PrEP

Learn this word. It’s going to be a game changer. Keeee—POW!!!!! Outta the park.

Yep. The introduction of (PrEP) pre-exposure prophylactic treatment for HIV, is the biggest change in HIV medicine since we all started taking fistfuls of antiretroviral drugs in the late 1990s.

And while that particular innovation, that earth shattering moment in the history of HIV/AIDS, caught all of us off guard and unprepared for the seismic changes it brought, (“Shit. I’m gonna live?!? I just spent all my damn money!!”) this particular change is something we can plan at least partly for.

Doctors and HIV organizations are counting on PrEP to keep HIV infections down.

In our modern world of impenetrable jargon and catch phrases, most folks in the medical profession blast you with indecipherable language around PrEP that is neither interesting nor helpful. As witness for the prosecution, I offer up the delightful terms “vector transmission” and “sero-discordant relationships”. ‘Cause, ya know, that’s how ‘edumakated’ people actually talk and stuff. Pffft.

Anyway. Governments are also starting to talk about PrEP. It’s all dollars and cents. Fewer people gulping down HIV pills that the taxpayers are footing the bill for, is better for everyone. Offset the cost of the PReP meds against the cost of fulltime and ‘forever’ “cocktail” medications, and suddenly things look brighter when you’re talking about what people do with their bums around provincial budget time.

But I think it’s way more fun to forecast the unintended consequences of PrEP. Like what’s all this gonna mean to me when I want to get naked and do the nasty? If I’m a big ol’ bottom (“use me”), or a tatted up ego-driven top (“masculine looking for workout bud”), how’s this going to change my life? Well, a couple of different ways. But it’s going to take time.

Yep. I’m talking ‘gay’ talk here. I know we’re supposed to be all-inclusive, but I’ll let someone else write about that stuff. I’m a gay fella. And I’m writing for my ‘tribe’. So here goes….

What’s PrEP? Short and simple – they’re pills you take BEFORE you have unprotected sex (no need to pretend it hasn’t happened from time to time) so that your chances of getting HIV are WAAAAY lower. Not zilch. But lower.

Now every doctor on the planet is going to say that you still need to use condoms as well and PrEP pills. And I’m sure everyone will smile and nod as they fill out the prescription. But I think we all know what the chances are of condoms happening after a night of wanton abandon. Of boozing it up and going home with some random guy with a hot ass, or that guy with the eagle tattooed on his chest. So rather then continue the condom fiction…let’s just talk about what really happens….at least sometimes.

If you’re HIV negative, PrEP’s going to change the way you date. It’s going to change who you date. It’s going to change how and when you have sex. It’s going to make sex a lot less scary. It’s also going to open up a whole bunch of stupid mistakes for you to make.

First. You’ve got to take the damn pills. And take them the right way. These drugs are pretty serious stuff. As it stands now – a pill each day, to keep ‘the bug’ away. Sorta like cartoon vitamins from when you were a kid. A ‘Barney’ or ‘Fred’ will make your life safer if you decide to stick your bum in the air for a Barney or Fred.

You’re chances of getting HIV go down about 92% (depending on which punishingly complicated bit of science you decide to trust). But here’s the deal. You’ve got to take it regularly. No skipping. It might make you feel a bit sick to your stomach at first. It might give you headaches. But you’ve got to do it. Because if you start messing around, and skipping doses….it’s just not going to work. You need to have the drug in your bloodstream, if it’s going to protect you.

Now, there’s a hell of a lot of barebacking going on out there. Not many people admit it, but we all know it’s true. I get a lot of late night Scruff and Grindr messages from guys who are all in a panic because they ‘did something stupid’. Or ‘heard that the guy they were with “has it.”’ Or they barebacked ‘once or twice’ and got brave enough to be tested and “tomorrow I get the results and I’m totally scared now.”

PrEP will take a LOT of this fear away. It’s going to make sex less scary. Less reason to panic. Less reason to fear. But it’s not fool proof. So don’t be a fool.

And….to all the 20-something dance club boys out there (you know who you are) with your 26 inch waists and metabolisms like humming birds; the ones who flit around in your skinny jeans being ‘fabulous’ on a Friday night with a drink in your hand. Here’s what not to do. DON’T get drunk and then do the dirty raw with some random ‘daddy’, and THEN panic and decide to take a hand full of PrEP pills in a panic when you get home. You’ll make yourself sick. Bad sick. And there’s not a lot of science to say it will do any good.

Slow and steady wins this race. And it may just save you decades of having to deal with HIV infection.

Now, it’s not the end of the world to have HIV. But it’s not like it’s a lot of fun. The pills and side effects are a major pain, the blood work and appointments are annoying. And the way people treat you? Well that’s just shitty.

On that note:

If you’ve got HIV, even though PrEP isn’t intended for you, it just might make your life a whole lot easier. How so?

Despite decades of posters, marches, seminars, ad campaigns, outreach programs, green tea conversations and sympathetic hugs from well meaning people with sorrowful eyes, “The Bug” is still all about fear. Allow me to illustrate….using GRINDR.

