This week, PositiveLite.com is focusing on Post-exposure Prophylaxis, or PEP — medication that can help prevent HIV after a possible exposure. Yesterday, I sat down with Duncan MacLachlan, the Director of Community Health Programs at the AIDS Committee of Toronto, to talk about PEP, its effectiveness and its availability. Join me today, as I have a conversation with Raj Singh, a Toronto gay man, who took PEP a year ago after a potential exposure to HIV.
John McCullagh: Raj, thank you for agreeing to talk with PositiveLite.com about your PEP experience. Maybe you could start by telling us a little bit about yourself.
Raj Singh: Sure, John. I’m a 40’s gay professional living in Toronto, where I work in the financial consulting industry. I moved here a few years ago from Europe where I had gone to university, even though I was born and brought up in India. I’ve managed to build a stable life for myself here — I love my job and I have a tight circle of friends whose company I enjoy.
So what was the incident that led you to seek out PEP?
Well it was a year ago, about midnight on a Saturday evening. I was horny so I was on one of those hook-up apps. I started to chat with this guy and the chat went well. He said he was having a couple of guys over and would I like to join them. I said okay but let him know I only play safe. He said, well, I’m partying and playing, would you have any objections? I said no but I’d like to stick with weed. He said okay. So I went to his home and sat down and I chatted with the other two guys that were there. I smoked some weed and they had some of the harder stuff and then we graduated to some kissing, caressing, foreplay.
Eventually we made our way to the bedroom and I started playing with one of the guys. And he turned me over and he started fingering my ass which I found hot. And then I got distracted by the other two men and then after a while I felt a little pressure and it felt really good — I guess the weed was really kicking in. After a minute or two I thought I should check to see whether this guy was using a condom. So I put my hand back, touched his penis and felt reassured — yes, I thought to myself, I think I did touch a condom. And then half-a-minute or so later I thought I should look and see, just to be sure. And when I looked around there was no condom. And I think for two or three seconds I froze and then just gently guided him out. And at that point after a second or two he looked at me and said, Well, should I use a condom?
I shook my head and said no. I was thinking to myself, okay Raj, make an informed decision. I replayed the entire sequence of events in my brain and I said, Raj, you’ve got to stop. I said to the guys that I thought I needed to go home right now. So I got dressed, rushed home and laid down. I was in a clear panic.
Because I realized this guy had actually fucked me without a condom, maybe not for too long. But the issue with transmission is never the length of the time, it’s the fact that it had happened without a condom. And you know, everyone always says it’s a low probability but low probability does not mean that the risk is not there.
So what did you do?
I immediately texted a friend of mine who works in the HIV-related medical field. I told him what had happened and he said, well, do you want to go to St Mike’s [St Michael’s Hospital, a downtown Toronto teaching hospital with a large HIV clinic — Ed.] and get PEP?
Did you already know about PEP or did your friend tell you about it?
I already knew about PEP. I consider myself a “normal” gay guy, however you want to define that, be it in terms of professional experience, my circle of friends, how I spend my spare time, etc. And I know that any one of us can be exposed to HIV as, sadly, it’s endemic in our community. Because of this, I think it’s vital that we educate ourselves about HIV, about how we can protect ourselves and what our options are should we be exposed to the virus.
So I already had that knowledge but my friend discussed it with me some more. He said if you go on PEP immediately for the next month you know that even if you were infected the infection would be killed off. On the other hand, if you don’t go on PEP and you take the risk it is true that maybe you haven’t been infected but if you were you would never in your life be able to turn back the clock. And that’s what really did it for me. My friend offered to come with me, so I called a cab and we went to the hospital.
How long after the potential exposure was this?
The potential exposure happened between 2:30 am and 3:30 am and we arrived at the hospital by about 5:30 am.
So less than three hours afterwards you were in the hospital emergency department.
Yes, and I went to the triage, it took maybe took 20 minutes, I waited maybe another 10 minutes before I saw the doctor. So I would say overall between the time of potential exposure and seeing the doctor, maybe it was three-and-a-half hours. And for me to take the first pill, which I was given at the hospital, another 20 minutes. So I’d say I took that first pill four hours max after the potential exposure.
That’s excellent! What kind of support did your friend provide you with?
Firstly, excellent medical advice, because he works in the field. He told me what would happen and it happened exactly the way he said it would. Secondly, he was reassuring, he held my hand and I really needed that physical support. And he sat in the room to support me while the doctor and I were talking together.
Not everybody has friends who work in the HIV sector, so do you think someone in a similar situation to yours should try to go to the hospital with a friend, even if that friend didn’t have the specific knowledge your friend had?
Absolutely. And I’d say it would be good if that friend was gay too, because he would be able to relate to the situation more easily perhaps than someone who was not. I think most sexually active gay guys can relate to something like this and it helps you to realize what happened to you isn’t extraordinary. It normalizes the experience.
How easy or difficult, though, was it to tell the doctor what had happened?
