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I believe PrEP to be one of the most significant moves forward in HIV prevention, and having lived with HIV since 1980, that’s saying something!

Truvada, the medication currently used as PrEP.
Truvada, the medication currently used as PrEP.

The recent community call for PrEP (Pre-Exposure Prophylaxis) to be made available on the NHS has brought with it a number of doubting Thomases, which is a shame as PrEP is another weapon in the war against HIV. True, it’s not perfect and other drugs remain under investigation for the potential as PrEP.

One of the biggest arguments is “why can’t they just use condoms?” Well, the surprising thing there is that some men cannot use them. They’re not exactly user-friendly. If a guy has Peyrone’s disease, where the shaft of the penis has an unusual bend in it, that can cause problems with condoms.

Erectile dysfunction is another reason that condoms can be awkward. Sometimes the cause is psychological and simply talking about the problem can resolve it. In diabetes, the nerve that controls the blood flow to the dick is slowly destroyed, making a full hard-on a rare event and its duration pretty short. By the time you’ve got a condom on, if you manage to shove the bit of overcooked spaghetti up the wildcat’s arse, as the joke has it, the hardon has gone.

And let’s not forget that sexuality doesn’t end when you get that letter from the DWP telling you your old age pension will be paid into your bank account. Older men, too, can have problems with ED, are more likely than younger men to have had prostate problems which affect their ability to achieve and maintain a hard-on.

PrEP gives these two groups of men a chance at topping, rather than being the eternal bottom (which, I admit, has its appeal). And let’s not forget those who bottom, PrEP gives them much more control over their protection than relying on a top to use a condom properly – or at all.

Doubt is thrown on someone’s ability to take a pill every day – women have been doing it for fifty years now in order not to conceive. Are men really that stupid? But given the number of times that a gay man goes out on the pull without lube, condoms and toothbrush (for the morning!) it would seem so. Condom adherence is falling.

And why is condom adherence falling? Because HIV is seen as less and less of a threat, or else there’s a certain fatalism (which I’ve heard) “oh well, I’m going to get it anyway, so why worry?” Twenty years ago, if you were poz and met another poz guy, you might forget about the condoms. Nowadays, it’s down to numbers: “are you undetectable?” – the barebacking public has caught on to the implications of Treatment As Protection (TAsP) far faster than anyone would have suspected.

“Oh, but think of the other STIs out there”. Newsflash: pretty much the only thing you can’t get from oral sex is HIV. All the others are sitting there waiting to jump down your throat. And don’t kid me that you use a condom for oral (unless your into punishment porn scenes: “no, you haven’t earned my cum yet, boy…” as he knots the condom and throws it into the trash)

And besides, in the 1970’s, your three monthly STI checkup was just one of those things you did. There are STIs that a condom doesn’t stop. Are you still going every three months, if not why not?

Personally I think what scares some HIV-Negative people about PrEP is having to do something actively to protect their own sexual health as regards HIV (because we all know that it’s the PwHIV’s responsibility ), and what scares some PwHIV about PrEP is the HIV-Negative person taking charge of their own health rather than depending on the PwHIV.

I remember the initial resistance of gay men to using condoms, albeit when we thought they’d only be necessary for five years or so: “I didn’t go on all those gay demos to put a nasty hetero thing like that on my cock” (as near as I can remember an actual quote from the early eighties).

PrEP means rebuilding trust into relationships, one-night stands and evenings of pigging out at a sex club. Just as the next guy I fuck with is going to have to accept that my viral load is undetectable, I’m going to have to accept that he’s taking his truvada as prescribed.

It’s a major shift in culture, and such shifts don’t happen easily. But it’s a shift we should embrace: yes they’re powerful drugs, but they also allow us to live life with less of that awkward fumbling – by the time the average guy has managed to get a condom on, I’ve probably lost interest.

We have the offer of natural sex on the table and we’re really going to sweep it to one side and say “no thanks”? It’s not compulsory, and condoms have their place, but compare the remarks made about #truvadawhores with those made about early adopters of the contraceptive pills…

Finally, the side-effects. I’ve read so many comments on Facebook about how people (it’s for women too, don’t forget!) are finally being able to relax about sex because they have taken proactive action to ensure their own health, that it seems a downer to write about them.

The most people will have to contend with is a slight GI upset. Your doctor, who you’ll see every three months for HIV, liver and kidney monitoring, will stop your prescription if s/he thinks anything is going wrong.

You want the gory stuff? I took truvada therapeutically and my doctor wasn’t looking at the right bloods (or even taking them). I used to ride a Suzuki Bandit. He got trashed when I misjudged a corner I knew well because I wasn’t thinking clearly. My thought process deteriorated, and I developed osteopenia (the stage of bone thinning before osteoporosis), so I get around on a walking stick instead of a motorbike. I’m told by my social worker that had I not been got into hospital I would have died within a week or two. THIS IS A WORST CASE SCENARIO. Unless your doctor is a total incompetent there’s no way it can happen to you. I put in this gory example to satisfy the opponents of PrEP – consider it like one of those package inserts that list “death” as a side effect (usually in the millions to one range).

I believe PrEP to be one of the most significant moves forward in HIV prevention, and having lived with HIV since 1980, that’s saying something!

Please read, and sign, the petition calling for access to PrEP on the NHS at http://www.prepaccess.org.uk

Steve Craftman. 

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