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Revolving Door

Nov26

The case for PrEP, or how I learned to stop worrying and love HIV-positive guys

Wednesday, 26 November 2014 Written by // Guest Authors - Revolving Door Categories // As Prevention , Gay Men, International , Treatment, Living with HIV, Opinion Pieces, Population Specific , Sex and Sexuality , Revolving Door, Guest Authors

From Seattle's The Stranger, Evan J. Peterson says “Taking Truvada changed my life. No, really.”

The case for PrEP, or how I learned to stop worrying and love HIV-positive guys

Levi Hastings

This story by Evan J. Peterson first appeared in The Stranger here. Copyright material reproduced here with the specific permission of the author. 

The pills are sky blue. Large, but not horse-sized. The corporate stamp, GILEAD, is printed on them in all caps.

Holding the bottle, I wonder if I'm ready to take it. I've read the list of potential side effects—mainly liver damage and bone density loss. My friends who've been on the drug for over a year have experienced neither. I've heard the rumors that taking this will influence me to stop using condoms and start screwing the whole touring cast of The Book of Mormon. It has taken me several months to get these pills—for free, thanks to a combination of insurance and Washington State's drug-assistance program—and there's something unreal about finally holding them. Holding the "miracle" HIV-prevention pill, Truvada.

My daily Truvada regimen is called PrEP, or Pre-Exposure Prophylaxis. That means I take it now, while I'm HIV-negative, and it prevents infection if I'm exposed to the virus. A single Truvada pill is actually a combination of two drugs, tenofovir and emtricitabine, which block reverse transcriptase, an enzyme that allows the virus to multiply. They essentially stop the virus from reproducing in the body. Truvada is also commonly prescribed as part of PEP, or Post-Exposure Prophylaxis, for people in the immediate aftermath of HIV exposure who want to prevent the virus from taking hold in their body. And it's effective at treating people who are HIV-positive, in combination with other drugs. My neighbor has been on Truvada to treat his HIV for years. He's healthy and strong and grateful to be alive. This is not a new drug with unknown side effects.

There's been far more controversy about Truvada than is warranted—most of it speculation, superstition, and sex shaming. The term "Truvada whore" gets tossed around ironically among gay men, and unironically among people who like to criticize gay men. For PrEP, Truvada is prescribed to be taken daily. Naysayers have claimed that the daily dose is an unreliable expectation because they know gay men, and we won't take it every day. They also claim that it's on its way to being treated as a sex-binge drug alongside meth.

To these folks, I can only offer my most considerate "Fuck off."

Everyone I've asked takes it every day, and I know a lot of people who take it. But even this daily regimen is now in question—just a few weeks ago, news broke that you may not have to take it every day. According to research conducted in the French IPERGAY trial (which also studied participants in Canada), Truvada is highly effective when taken just 24 hours prior to exposure to HIV and then again in the days following exposure. So effective, in fact, that researchers canceled the blind portion of the trial early and put everyone who was on placebos on Truvada.

This is an amazing development. The daily regimen is fine for people who are frequently sexually active, especially those in relationships with an HIV-positive partner, but not everyone is. And what about when we surprise ourselves? A sudden encounter with a still-affectionate ex-lover? A brief sign-on to Grindr, just to "see who's around"? For heaven's sake, Halloween?

The point is, whether you're taking PrEP vigilantly every day or less frequently, it's highly effective, and even more importantly, it's nobody's business how you take your medicine, other than perhaps the people with whom you're having sex.

I grew up at a time in which HIV was every bit the "death sentence" that we now affirm it's not. This is why I'm staring at the bottle of Truvada, still in mild disbelief after several months of waiting to get it. I've told my new HIV specialist, Dr. Kathy Brown, that I've dragged my feet on getting the preliminary blood tests to clear me for my prescription. I've done this because part of me still doesn't believe that I can take one pill every day and be protected from HIV. It still feels like science fiction.