Me: Hey
Him: Hey
Me: You’re hot. What’s up?
Him: You’re hot too. Bottom here. Looking?
Me: Yep. Get your legs in the air.
Him: Oh shit! You’re poz?
Me: Yep. It’s in my profile.
Him: (BLOCK)

I would say this has only happened to me two or three DOZEN times over the last few years in this city. Calgary!

Yes….stigma is still a plague when it comes to HIV.

People terrified they’ll get it. Use to be – in the bad old days – everyone was afraid they’d get it and die. Now people are afraid they’ll get it and become ‘untouchable’. A lot of gay men who are negative avoid (to put it mildly) people who are positive. There are days when I feel like a leper. Like I should have a bell around my neck, and shout, “Unclean!” as I wander the streets. But that’s just me. When men put “clean…u b 2” in their GRINDR profile, I want to write back, “Clean Yes…but you’re poorly read, and your profile lacked appropriate verb tenses, so I’m not interested in YOU!”

But PrEP might just slowly begin to change the stigma struggle. It might just calm negative people down and make them less likely to reject you on the ol’ online dating scene.

If we can reduce the ‘terror’ of getting HIV – make all the negative boys less afraid of getting it, less afraid that if they did they’d be ‘unclean’ and therefore undateable – we might just be able to make dating someone how has HIV, or (gasp) having sex with him, a lot less scary. This is what I call an ‘unintended consequence’ of PrEP. It’s not something doctors think about, or drug manufactures are aiming for, or the public health baffle-gab gets across, but it’s likely to mean BIG changes to people with HIV already.

It could frankly, make dating, humping, and yes, loving, a whole lot more pleasant for negative and positive people. Instead of that common and hateful response from negatives to positives – “I don’t judge.” (What makes them think there’s even a question that they should be allowed ‘to judge’ is beyond me). We may end up hearing a lot more of “I’m not worried.” It might even make more people go to get tested.

Right now, there are people out there who don’t get tested, because if they are positive they’ll have to tell all the people they want to “wreck” on a Friday night. And they know that being positive means there’s a lot less people who are going to want to BE wrecked by them on a Friday night. (See how that stigma thing works?)

I-don’t-get-tested-because-if-I-do-and-then-I-have-to-tell-and-then-I’ll-never-get-laid-again-but-I-have-it-and-don’t-know-that-I’m-spreading-it-because-I-don’t-get-tested-and-no-one-can-blame-me-for-not-telling-because-I-didn’t-know-I-had-it-because-I-didn’t-get tested.

But if this cyclical nightmare begins to change, maybe more people will get tested, get on the cocktail, and get undetectable. That means less chance of giving someone HIV. It’s win/win.

But, there are other unintended consequences, and NOT all of them come with a smiley face. While everyone touts the joys of PrEP. There are also some to deal with.

If you’re under 50, you won’t remember the days when while no STD could kill you, but they sure could make you feel dirty. “CRABS!!!! ICK ICK ICK ICK!!! Where’s the bleach?!!!!” or, “It burns when I pee!!!” or, “Oh Gross, what’s that on my dick?!?”

I suspect an unintended consequence of PrEP will be a spike in STIs.

If the ‘id-jets’ now all think they’re invulnerable to HIV, and start barebacking with disregard, bad things can happen.

Syphilis and gonorrhea are just plain unpleasant. Worse, there are strains of them going around even here in Alberta that are becoming resistant to antibiotics. And that’s some seriously bad shit. And the waiting room at the STD clinic downtown is like the “circle of shame”. And when they say there might be some, “mild discomfort” when you get swabbed, they’re lying. It hurts just slightly less than a branding iron.

So, this is partly why doctors and the well-meaning preachers of public health are still going to tell you to use condoms.

I know I know. It’s hard to look at your straight middle-aged flabby doctor and not think, “You’re like married….so probably have sex…what…..three times a year at best? So, what would you know from condoms???” But keep in mind, as sanctimonious as they seem, there’s a point in there somewhere. A price still has to be paid. Just be sure you want to pay it.

And here’s a price you don’t want to pay. Ever.

If you mess around with PrEP drugs, and don’t take them regularly or the right way, there’s a good chance that you will become immune to them. Which means, that they stop working as PrEP. And (god forbid) you DO become positive, there may be entire classes of HIV medication you can’t take. It cuts down your options, and that can mean having to take the less pleasant kind of pills, with worse side effects.

Still, despite all the doom and gloom and whatnot, PrEP offers us a whole new way of coping with HIV and subverting stigma.

Some, not me just yet, but some, are already saying we can envision a world without HIV. That kinda makes me smile. It’s something I couldn’t have imagined even a few years ago, no less during “the plague”.

When the ‘cocktail’ medications came out no one knew if they would work. No one knew if they would help. No one really guessed that, “everything had changed.” And it changed in ways we could have never imagined. Stigma and fear remained. But we lived. We survived. It worked.

We know PrEP works. Works beyond our wildest hopes.

It offers hope to us all. Hope that we can keep almost everyone from getting HIV. Hope that those who have it will have an easier time in our own community. Hope that HIV could someday be like Polio, will be a disease of the past