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| 'Honestly, it’s a revolution. It's so great taking control' | 'Honestly, it’s a revolution. It's so great taking control' |
| (35 minutes later) | |
| When San Francisco city supervisor David Campos introduced a proposal to make Truvada available to everyone in the city, it prompted a new wave of interest in the drug, which has been approved by the US federal regulators for reducing the risk of HIV infection. | |
| Truvada,which was originally developed as part of combination treatments for people living with HIV, was approved by the FDA in 2012 to be used preventatively (often referred to as PrEP, or a pre-exposure prophylaxis). But despite the drug being available on most insurance plans in the US, uptake on that option has been slow. | Truvada,which was originally developed as part of combination treatments for people living with HIV, was approved by the FDA in 2012 to be used preventatively (often referred to as PrEP, or a pre-exposure prophylaxis). But despite the drug being available on most insurance plans in the US, uptake on that option has been slow. |
| We asked people who might benefit from PrEP whether they were already using it, considering it, or had rejected it, and their reasons for doing so. Here is a sample of responses. | We asked people who might benefit from PrEP whether they were already using it, considering it, or had rejected it, and their reasons for doing so. Here is a sample of responses. |
| Gay manTruvada userUses condoms | Gay manTruvada userUses condoms |
| I am a single gay man in my 20s living in New York City – a city with one of the highest HIV infection rates in the US. While I practice safe sex with strangers almost always, my perception of risk has been clouded and I have slipped twice. | I am a single gay man in my 20s living in New York City – a city with one of the highest HIV infection rates in the US. While I practice safe sex with strangers almost always, my perception of risk has been clouded and I have slipped twice. |
| A lot of anti-Truvada rhetoric came from the “they can’t adhere to it” camp. The way I think about this is: I am more likely to take a pill in the morning when I’m sober than remember to put on a condom (let alone on someone else) when my decision making can be clouded by other factors. | A lot of anti-Truvada rhetoric came from the “they can’t adhere to it” camp. The way I think about this is: I am more likely to take a pill in the morning when I’m sober than remember to put on a condom (let alone on someone else) when my decision making can be clouded by other factors. |
| A lot of discussion has focused on the extremes – that people taking Truvada will go out on the town and have bareback sex all the time. I disagree. I have many many friends like me. This is a layer of added protection, not an excuse to get rid of existing ones. | A lot of discussion has focused on the extremes – that people taking Truvada will go out on the town and have bareback sex all the time. I disagree. I have many many friends like me. This is a layer of added protection, not an excuse to get rid of existing ones. |
| —Name withheld, New York, New York | |
| Straight womanTruvada userDoesn’t use condoms (currently) | Straight womanTruvada userDoesn’t use condoms (currently) |
| My husband was diagnosed with HIV six months into our marriage. I remain negative. We would like to have a family, and Truvada gives us the ability to do that without spending a fortune on artificial insemination. | My husband was diagnosed with HIV six months into our marriage. I remain negative. We would like to have a family, and Truvada gives us the ability to do that without spending a fortune on artificial insemination. |
| Every time I have a sore throat I think about HIV. Every time I see a drop of blood – my own or my husband’s or someone else’s – I think about it. I probably think about it 100 times a day, wondering how he got it and what the long term will be like and whether I and our still-theoretical children will be safe. | Every time I have a sore throat I think about HIV. Every time I see a drop of blood – my own or my husband’s or someone else’s – I think about it. I probably think about it 100 times a day, wondering how he got it and what the long term will be like and whether I and our still-theoretical children will be safe. |
| —Name withheld, Birmingham, Alabama | |
| Gay manNot considering TruvadaDoesn’t use condoms | Gay manNot considering TruvadaDoesn’t use condoms |
| Most straights seem to assume that anal sex is the main (or only) sexual activity accessible to two men. This belief is factually wrong. A majority of gay men, believe it or not, do not engage in anal sex; fellatio, mutual masturbation, frot, intercrural sex, are the choice activities of most of them – me included. | Most straights seem to assume that anal sex is the main (or only) sexual activity accessible to two men. This belief is factually wrong. A majority of gay men, believe it or not, do not engage in anal sex; fellatio, mutual masturbation, frot, intercrural sex, are the choice activities of most of them – me included. |