It's not science fiction, though. These sky-blue pills are here, and they work. They've been working for years, but it's only lately that the public, even the gay public, has heard much about them.

On second thought, they aren't sky blue, they're more Smurf-blue—candy-like and cartoonish. Pretty nonthreatening for something rumored to soften my bones, damage my liver, and transform me into a sex-starved orgy queen.

I swallow the first pill. The coating is just a tad sweet.

I remember the first conversation I ever had about PrEP. It was on the dating app Scruff. A guy who identified himself in his profile as RN mentioned being "on PrEP" and told anyone who had questions to ask away. We talked quite a bit about it, in between flirting. Now I'm the one inviting questions about PrEP on my Scruff profile.

To get cleared for a PrEP prescription, I had to show a negative HIV test, so I went and got tested for HIV as well as several other STIs. Just fine. I also got tested to make sure my hepatitis A and B vaccinations were still effective, as Truvada can work against treating hep B if it is taken but then improperly discontinued. That was almost a month before I finally got the pills into my hands. Dr. Brown and I agreed that I should get one more HIV test as I start taking the pills, just in case. Truvada by itself, without other drugs in combination, can make HIV harder to treat. For those without HIV, only Truvada is taken to block infection.

As my blood filled the collection vial, I thought about my first HIV/STD test in Tallahassee, Florida. I was 18 and terrified; the second person I ever hooked up with had done things I didn't consent to. I went to the health department and got tested for everything they would test me for. When I got my negative test results back, I was ecstatic.

This is a virtually universal experience for gay and bi guys who get tested. The nervousness of making the appointment, the anxious nausea of waiting for the results, possibly even feeling judged by the medical staff. Judging ourselves. Then, a few months later, we do it all over again. The trepidation of getting an HIV test, followed by the relief of a negative result, has faded for me over the years. There's always a faint and ominous shimmer of what-if, but in general I just go in, get the finger or arm poke, and move on.

While waiting for the results of the HIV test administered a few days after I started taking Truvada, I thought about how far I've come, how diligent about condoms I've been, how many awkward conversations I've had with new partners. I always be sure to ask how recently they've been tested, and for which things, and what the results were. But still: When to ask? Before we start kissing? After we're down to our underwear? How do you make an HIV-positive partner feel truly respected when he discloses his status, if you don't have the same status as he?

A few days after they took my blood, I clicked the "lab results" link on my Group Health online profile—the first time I've ever been able to check my HIV test results online. It felt strange. Extra vulnerable. I was home and alone. If I were to test positive now, on the verge of being possibly impervious to HIV—well, that would be a bitter irony.

My HIV test came back negative. I cried.

I was born in 1982. I have lived my entire life in a world in which AIDS exists and is a sex-borne bogeyman ready to "get" me. HIV was nearly a phobia for me early in my adult life, and my safer sex practices were hyper-vigilant.

My earliest memory of someone using the word AIDS in front of me was my best friend, Tony. We bought and shared a soda with some other boys in the neighborhood. When one of them hesitated to drink from the same bottle, Tony said, "Why not? I don't gots AIDS. Evan don't gots AIDS," as though it could be spread like a terminal flu. We were 9.

The first day I took PrEP, I had to use the toilet four times in the first four hours, and then that was it for physical side effects. It's now been three months since my first dose. I'm not entirely out of the woods as far as tracking side effects, but I feel great. I have a rather sensitive digestive system, and I had feared weeks or even months of stomach pain, nausea, and diarrhea. What would even be the point? I don't even want to cuddle when I'm sick to my stomach.

But that's not what happened.

I have only talked to two guys who've had digestive side effects. The side effects that my friends and I have noticed have been more psychological/behavioral. My buddy Scott, a 33-year-old shamanic practitioner who does god knows what for the corporate sector during the day, told me that his behavior has shifted significantly since getting on PrEP a year ago. Scott told me that he initially had fewer sexual partners than usual once he got onto PrEP, but now he has more. Scott and two other friends have formed a little PrEP tribe amongst themselves. While they do have sex with others, the three of them all take PrEP and have unprotected sex amongst themselves. He invited me to try it out, but I'm a little shy about group dynamics like that. I'm less sexually adventurous than I'd like to think.

