To PrEP or Not to PrEP

Let’s Be Frank: The Diary of a Divorced Gay Dad


To PrEP or not to PrEP? That is truly the question if you are a gay man living in today’s era. First of all – I AM NOT A DOCTOR. I do not know any doctors, have not slept with any doctors – I have nothing to do with doctors. This is merely my opinion on the subject as well as documentation of my own decision struggles.

From what I know, PrEP is a preventive drug, a drug that, when taken daily, reduces the risk of HIV transmission by somewhere between 90-95%. Condoms reduce the risk of HIV transmission by somewhere between 98-99%. On paper, this is a no-brainer. In real life, this can be a major conundrum.

I am a 39-year old gay male who grew up terrified of AIDS. As a product of the 1980s, AIDS was just as scary as those “this is your brain on drugs” commercials. I knew about AIDS before I knew what being gay meant. So you can imagine how horrific it was when I was old enough to realize I’m gay – it had me convinced I was destined for a short life. None of those fears, of course, were founded. Once I learned about safe sex, I was a stickler for condoms, and stayed relentlessly vigilant until I met my ex-husband. We were monogamous and therefore we trusted each other, and you know the rest. I enjoyed a wonderful long relationship with him and never had to worry. Now that it’s over, the worry is back and more intense than ever.

I’m a dad now. Sh*t has changed. I am no longer protecting just my life, but also my son’s life. I can’t do risky things anymore (not that I would). But PrEP aka Truvada aka the giant fu*king blue horse pill is now a reality that I can’t ignore. When I first was divorced, I made it a priority to find a gay doctor who is very knowledgeable about a gay man’s needs. It took some sleuthing, but eventually I discovered exactly that, and it was a life changer. He discussed PrEP with me within the first half hour of my first appointment, and gave me so much information it made my brain hurt. I left feeling empowered and amazed, for there’s now a drug that can prophylactically reduce the risk of HIV transmission. The timing is almost uncanny, from my personal perspective.

On the flip – if I do decide to go on PrEP, I have to get kidney and liver screenings three months in to make sure they are unaffected by the drug. From the drug’s website, adverse side effects can include: lactic acidosis, liver problems, kidney issues (including failure), and bone density loss. None of those should be taken lightly, but all of those can be caught early. Worst case scenario – my body shows some sign of rejecting the drug and I go off of it. Is it worth it though? Potential health risks?

Health advisors suggest using PrEP in conjunction with condoms. In reality, PrEP will most likely be used in place of condoms. This is about being able to have unprotected sex. And really, why shouldn’t we? Heterosexual couples have various contraception methods and have unprotected sex all the time. Unprotected gay sex has been taboo within the gay community since the outbreak of AIDS. It is technically now back on the plate again, but the pill may only be up to 95% effective. So is that 5% worth it? This is what is going through my head. What really are the chances of getting HIV if I went on Truvada? To date, there hasn’t been one documented case of HIV transmission when the patient adheres to the daily routine. The research only goes back 2½ years though, and I wouldn’t want to be the first case.

Finally, there’s the emotional aspect. If I choose this, I’m basically committing myself to being single. Not long-term, of course, but it’s a friendly reminder that I don’t have a boyfriend. There are tons of stigmas around Truvada users – they are promiscuous, partiers, irresponsible, etc. I find that to be obnoxious because a person who goes to the trouble of using PrEP clearly is prioritizing his health. The key is never missing a dose – the daily dose that will be a daily reminder that I am single. Will this giant blue pill become my next relationship? If so, will that relationship be a healthy one? After more soul searching, I will soon decide … to PrEP or not to PrEP.

 

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