| I, and a sizeable proportion of my fellow gays with me, have a lower risk of HIV infection than the straight population. Truvada is not a remotely valuable option to us. But the discussion is skewed by the apparent inability of straight people to conceive of homosexuality as a fundamentally distinct entity – as opposed to a sort of re-enactment of straight sex, where the anus substitutes for the missing vagina. | I, and a sizeable proportion of my fellow gays with me, have a lower risk of HIV infection than the straight population. Truvada is not a remotely valuable option to us. But the discussion is skewed by the apparent inability of straight people to conceive of homosexuality as a fundamentally distinct entity – as opposed to a sort of re-enactment of straight sex, where the anus substitutes for the missing vagina. |
| Cultural (mis)representations warp the medical perspective on this issue. Calls on the entire gay population to take up a chronic pharmacotherapy are, as a consequence, patently absurd. | Cultural (mis)representations warp the medical perspective on this issue. Calls on the entire gay population to take up a chronic pharmacotherapy are, as a consequence, patently absurd. |
| —Name withheld, Baltimore, Maryland | |
| Gay manTruvada userSometimes uses condoms | Gay manTruvada userSometimes uses condoms |
| I’m 45 and have been scared of sex my entire life - when I was coming out in the early 90s, HIV-Aids was a death sentence. Despite knowing how HIV is transmitted, I use condoms probably 60% of the time for receptive sex – and it only takes once. I figure I’ve used up my chances. | I’m 45 and have been scared of sex my entire life - when I was coming out in the early 90s, HIV-Aids was a death sentence. Despite knowing how HIV is transmitted, I use condoms probably 60% of the time for receptive sex – and it only takes once. I figure I’ve used up my chances. |
| It’s been a month, no side effects to this point that I’ve noticed (and I’m very drug sensitive). I’m not having more sex, but I am less nervous about sex and am enjoying it without in the back of my mind thinking, “This could kill me.” | It’s been a month, no side effects to this point that I’ve noticed (and I’m very drug sensitive). I’m not having more sex, but I am less nervous about sex and am enjoying it without in the back of my mind thinking, “This could kill me.” |
| I’ve lost friends to HIV, and it feels sometimes disloyal to their memories to not be 100% condom compliant, but I don’t like them. It feels petty and whiny to say “I don’t like them” when they can stop the spread of disease, but sex with them … well, it’s not really sex. | I’ve lost friends to HIV, and it feels sometimes disloyal to their memories to not be 100% condom compliant, but I don’t like them. It feels petty and whiny to say “I don’t like them” when they can stop the spread of disease, but sex with them … well, it’s not really sex. |
| The more people who know about Truvada and who go on it, hopefully, the more affordable it will become. I do worry that my insurance company will stop covering it when they realize I’m HIV-negative. My prescribing physician said that was a very real possibility. But for now, it’s covered. | The more people who know about Truvada and who go on it, hopefully, the more affordable it will become. I do worry that my insurance company will stop covering it when they realize I’m HIV-negative. My prescribing physician said that was a very real possibility. But for now, it’s covered. |
| —Name withheld, Long Beach, California | |
| Gay manConsidering TruvadaDoesn’t trust condoms | Gay manConsidering TruvadaDoesn’t trust condoms |
| I absolutely want to use it, and I absolutely can’t afford it on my Affordable Care Act health care plan, even with Gilead subsidies. I don’t trust condoms enough, so I don’t engage in anal sex or play at all – but with Truvada, I would seriously reconsider anal sex with condoms. | I absolutely want to use it, and I absolutely can’t afford it on my Affordable Care Act health care plan, even with Gilead subsidies. I don’t trust condoms enough, so I don’t engage in anal sex or play at all – but with Truvada, I would seriously reconsider anal sex with condoms. |
| –Matthew Hintzen, Orlando, Florida | |
| Gay manNot considering TruvadaDoesn’t use condoms | Gay manNot considering TruvadaDoesn’t use condoms |
| I’ve been an HIV-negative sexually active gay man since 1979. I did not survive this plague by being reckless and ignoring conventional wisdom. Even if an expensive drug with unknown side effects prevents HIV infection, you can still get Hep C, herpes, warts, and crabs! | I’ve been an HIV-negative sexually active gay man since 1979. I did not survive this plague by being reckless and ignoring conventional wisdom. Even if an expensive drug with unknown side effects prevents HIV infection, you can still get Hep C, herpes, warts, and crabs! |
| I don’t even use condoms and I never have. You can be sexually active and not engage in anal sex – you don’t even have to have oral sex or kiss. Sex is creative energy, not just mechanical. And anal sex is really overrated, considering the consequences. | I don’t even use condoms and I never have. You can be sexually active and not engage in anal sex – you don’t even have to have oral sex or kiss. Sex is creative energy, not just mechanical. And anal sex is really overrated, considering the consequences. |