Over brunch at a precious little diner in Burien, Scott told me that his doctor said plainly that Scott can have unprotected sex with an undetectable HIV-positive partner while on PrEP without the risk of transmitting HIV. "There's another level of okay-ness with having a long-term, HIV-positive partner that wasn't there before."

As adventurous and open about his sexuality as Scott is, he didn't want his last name to be used. He has concerns about social stigma toward himself as well as his partners that may result from being publicly identified as being on PrEP and having unprotected sex. This was common among those I interviewed, because there is still a culture of judgment and finger-pointing about gay men's individual sexual decisions, probably left over from all the infighting and outside commentary about our sex lives in the 1980s and 1990s.

Once, condoms and abstinence (and some creative kink) were our only weapons against HIV. During a deadly epidemic, condoms and abstinence were the only solution, but these were always supposed to be temporary. Condom vigilance was knocked into our heads with croquet mallets, and the community is having a lot of difficulty getting over this. There are so many clinging to the idea that condoms are our only defense in sex, and that a choice to use PrEP instead could doom us all.

My own doctors have emphasized that being on PrEP is not a reason to stop using condoms. Truvada indeed blocks HIV if used appropriately, but that's as far as it goes. I may now be protected against HIV, but if I don't use condoms I'm still vulnerable to gonorrhea (now available in an antibiotic-resistant form!), syphilis, hepatitis, herpes, crabs, etc. Some guys keep using condoms on PrEP, some don't; the ones that don't are still staying HIV-negative when they use the drug as prescribed, even if they're catching everything else.

Several of my friends on PrEP have had no reported change in their behavior since starting Truvada. Stephen Mills, a 31-year-old poet and author in New York City, told me that he and his partner continue to make the same choices they did before getting on PrEP, but he likes knowing that he has extra protection. He and his partner currently have an open relationship, but that started long before they got on Truvada. They continue to use condoms for casual partners but not with one another.

"[PrEP] provides a safety net if there are ever any slip-ups," Stephen told me. He and his partner pay for their PrEP with their insurance, and then Gilead's own assistance program covers the remainder of the cost. Stephen has experienced no side effects.

Like me, Stephen feels called to be a PrEP activist, especially as a writer. He's been "extremely disappointed in many members of the gay community" who have "spread completely untrue and unfounded claims. I did my research carefully before choosing to [start PrEP]."

"We have to educate people... We've been telling people to use condoms for years, and it hasn't completely worked, so why not offer something else?"

Another friend, Joshua, let me in on the fact that while there's a lot of caution in the United States, British, French, and Canadian research supports 100 percent effectiveness for Truvada. As shown in the latest IPERGAY study, we're still finding out how frequently or infrequently it can or must be taken to be 100 percent effective. Josh is of the opinion that American doctors are so ultra-cautious about malpractice lawsuits that they tend not to disseminate information that isn't completely approved by the CDC and FDA. Having read these studies, I believe that if I'm on PrEP and my partner is poz-undetectable, I am completely protected from contracting HIV, condoms or not.

My doctors and friends have often been surprised to learn that before getting on PrEP, I had never once had intercourse without a condom. I never got far enough into a relationship to feel right about not using condoms. I even used condoms for oral sex until I was about 20. That eventually became tedious, so I did some research on risk factors and made my own choices.

