It’s been a long time since I’ve posted anything – more than half a year. Admittedly, I’ve not had much inspiration to write recently. Leather-life-wise, Sir and I have not had the chance to spend much time together and with both of our jobs being very busy, setting up for intense scenes and such has been lower on the priority list than just spending time together. That’s life. While the leather is in our hearts, life happens.
That said, I’ve been following the debates and research on PrEP. Face it, I have a reasonably high sex drive and I like getting out there and having a good time whether I’m at home or on the road. I’m not shy to say that I like my bath house and public sex action. That’s me and what gets me hard. I’m a pig at heart, and the reality is that I play with guys who are negative, positive, undetectable and somewhere in-between.
Earlier this year I went in to see my doctor after 3 years of going without. I have a new doctor as my previous doctor is now out in Vancouver. This doesn’t mean I’ve not looked after my STI checks and such. I like going to Hassle Free Clinic for that. It’s kind of tradition, it’s home, it’s where my tribe go to get checked out. Yeah I could go to a nameless blood testing lab – and I’ve had some great experiences with them, as well as some awful. It just feels right to me going to Hassle Free Clinic.
On my list among other things to go through with my new doctor was PrEP. We had a good chat about my practices and such, and he referred me to Dr. Isaac Bogoch at the Immunodeficiency Clinic at Toronto General Hospital. The link there is to a talk he did at a TEDx in Stouffville.
What a fantastic clinic. Everyone I met was awesome. Dr. Bogoch is so personable and with his bedside (office-side?) manner, it was easy to open up to him. He was also impressed by my GP’s thoroughness in all the tests. Dr. Bogoch was more than happy to provide me with a prescription for Truvada after checking everything out.
So that was two hurdles, of sorts, to get through. Not that it was difficult, but none the less, had to get over them. The next step was getting the prescription and wondering if my insurance through work would cover it. I did ask Dr. Bogoch if he’s heard problems about it being covered by insurance, and he literally said that he had not heard of anyone not being covered.
Truvada is, for a one month supply, $967.22 with an $11.99 fee if dispensed at Toronto General at the Immunodeficiency Clinic. Seeing Patient Pays: $0.00 on the receipt gives me new hope that more people who choose to go down the route of using PrEP to enhance their protection and the protection of others, will do so.
PrEP is a total mind fuck for those of us who grew up in the period of so many of our brothers and sisters dying from HIV. The message has been consistently, “Use condoms”.
The thought of being covered by up to 99% if having unprotected sex with someone who is undetectable is huge in the world of harm reduction. Stats say PrEP reduces the chance of contracting HIV to 92% to 100%; being undetectable reduces the chance of contracting HIV to 97% or so conservatively. While research has been done on people who are not detectable, the jury is still out on the degree to which the risk is reduced.
So why am I choosing to use PrEP as part of my personal harm reduction strategy? Well, I do play in bath houses a fair bit although admitedly how often I go has dropped, I do have regular fuck buddies that I do play with, I play a lot on the road when I can, and I am definitely playing with people who do not know their status, are undetectable or otherwise positive.
For the things I do (primarily oral and fucking as a top with condoms), at one level I’m pretty low risk. That’s not no risk, but low risk meaning there is some risk. With specific close partners, there are things that we are doing that are riskier, and given between myself and one of my partners, we’re probably equal in the amount of action we get on the road, so why wouldn’t I do my part in “getting to zero” meaning – let’s do what we can to eradicate this virus.
The other thing I questioned myself on was, I was playing at bath houses between 1996 and later, at a point before the current generation of ARVs, and I got to my 40s without becoming positive, why bother with PrEP? Well, I admit, I was picking and choosing my activities, wasn’t swallowing, etc. These days, I admit I am being less picky and have gone out to be a cum swallowing pig at the baths. Yes, my risk has increased. I’m not always at ease with that, but I will say that being on PrEP does put me at ease that a low risk activity is now even lower.
Again, it protects me, and it protects my partners. And if that makes me a #TruvadaWhore, then so be it. The stigma doesn’t hurt me, it challenges me to push back on the stigma and be out there.
Me being open about this allows me to open the eyes of people, but in particular those of us in Canada. PrEP is not approved, yet, by Heath Canada as a preventative but doctors are free to prescribe it for prevention. This needs to change and it will be changing, let’s hope sooner rather than later.
PrEP does not protect you from other STIs that are out there. Syphilis, Hepatitis C, and antibiotic resistant strains of STIs are a major issue in this and any other big city. You still have to be careful.
I plan on writing a bit more about my experience in PrEP. Specifically any side effects and such that I am feeling, possibly ethical questions that come to mind, and challenges to stigma.
For now, daily PrEP and Condoms are the new norms. I am happy about this.
Here a few handy resources:
To quote this article briefly:
– If one partner is HIV positive and is undetectable on medication (viral load <40 copies/mL on some tests and <20 copies/mL on others), then the chance of passing HIV is reduced by 97% or so (conservatively).
– If the negative partner is on PrEP, and taking the medications reliably, then that person’s risk of acquiring HIV is reduced by, let’s say, 92% to 100% according to various studies. (Just using PrEP)
– With these reductions in risk (97% and then 95%), the risk becomes something like 1 out of 50,000 encounters. If we use a 99% figure for PrEP, we’re looking at 1 per 250,000 episodes.
Both Partners Negative, Both on PrEP
– If both partners are negative and on PrEP, then both are being seen by medical providers. And if those providers are following protocol, then the patients are getting tested every three months for HIV and STIs and taking their meds and should reliably be negative.
Both Partners Say They’re Negative, One on PrEP
– If you are the person on PrEP, you need to ask yourself how well you know the other person. Do you trust that the person is really negative? Do you know when the individual last got tested? Do you know the individual’s sexual history? And finally, are you comfortable enough with what you know and with Truvada’s ability to prevent HIV infection to not use a condom with this person? A more difficult choice to be sure, but one where knowledge of your partner can help to reduce risk.
The Unknown Partner Scenario
To those who say they would use a condom, I say that is the way they then need to handle every unknown hookup.
For those who say they would still have unprotected sex, I first say that I hope that PrEP will be as effective in this scenario as it was in studies overall. I then caution them that the data we have from studies have not proven that is true. The studies of PrEP have not looked at the HIV status and viral load levels of every partner of the study participants. We cannot say for sure that PrEP will work as well overall if one is constantly encountering partners with very high HIV viral loads. That is not to say for sure that it won’twork, but we just don’t know. People who are on PrEP and not using condoms with strangers are, in fact, experimenting with their own bodies. I am not saying that they are wrong or stupid or ill-informed, but they need to be aware that we do not know for sure that this will be safe.