My name is Jason, I’m HIV negative and so is my partner – but I’d like to have access to a HIV drug called Truvada.
We’ve been together five years and for a considerable part of that we’ve described our relationship as open. We made that decision as a deliberate gesture of empowerment and mutual respect – neither of us experienced jealousy at the idea of the other having sex with other guys, which meant if that’s what either of us needed to do, as long as we were totally honest and respectful of one another’s feelings, that would be ok. It’s been a decision we’ve both been extremely proud of, and because it wasn’t about agreeing a licence to have unlimited sex with other guys, in practice it’s meant very *little* sex with other guys.
We gave up using condoms with one another quite soon after beginning our relationship. Our initial HIV tests came back negative, we both concluded we could trust one another not to cheat, and after five years, further testing has regularly proven our decision right. Of course opening sex up with others has then meant revisiting the question of safer sex, and we had the odd STI mishap to start, but they were easily treated, and because neither of us had penetrative sex with anyone, there was never a significant worry about HIV.
Recently though I met a boy whom I started having sex with regularly, and we both wanted to fuck, but I get very little sensation even through the thinnest condoms, and our first attempt was good for him, but led to nothing for me; I lost my erection and didn’t cum from fucking. We talked about not using condoms, but the conventional wisdom said to do so was madness – you can’t trust gay men after all, I’d court the probability of contracting HIV and I’d be an idiot for doing so. The more I thought about that though, the more angry it made me. Why should trust between partners, even irregular ones, be impossible in gay life? Why too should there have to be an elephant in the room every time– fear (even low level), anxiety, guilt, shame, all for having a fun and intimate experience with a nicer person? This week my partner and I attended the premiere of the documentary ‘PROUD and PrEPared’ (video link) – a look at PrEP and the PROUD study in the UK, which centred on just these issues.
PrEP is the use of a drug (currently Truvada) which can prevent HIV infection for those who are at risk of contracting it, and the documentary explained that the PROUD study found its effectiveness was 86%, which was a surprise, because the trial leaders expected only a larger study would be able to prove it scientifically. Their findings essentially demonstrated that using the pill regularly, as directed and when needed would provide at least as much protection from HIV as condoms, and the documentary and discussion which followed questioned what the impact of the drug being freely available in the UK (it already is in the US) would likely have.
Participants talked about sexual liberation for gay men in the same sense as the contraceptive pill first provided women decades ago – the freedom to have the sex you want without anxiety, guilt or shame. There has been resistance to PrEP from some corners of the LGBT community – it’s an “unsafe sex drug”, there’s an agenda to medicate all gay men, big pharma can’t be trusted, but the documentary very carefully steered the debate around the usage of PrEP as only one tool in a larger kit for managing sexual health. Used in conjunction with condoms and regular testing, this versatile drug could significantly lower the current record numbers of HIV infections of gay and bisexual men in the UK.
The discussion afterwards spent a considerable amount of time questioning why the drug wasn’t already available on the NHS for those who need it. Guests from the Terrence Higgins Trust who are involved in that process with the NHS were surprisingly forthright, and explained how difficult it was for the service to take the drug on in the middle of a budgetary period. The NHS budget has already been squeezed dangerously, and the case for adopting it in practice needs in turn to be demonstrably overwhelming. Whilst it’s possible that Truvada may be taken on in the short term, it was more likely that there would be a further wait, and further campaigning and lobbying would need to centre on demand and cost – a pressing need from those who need it most would need to be made, and Truvada would need to be shown as a cost-saving drug for the NHS. When the cost of treating new HIV-infected person is upwards of £300,000, it may seem self-evident, but the argument may become even more persuasive after 2017 when Truvada’s first patents expire allowing low-cost generic copies of the drugs to be manufactured.
The next day I went to a demonstration outside London’s 56 Dean Street sexual health clinic by ACT UP. Following on directly from the documentary premiere its purpose was to draw attention to the NHS’s delay in taking on PrEP, and after a good natured picket (with the support of the clinic) the demonstration walked briefly down Old Compton Street, gaining even more attention. They say it won’t be the last action they put on to gain greater public awareness of the need for the drug, and I’ll be there to help promote as many as I can. I’ll also be waiting along with many others for the arrival of PrEP on the NHS.
I don’t have any intention of having unprotected sex with as many men as I can, it won’t provide any protection against syphilis, gonorrhoea, clamydia or hepatitis after all, but I would like not to have to worry any longer about HIV. PrEP would be invaluable at specific times with individual guys, such as guy I sometimes see, whom I’ve stopped using condoms with. I’ve tested negative after our first experience, but how liberating it would be not to have to think about that test (or the feelings that accompany it) at all.