As I entered my 30s, I suddenly found myself surrounded with openly HIV-positive people. The dating apps especially showed the commonality of HIV, as well as how up-front many poz guys are being by putting the + symbol in their profile name. I didn't begin dating HIV-positive guys until last summer, a year before starting PrEP. Before then, like many HIV-negative gay guys, I couldn't get totally comfortable with the idea. I was vigilant about safer sex, but I had additional concerns: What if we fall in love long-term, and then he has a complication with his medicine and dies when we're still young? I'm sentimental, so I have overblown concerns like this all the time. I've since been educated and learned that poz people who take their HIV medication diligently have the same life expectancy as everyone else, provided they begin taking their meds early after infection.

When you've been a hypervigilant person who grew up in a world in which AIDS always existed, and you're suddenly faced with the fact that many of the guys you're attracted to are poz, you go talk to an older gay guy.

Or at least I did.

My mentor Everett Considine was the first person to encourage me to date HIV-positive guys. Everett and his husband are both HIV-negative, but his previous long-term partner was poz. Everett told me that, if I did indeed want to find a lasting relationship, I was overlooking a huge swath of very worthy gay and bisexual potential partners by avoiding poz guys. I sat in Everett's office, with counseling-office soft lighting, trying to wrap my brain around his advice. He told me that in his own experience, poz guys have tended to be more responsible, more diligent about their health, and better in bed. We talked extensively about what undetectable means statistically (it means that levels of HIV in the blood are so low that transmission is virtually impossible). Undetectable plus condoms equals an infinitesimally small chance of infection. To say nothing of undetectable person plus person who's on PrEP, although this was before I ever started PrEP.

After leaving his office, I began the same day to search for profiles with a [+] sign on Scruff. I immediately found Nick.

Nick is tall, dashingly handsome, strong, and very smart. I enjoyed chatting with him, so we made a date. We took a walk around the lake, then got hungry and decided to have a picnic. I noticed that his eyes are different colors. He noticed that my tattoo is in Hebrew. The attraction was building, and we lay down together in the grass and looked up at the summer clouds. Then I kissed him. Then we went back to my house and did it for two hours.

Dating Nick was wonderful. This was the first time I didn't allow someone's HIV status to deter me from a romantic connection. I still had reservations about some aspects of sex, but as far as being openhearted to the possibility of falling in love with someone poz? I was all about it.

This went on for a couple months, and eventually Nick told me that it wouldn't become serious. He's a staunch atheist, and I pray. That didn't matter to me, but it did to him. Oh well. After that dissolved, I didn't date or hook up with anyone until I met Kent at a Halloween party. Kent is quite the fashion plate, and he wasn't in costume, just dressed in a smart suit. I was in full costume and makeup as a Cenobite from Hellraiser. I was afraid to get too close to him, lest my stark white makeup and fake blood stain his beautiful suit. He made out with me anyway, for quite a while. So I took him to my place.

On the way to the car, he said, "I should tell you—I'm poz, though I'm undetectable."

I let him know that this wouldn't stop me from hooking up with him. He even helped me scrub off all the white grease paint and fake blood in my rather small shower.

Kent became a regular sex buddy, and a year later, we're very close. We never explored being boyfriends for a few reasons, but none of those is HIV. Ironically, now that I'm on PrEP, we rarely hook up, but we were always safe when we did.

In response to finding out that I have been dating poz guys intentionally, Dr. Brown brought up the term "sero-sorting" at my recent visit. The term means asking one's sex partners about their HIV status and making choices accordingly. While the traditional sorting practice for HIV-negative people has been to only have sex with HIV-negative partners, Brown's gay male patients are starting to report the opposite. With the rise of the "undetectable" HIV category, contracting the virus is statistically much lower-risk when intentionally having sex with an undetectable poz partner than it is when having sex with a partner who thinks they're probably HIV-negative but isn't 100 percent sure.

I am one of these new, inverse sero-sorting queer men. I feel safer having sex with someone who is poz and undetectable and who is vigilant about taking his pills daily. With PrEP, I now have even more peace of mind about sex.

