Can we talk about PrEP without the hysterics?

Can we talk about PrEP without the hysterics?

The courts have told NHS England that they are able to commission PrEP. We know PrEP works. So why can’t we discuss it without turning to mudslinging?

Jason holding PrEP

Jason holding his daily PrEP pill, Tevir-EM – the generic form of Truvada

Today NHS England finally got told by the Appeals Court that it must be the body to provide PrEP, if a health body in England/Wales is going to do so at all. In response the usual suspects, including Talk Radio’s Julia Hartley-Brewer, threw up the old favourite ‘why should I pay taxes to support your having ‘risky sex”, and a beyondpositive‘s editor to boot. I guess in the old days, when it was a lot harder to talk about gay sex in public, and much less was known about HIV transmission, that might have been a seductive argument. Why shouldn’t people behave responsibly? Why shouldn’t we all be having safer sex? Wait a minute, and let me take the prism of ignorance off this discussion and try again.

I was conceived as a result of my parents having ‘unsafe sex’. My sister has two daughters, so I suspect she’s done the same, and of course straight people have ‘unsafe sex’ all the time (ie. without a condom) and there’s little outcry about the sky high STI rate, nor the levels of teenage pregnancies experienced by straight people.

Gay men though are supposed to wear a condom for literally every sexual interaction we have, and given how thoroughly our community was decimated by the HIV pandemic over the last 30 years it’s not surprising that fears about HIV infection should persist inside and outside of our community, but there’s a problem – the HIV infection rate is currently at an historic high.

Memories of mass deaths caused by the pandemic (in this country) are fading, HIV is no longer a death sentence (in this country), and the way safer sex is being framed everywhere no longer resonates with people’s lives. ‘risky’, ‘dangerous’, ‘irresponsible’, ‘safer’ – all words used regularly used to describe sex between men – but there is no widespread discussion about trust, honesty, communication or fun.

Now we have a technology, in PrEP, where the latter qualities can become more of a norm than ever before, and why shouldn’t we embrace it fully? When the success rate PrEP has at preventing HIV (when used correctly) is effectively 100%? Yes, you heard – there’s a pill which can remove the danger, the stigma, the fear and shame from our (entirely valid) sex lives, and the NHS has fought tooth and nail not to provide it, when countries as diverse as France, Israel and Norway have understood that we’ve got to change the message and tools from the 80s if we’re to have an effect on the ever increasing HIV infection rates.

Let me put PrEP in the context of my life. I have been in a relationship with my partner for six years, and we agreed four years ago that we should pursue an open relationship. The ignorance prism the tabloids and Talk Radio would have you see this issue through would suggest one of us ‘wanting to have our cake and eat it’ or our relationship wasn’t strong enough on its own to survive, but neither of those things is true.

We both believe sex is good, sex is fun, and sex with other nice, fun, intelligent, honest guys is bloody awesome. Neither of us gets jealous about the other, and each of us wants the other to be as empowered as possible as a person. We talk about this a lot and have an agreement both to be completely honest and always to protect the feelings of one another above any other consideration.

I am currently in an ongoing sexual (albeit not polygamous) relationship with another man, and I don’t use condoms when I have sex with him. I take PrEP, and was HIV- last time I tested, so are both of my sexual partners. The sex is fantastic – very different with each of them, and there’s no doubt in my mind this arrangement allows us all to develop as people. For a month’s supply of PrEP though I alone need to fork out £50+, and have to get my supply from an unpredictable supplier of the generic drug from India, which is a hefty drain on my budget, albeit a manageable one. How should people cope when they can’t afford that absurd price, or if they don’t have the resources to place that order?

PrEP isn’t magic. That it works is undeniable but it’s given me headaches and terrible stomach complaints as well, even though when taking it I always watch my blood sugar and keep myself hydrated. Taking PrEP daily also means testing every three months, not just for HIV and other STIs, but to ensure my kidneys and liver aren’t being affected by the drugs.

Some say taking the drug encourages ‘risky behaviour’, but that’s a loaded term too. Is it a bad thing if gay men are free to fuck more, with better protection from HIV than condoms provide? Why do the Julia Hartley-Brewers of this world omit that the drug isn’t only for us? And why is there a presumption that the first thing we’ll want to do on PrEP is fuck literally every man that moves? Who has the time? The stamina? I only use it to fuck two, and it’s supposed to be just one tool in a safer sex toolkit anyway – I’ll risk assess and then use what precautions are appropriate with each subsequent man I have sex with.

Imagine that – an historic chance at empowerment for men and women alike to have sex lives free from the fear and shame of the sex we have. But with discomfort in talking honestly and openly about sex in this country still widespread, it seems we still have a lot of campaigning and educating to do in getting PrEP normalised as an item in all of our safer sex toolkits. The ignorant language and ideas about this groundbreaking means of HIV prevention need to be challenged from as many corners as possible. This is my challenge.

Jason – @LewishamDreamer on Twitter

If you want to know more about PrEP and how to get it in the UK head over to our friends at iwantprepnow.co.uk

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