You know, John, I’m not one to be ashamed of my sex life, but when you’re facing a potentially life-altering event such as this, any feelings of embarrassment I might have had just melted away. As well, I knew this doctor was there to help and that anything I discussed with him would be held in confidence.
So, was the doctor you saw knowledgeable about PEP and did he treat you respectfully?
He was both respectful and knowledgeable and his advice was consistent with that my friend had given me. That all built up my confidence that I was doing the right thing.
Were you given a supply of anti-HIV pills at the hospital or prescription to fill at a pharmacy?
Both. I was given a starter kit for a few days and took the first dose at the hospital. I had to go back to the hospital a few days later to get the prescription for the rest of the month that I had to take the meds.
Now PEP doesn’t come cheap and, in Ontario, non-occupational exposure, such as you potentially experienced, is not covered by public or most private drug plans. So how much did you have to pay out-of-pocket?
I think I paid close to $1,000.
Did you find paying that bill financially challenging?
No, although I did find the price a little high. But I looked at it as an investment in myself, in my health.
What was your experience in taking PEP and did you have any side effects?
Yes, I had side effects and they fluctuated over the weeks I was on the meds. I had some body rashes but they went away quickly. I also experienced diarrhea, some nausea although I never actually threw up, and a lot of fatigue. Emotionally I was drained and didn’t sleep well for most of the time I was on the meds. I was still processing what had happened. I knew that by taking PEP the probability of any virus being killed was reduced but not eliminated. And because there wasn’t that 100% guarantee, the anxiety was eating me inside out. So I was tense, I couldn’t focus very well, I couldn’t relax basically.
Were you able to go to work?
I went to work, yes, but it was tough because I was demotivated because of my anxiety. But I’m lucky to have a great boss and I felt able to tell him him I was on some strong meds and that I may not be able to perform at 100% for the next few weeks and he was very supportive. As were the team members I work with.
Were your friends supportive?
Actually, I cancelled all my social life because I wanted to be home to be sure I didn’t miss any of my dosages. I had to take the pills twice a day and, with the help of two alarms, I was fully adherent to the schedule, although I think I may have been a little late on one occasion.
So you were alone the whole month?
No, besides the friend who went to the hospital with me, who remained a great support throughout, I also contacted another friend of mine, who also works in the HIV education and outreach field. When I called him up and told him what had happened he dropped what he was doing and immediately came over to be with me. And we spoke on the phone every day or so, so whenever my spirits were low he kept me motivated to keep taking my meds.
You were tempted not to take them then?
Yes, at several points during that month I really questioned if I could take any more of the dosage because of the fatigue, the nausea and the anxiety. The reality is I could not have managed without the support of those two friends. Words of gratitude don’t do justice to the great support they gave me during this stressful time of my life.
I take it that the subsequent HIV tests you’ve had have come back negative.
Yes, they have.
Good. So, Raj, I’m just wondering about what you think now about what happened to you that night you were potentially exposed to HIV. The guy you were with started fucking you without a condom until you stopped him. Whose responsibility was it, do you think, for what happened?
Well I smoked weed, as I said.
He was doing something stronger?
Yes, something much stronger. I realize that I had made a mistake by putting myself in that situation.
As we went into the bedroom I should have asked where the condoms were. Because when you say “Where are the condoms?” that’s a very non-invasive way of ensuring that the other person really understands that you’re only going to play safe. I hold myself responsible for that. But I also hold the other guy responsible. With the passage of time I can see a little more clearly what he did. And he was really young, 21 or 22, and I subsequently learned that that was not the first time he’d barebacked. We do make mistakes, especially when we’re younger. But I do not excuse myself from my behaviour either. In fact, after I got my first dosage, I texted him and said what happened was not right and I told him that I’d gone for a test, that I was on medication now and that I think he should do the same.
I don’t know.
Having had this life changing experience, what would you say, Raj, that you do now to reduce the possibility of being exposed to HIV a second time? Has anything changed, or what might be different for you now?
Well, for starters, I don’t feel like having anal sex right now but if I did I’d insist on using a condom. And also, since then, I haven’t been to another sex party. I’ve certainly been chastened.
Are you saying to me then, that you think that having threesomes or going with guys who are partying and playing is potentially risky for you?
Yes, it is, and I’m trying to avoid that.
Are you still having sex though?
Yes, because I’m not ashamed of being a sexual person. But I’m really clear of the importance of having sex in a safe way.
So, in the event you did have another exposure, and I hope you won’t, but we are all human, these things happen, would you take PEP a second time around?
You said that without hesitation.
Despite the side effects?
It seems like you had a good PEP experience, although it wasn’t without its challenges, but if you had a friend who thinks he’s been exposed to HIV and he came to you for advice, what would you tell him?
I’d tell him to take PEP immediately. I would do for him exactly what my friends did for me. I’d go with him to the hospital. I would call him every day. I would try be the pillar of strength for him that my friends were for me.
Thank you so much, Raj, for this.
And thank you, John, for allowing me to share my story with the readers of PositiveLite.com.
This interview has been condensed and edited.
Tomorrow, Daniel tells us how he sought out PEP after a condom broke.