Unfortunately, people who aren't on PrEP are experiencing less peace of mind about others' choices. In November 2012, David Duran, an HIV-positive journalist, published an article in the Huffington Post actually titled "Truvada Whores?" In it, he denounced the perceived-risky choices of many who were clamoring to get on PrEP. Adam Zeboski, a gay, 26-year-old HIV testing counselor at the San Francisco AIDS Foundation who is on PrEP, read Duran's post and reappropriated the term, turning #TruvadaWhore into a social media meme about empowerment and solidarity. Now #TruvadaWhore is a rapidly growing campaign with a Facebook page. Zeboski has become the movement's leader and poster boy, and Duran has since recanted his original position. Zeboski told me that he and Duran have reconciled.

Zeboski began following me on Twitter and favoriting my #PrEP posts the day I began tweeting my daily side effects (or lack thereof). I joined his group on Facebook and began talking to other guys about their experiences.

"I've only had amazing side effects, like no more anxiety about sex, more fun, more intimacy, more connection, better relationships," says Zeboski. His condom use is inconsistent, but he believes "condomless sex on PrEP is safer sex." He's been on PrEP since November 2012, and he receives the drug at no cost through his Kaiser insurance and Gilead, who supplements his co-pay.

Roger Klorese, a 58-year-old, queer-identified Seattle man in a sero-discordant same-sex marriage, told me that he did have mild digestive discomfort for the first two weeks, but that these symptoms quickly abated.

Like many of the #TruvadaWhore guys, he's in staunch support of Truvada. "Had this pill come along in 1984, or 1994, many of our friends and lovers would have taken it in a second, and would be here with us today... Given that, the rest of the debates are absurd."

Luke, a therapist working in San Francisco, told me that he is finding his patients in sero-discordant relationships (i.e., one partner is HIV-positive and the other is HIV-negative) are likely to use PrEP now instead of condoms, which some patients considered "literal barriers to intimacy."

However, this is not the case with all his patients. "Many of the patients with whom I work have been using condoms more since going on PrEP... Part of their strategy has also been more open discussion with partners about testing and treatment, status and viral load, etc. ...Most of these patients were not using condoms at all before."

One trend I noticed among every man I interviewed: They're all invested in conducting their own research to make educated choices about their sexual health. They're informed.

Eric, a musician in an open relationship, was happy to be interviewed, but didn't want his full name used. "There is such an odd backlash against guys on PrEP... People are calling it the 'whore pill.'"

Eric's doctor, who is also gay, told him that guys on PrEP are actually quite likely to continue using condoms. The fact that Eric's doctor is gay is part of another pattern worth pointing out. Scott's doctor, the one who said he could have unprotected sex with poz-undetectable partners while on PrEP, is gay. To me, this indicates not only that gay people tend to prefer to have gay doctors (duh), but that gay doctors are more PrEP-savvy than many straight ones.

The #TruvadaWhore Facebook group requires approval to join and post. This is fair considering the flame wars happening on the net about PrEP and sex. I received a bit of verbal shaming when I decided to post on Facebook about my choice to get on PrEP.

I decided to "be the change" I want to see in the world and put on my activist hat.

One acquaintance whom I never see in person felt the need to question why I would announce such a thing on Facebook. A closer friend in New York City, who tends to be Polly Pessimist in general, commented that while he supports my decision, he would never take this pill because he doesn't participate in "high-risk activities" and doesn't support what he described as an American obsession with overmedicating, which struck me as rather self-righteous and not-so-subtly prejudiced against poz people.

Me? I do participate in "high-risk activities," since protected sex with HIV-positive people is commonly considered "high-risk."

The other reactions were pretty much as expected. Most friends and family, straight and queer, conservative and liberal, were supportive and encouraging. Some made sure to remind me to "be careful," which is the well-intentioned common response when a gay man—or, for that matter, a straight woman—mentions that they intend to have sex. Several middle-aged friends and family, survivors of the AIDS crisis, cautioned me to be wary of side effects. The generation that came before me is still reeling from the nasty complications of AZT and the other early treatments, but they supported my decision.

