrastinator. 

SO, yesterday I pulled it out and finally called. The process was super easy - a series of automated menus, and a few prompts for my name and phone number, and then it was active. Easy! The whole process took me about 7 minutes. I'm so glad I did it, too - but I'll get to why in a second. There's one really important thing to know about the copay assistance program: it is not available for people on Medicaid/Medicare, or anyone receiving any sort of state or federal assistance (such as participating in a state-run Drug Assistance Program). Gilead's program is specifically designed to make their medications accessible for those who can't get other assistance - those without insurance, those whose insurance doesn't cover Truvada (or does, but at an extremely high copay, as mine does), and so on. Make sure that you know all of your options for assistance before you plan to start filling scripts - there is no reason that any person should not be able to get Truvada for PrEP (or for HIV treatment) because of cost. Period.

Okay, so copay assistance card, check. That done, I went to my follow-up appointment with my doctor yesterday afternoon. I'd already gotten the results of my initial labs (an HIV test and liver and kidney function panels), which all looked good (no HIV, liver and kidneys doin' their thing), but in order to get on PrEP, standard practice is to perform a follow-up (confirmatory) HIV test. They took some blood, and I headed home; my PCP had explained that he should have the results the next morning, and that if they were clear, then he'd call in the prescription. 

This afternoon, I got a text from my pharmacy that I had a prescription waiting. When I got off of work, I ran over and picked up my prescription (copay card in hand). Remember I mentioned that I was really glad I'd activated that card? Well, the reason why: my prescription was free. Yep, totally free... after insurance and the copay assistance, I walked out the door with a month's supply of HIV prevention with as much little money as I had when I walked in.

Not everyone is going to get their meds for free - even the best insurance and discount programs have some limits. I have decent insurance, so my copay was high, but still low enough to be completely covered by the copay card. Still, given the variety of programs available, there are options to make Truvada affordable for virtually anyone.

Well, so there it is! I took my first dose tonight with a glass of chocolate milk (Truvada can cause nausea for some, so many people recommend taking it with food). Over the next several days, I'll update y'all about my experience beginning to take PrEP, especially any side-effects.

Cheers, folks!

Happy New Year

[T-Minus 7 Days!]

Well, it's 2016... Happy New Year! Sorry for the brief pause during the holiday season, but this otter's back in business, and down to ONE WEEK until I get my first PrEP prescription! This is, of course, dependent upon my confirmatory negative HIV test, but I'm feeling pretty good about that - this has been a pretty tame holiday season, all around.

Still, one week til I get my first script means that I have some serious preparing to do. First of all, I need to think about cost. As I've mentioned in the past, Gilead has a fantastic copay (and even retail-cost) assistance program, which will help me defray some of the costs of the prescription. but it's best to get that all set up well in advance of trying to fill your script. I haven't actually called yet, so that's going to have to be my main priority this week. Besides that, it's relatively smooth sailing, until I actually start the meds in about a week. Then... we'll see! Most people don't report a lot of side-effects, but they're certainly possible. I'm a little anxious about it, but not enough to stop this process, for sure!

Over the next few days, I'll detail the process of getting signed up for copay assistance and what covering the cost might look like.

Cheers, friends!

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