To PrEP or Not to PrEP?

Last September I was on holiday in Los Angeles and as usual whenever I visit a new city, I went sight seeing during the day and cruised the local talent at night. I logged onto the gay hook up apps and websites to check out the local talent. Being LA – Land of Hollywood where a large number of the residents are fit aspiring screen actors/models waiting for their big break and also staying in the predominantly gay West Hollywood, I had high expectations.

Yes the guys were hot, however on most of the profiles that I found interesting, I noticed that most of the guys were on Pre-Exposure Prophylaxis (PrEP). The guys I sent messages to, though according to their profiles were HIV negative, said they wouldn’t mind having bareback sex because they were on PrEP. I did some digging around on the internet to understand PrEP, and I found quite a bit of information and research based data on it.

PrEP is the use of anti-HIV medication that keeps HIV negative people from becoming infected. PrEP is approved by the FDA and has been shown to be safe and effective. A single pill taken once daily, it is highly effective against HIV when taken every day. The medication interferes with HIV’s ability to copy itself in your body after you’ve been exposed. This prevents it from establishing an infection and making you sick.”– Source – http://www.whatisprep.org

https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/

I knew then it would be a matter of months before PrEP hits the UK and now it is being trialled.

PrEP2

No HIV prevention technique is 100% effective, but I think some are more effective than others. Clinical studies carried out show that HIV virus did not infect 86% of the men on PrEP when there were exposed to the virus. (For condoms, its 97% (assuming the condoms are used correctly – 100%), plus condoms protect against other STDs.)

I think PrEP should be used to augment condom use as a preventative measure against HIV infection, but what I see are an increasing number of guys using PrEP instead of condoms. Some guys say they don’t like using condoms – because they don’t like how they feel and therefore PrEP would suffice.

A large number use it because they intend having chemsex where sexual inhibitions are reduced and they have PrEP to fall back on, if condoms are not used. I have only met one guy online Mike (not his real name) who said he used PrEP when he started seeing a HIV Poz guy and thought the relationship was going somewhere. He was being responsible. He however stopped using it when the relationship did not take off.

I came across a gay sex club the other day in my area that advocates Pro-choice. I used to think that phrase relates to abortion rights, but not at this club. It relates to a choice whether to use condoms or not. It does not frown on people who don’t use condoms. Quite the opposite – I dare say it actively encourages bareback sex. This stance is probably buoyed by PrEP.

I am not saying PrEP is bad. I think it is a good drug to use for people in vulnerable situations like sex workers  or in Mike’s situation, where one person in a relationship is HIV Poz and the other Neg. But I don’t think HIV neg guys who have casual sex with strangers, should be on it simply because they don’t like the feel of condoms; or so that they can have the freedom to attend chemsex parties and have high-risk sex.

 The advent of PrEP is quite recent and the knowledge of its long–term side effects on the body organs is relatively unclear. So far we have been told it doesn’t affect everyone the same way and that the effects could range from mild to severe to fatal. Side effects among others include vomiting, diarrhoea, bone density reduction and kidney failure.

PrEP1

The efficacy of PrEP is dependent on users taking it daily. If they don’t there is a possibility of drug resistance developing and the HIV virus, upon exposure would infect the individual.

Also PrEP does not stop other STD infections like Gonorrhoea, Chlamydia Syphilis and Hepatitis, which are easily preventable by condom use. So while the drug companies are spewing out convincing stats about the decrease in the number of new HIV infections due to PrEP, who is keeping an eye out for the increase in other new STD infections?

Do the benefits of using PrEP outweigh the risks of its long-term side effects? Maybe – if your idea of fun is having drug fuelled unsafe sex with random strangers. Only last week some 24 year old guy on Grindr, told me to come into 2015, get on PrEP and have bareback sex. I told him, I already ingest enough crap anyway – being on three different types of protein shakes a day- and I wasn’t sure what the long – term side effects of those will be. I didn’t need PrEP to complicate issues. Of course he blocked me.

We know that the rise in new HIV infections in the UK is directly proportional to the rise in chemsex. I would advocate for more resources to be channelled into providing a wholesome approach in dealing with the drugs issue, rather than trying to cure the symptom.

How does PrEP affect me? Well since I prefer safe sobersex sessions my hook up choices are already quite limited. With PrEP being actively promoted this will inadvertently translate to more guys wanting bareback sex. That is not for me.

Maybe its time to get off my increasingly untrendy white horse and find me a hot, like minded guy and settle down. And maybe Greece will pay off its entire debt by the end of the year.

Watch this space

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18 thoughts on “To PrEP or Not to PrEP?

    • You are welcome. Thanks for stopping by. Please do some more reading on the issue and make an informed decision. Think safety first

  1. The only way I’m going on PREP is if I’m dating a responsible HIV+ person. Kidney transplant wahala is not my portion IJN🙌. 😂😂

  2. Keredim, the established globe-trotting hoe is thinking of finding a nice Greek boy to settle down with? I wanna say ‘Hallelujah’… PrEP, thy message has done good.

  3. “If they don’t there is a possibility of drug resistance developing and the HIV virus, upon exposure would infect the individual.”

    You should probably note that drug resistance occurs AFTER not BEFORE infection. The consequences of none/incorrect adherence to the PrEP regimen are that Truvada’s efficacy is reduced and this can lead to HIV infection; it is after this infection has taken place that drug resistance can occur.

    You should also note that the PROUD study was already in existence when you visited Los Angeles.

  4. Keredim,

    There are a few issues I should point out.

    Firstly the effectiveness of condoms in terms of HIV risk is 80% and not 97%.

    http://apps.who.int/rhl/hiv_aids/dwcom/en/

    Secondly PrEP offers higher protection against HIV when compared to using condoms, but does not offer any protection against other STDs as you rightly pointed out

    Thirdly the Proud Study also found there to be no link in ‘increased sexual risk and the use of PrEP,’ but did find an increase in STDs.

    It is also important to stress Truvada is generally well-tolerated in patients and your alarm for HIV resistance are unfounded –

    http://www.aidsmap.com/No-significant-risk-of-resistance-if-HIV-infection-occurs-during-use-of-iTruvadai-PrEP/page/2849061/

  5. wow! I learnt a whole lot. to think that I’ve never come across PrEP’s even as a medical student.
    BTW, Keredim, I love your blog and I’ve read every single post on it. I came across it early this year. I wish you’d update it more often like KD. well done dear.

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