Except, of course, for my aunt.

She helped raise me, instilling values I stand up for, including my decision to become an activist for PrEP. She told me, fearfully and without a shred of sarcasm, that HIV does not cause AIDS—that AIDS is a hoax to sell pills and kill gays.

When I was about 18 and becoming sexually active, she sent me a book called What If Everything You Thought You Knew About AIDS Was Wrong, written by Christine Maggiore. Maggiore wrote somewhat convincingly that HIV is a harmless virus, while AIDS is actually the result of drug abuse and curable diseases that result in a severely weakened immune system. This was definitely food for thought to my impressionable young mind, but not enough to convince me to stop caring about HIV.

I'm glad I didn't get on that bandwagon. Maggiore recently died of AIDS-related illnesses, the kind that only kill people with severely repressed immune systems. She was wrong, and she died. So did her HIV-positive toddler.

My aunt called and left me a voice mail cautioning me not to take Truvada, saying that she'd read the side effects online and was seriously spooked. She asked me to call her as soon as I could. It got to the point where even my mother was calling to ask if I'd called my aunt yet.

Finally, I called. My aunt told me that she doesn't even think HIV exists, because it doesn't stand up to Koch's postulates, criteria developed to establish the relationship between diseases and the microbes that cause them. She asked me to promise to read about Dr. Peter Duesberg, a tenured professor at UC Berkeley, who has made outstanding breakthroughs in cancer research. In my non-expert opinion, Duesberg is a quack. He hypothesized that HIV doesn't lead to AIDS, but that hypothesis isn't why I call him a "quack"—I support dissent and scientific radicalism. The reason I think he's a dangerous fool is because I read his website, particularly the FAQ, and he claims all sorts of logical fallacies in his public statements about HIV and AIDS. It's abject hogwash.

My aunt's trepidation is mostly compassionate. She cares passionately about marginalized people, gays in particular, and she loves my sister and me as the children she never had. I say she is "mostly" compassionate because I don't believe that she's putting my autonomy before her own fear and convictions.

I kept my promise. I looked up Duesberg and read his ugly website. I then called my ex-boyfriend Lane Rasberry, a Wikipedian specializing in public health information. If anyone I trust intimately is up-to-date on HIV knowledge, it's Lane.

He explained Koch's postulates to me and how HIV is tricky enough to require extra measures to apply these standards. This is why there's room for AIDS dissidence, as illogical as it is. Further research convinced me that Koch's postulates have indeed been fulfilled for HIV.

My aunt is still angry about how the CDC handled the AIDS outbreak. She's still angry that some of her friends died from taking AZT prescribed to them by straight doctors before they were even tested for HIV. I understand her anger. I saw her in person this summer, between deciding to get on PrEP and actually going out and getting the pills. I told her that, as of that day, I was not on the drug. She patted my arm nervously and said, "Good."

I will have to speak with her before this article is published.

It's lingering AIDS panic and skepticism that fuels the Truvada controversies. Michael Weinstein, the president and CEO of the AIDS Healthcare Foundation, is a firebrand who calls Truvada a "party drug." This throws serious shame at the people who use the drug on the assumption that they enjoy anonymous unprotected sex, as opposed to those who are in a relationship with someone HIV-positive, or those like me who sometimes hook up with someone poz on the first date. There's this myth that, whereas bowls of free condoms are now provided at a variety of leather bars and gay sex clubs, soon they'll be thrown out in favor of passing around bags of Truvada like they're goddamn glowsticks. Remember those?

Many in the #TruvadaWhore tribe dismiss all STIs other than HIV as treatable, a position that is controversial at best. Even Dan Savage has been cautious about PrEP, bringing up the very reasonable argument that widespread dismissal of condoms will likely lead to an outbreak of the next incurable sex plague.

Aside from the debates currently raging between the Church of Condomless Sex and the People's Republic of Are-You-Fucking-Crazy, one thing hasn't often been trotted out into public arena: PrEP is expensive. I have good insurance with Group Health, and there are several ways to get the pills for a low- or no-co-pay rate, but I can't help thinking about those outside the United States who do not have insurance. The African AIDS epidemic is orders of magnitude more destructive than the HIV/AIDS situation in the United States. Who's covering their meds? We couldn't even get the so-called "First World" to donate much support to the Red Cross to contain Ebola.

As it turns out, if you live in Washington State, you have more access to free PrEP than perhaps anywhere else in the world. David A. Kern, manager of the infectious disease prevention section of the Washington State Health Department, teamed up with Richard Aleshire of the state's HIV Client Services Program to bring PrEP coverage to Washington. They realized that the PrEP breakthrough will save not only lives but also money that the state invests in treating HIV. It's quite timely that Truvada's use as PrEP has become approved right when the Affordable Care Act has gone into effect. Kern confirmed for me what Dr. Brown revealed at my recent visit with her, that our state is able to offer the DAP (drug assistance program) for PrEP due to the expansion of Medicaid under the ACA. Money that once covered DAP for HIV-positive citizens is now provided through the ACA and therefore freed up to cover other forms of care and prevention (thanks, Obamacare!). Kern and Aleshire made the decision to use this money toward providing PrEP to Washington's citizens. (To apply, call 877-376-9316, or google "Washington PrEP DAP.")

It took some diligent back-and-forth with faxing, phone calls, etc., and I missed some fine print and needed to send additional proof of Washington residency, but after a couple of weeks I got full coverage. I now receive PrEP without paying anything out of pocket. My insurance covers most of it, and the state covers my co-pay. For those without good (or any) insurance, Washington's drug-assistance program (DAP) can cover the cost of pills entirely.

Kern and Aleshire have a goal of reducing new HIV infections in Washington State by 25 percent by the end of 2016. One of six strategies they're using to accomplish this is to increase PrEP usage.

Kern e-mailed me some interesting demographics. "[Ninety-seven] individuals are active or in process clients of PrEP DAP; total PrEP DAP openings (at this point) is 200, so we're at just under 50% capacity... 75% are MSM [men who have sex with men]...7% are MSM who are also in sero-discordant relationships." He also stated that 25 percent of the DAP clients are in heterosexual, sero-discordant relationships.

This is as good a time as any to remind readers that HIV isn't a "gay" thing. We just got the worst of it, in America at least.

While DAP only covers the pills, those on Medicaid can get full coverage for Truvada as well as the medical and lab services. Another factor making this all possible is the fact that Washington has state funding for HIV prevention, whereas most states only have access to federal funding. Our state's PrEP DAP is a rare and beautiful thing.

Given all that, why wouldn't I take this pill? The side effects are minimal, I'm getting it for free, and most importantly, I have lost the culturally programmed fears that I used to have about sex.

I even had unprotected sex with my friend Scott, the one who invited me into his PrEP sex circle. A month after I began taking Truvada, we hooked up. Midway, we started talking about what it would be like to have condomless sex. We discussed risk factors, his recent sexual experiences, and my own. I determined that he was low-risk for STIs. I wanted this experience; I had not once in my entire life had condomless sex, and I care enough about Scott that it would be emotionally significant but not like some sort of ceremonial loss of virginity.

So we did it, and it was fantastic—but I'm still going to use condoms for casual sex.

After three months, I'm completely satisfied with my PrEP experience. I encourage my friends to get on it. We're so close to the end of HIV. Why wouldn't I participate in that?

About the author: Evan J. Peterson is the author of Skin Job and The Midnight Channel and editor of the Lambda Literary Award finalist Ghosts in Gaslight, Monsters in Steam: Gay City 5. His writing can be found in Weird Tales, The Rumpus, Glitterwolf, Nailed, The Queer South anthology, and Drawn to Marvel: Poems from the Comic Books.

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