| I resent having to subsidize gay men who were reckless and think they can continue to be so. This pill invites reckless behavior and enslaves people to pharmaceutical solutions for health. You never have to take pharmaceuticals if you are safe and maintain a healthy lifestyle. | I resent having to subsidize gay men who were reckless and think they can continue to be so. This pill invites reckless behavior and enslaves people to pharmaceutical solutions for health. You never have to take pharmaceuticals if you are safe and maintain a healthy lifestyle. |
| –Name withheld, Palm Springs, California | |
| ManTruvada userDoesn’t use condoms | ManTruvada userDoesn’t use condoms |
| I didn’t use condoms 100% of the time. So rather than keeping myself at risk for converting, I took responsibility for my own health. | I didn’t use condoms 100% of the time. So rather than keeping myself at risk for converting, I took responsibility for my own health. |
| Honestly, it’s a revolution. Finally I can have sex without fear that I’m going to contract HIV. And I’m not going to feel bad or wrong for enjoying sex in a way I want to enjoy it, or for practicing without condoms. There isn’t anything inherently wrong with enjoying bareback sex; regardless of what the moral police want us to believe. | Honestly, it’s a revolution. Finally I can have sex without fear that I’m going to contract HIV. And I’m not going to feel bad or wrong for enjoying sex in a way I want to enjoy it, or for practicing without condoms. There isn’t anything inherently wrong with enjoying bareback sex; regardless of what the moral police want us to believe. |
| People can contract STDs with condoms. And we certainly don’t chastise people for catching a cold or the flu, which are also preventable. So why STDs so harshly? People are so scared of intimacy and love. | People can contract STDs with condoms. And we certainly don’t chastise people for catching a cold or the flu, which are also preventable. So why STDs so harshly? People are so scared of intimacy and love. |
| It’s so great taking control. | It’s so great taking control. |
| –Charles Ludeke, Brooklyn, New York | |
| Gay manNot considering TruvadaUses condoms | Gay manNot considering TruvadaUses condoms |
| I think it is excellent that Truvada is available for situations where behaviour change is not forthcoming. As a gay man with multiple partners, I was faced with a choice of taking Truvada or modifying my behaviour. Taking Truvada comes at a cost – taking tablets everyday with the potential for side effects and expenses. | I think it is excellent that Truvada is available for situations where behaviour change is not forthcoming. As a gay man with multiple partners, I was faced with a choice of taking Truvada or modifying my behaviour. Taking Truvada comes at a cost – taking tablets everyday with the potential for side effects and expenses. |
| Changing my behaviour by reducing partners is free, has no side-effects and has vastly improved my mental and social well being. Multiple sexual partners offers small short term pleasures but has the potential to cause grave physical and mental distress in the long run. | Changing my behaviour by reducing partners is free, has no side-effects and has vastly improved my mental and social well being. Multiple sexual partners offers small short term pleasures but has the potential to cause grave physical and mental distress in the long run. |
| —Lester Mascarenhas, Melbourne, Australia | —Lester Mascarenhas, Melbourne, Australia |
| ManConsidering TruvadaDoesn’t use condoms | ManConsidering TruvadaDoesn’t use condoms |
| I am married but have issues with monogamy. If Truvada can keep me safe from infection, it could make a huge difference to my anxiety. | I am married but have issues with monogamy. If Truvada can keep me safe from infection, it could make a huge difference to my anxiety. |
| —Name withheld, New York, New York | |
| Gay manTruvada userDoesn’t use condoms | Gay manTruvada userDoesn’t use condoms |
| Truvada as PrEP takes the fear out of having sex, and the gnawing guilt that used to follow. Now, I don’t look at men and obsessively try to guess their HIV status before deciding whether to hook up. Instead I focus on the man, not the disease. It’s a freedom of mind and of thought that I never thought I would experience in my lifetime. | Truvada as PrEP takes the fear out of having sex, and the gnawing guilt that used to follow. Now, I don’t look at men and obsessively try to guess their HIV status before deciding whether to hook up. Instead I focus on the man, not the disease. It’s a freedom of mind and of thought that I never thought I would experience in my lifetime. |
| Condoms usually don’t fit well, they feel bad, sound awful during sex, and many times I end up with a lost erection. I can’t really touch someone like I want to with a piece of latex separating us. | Condoms usually don’t fit well, they feel bad, sound awful during sex, and many times I end up with a lost erection. I can’t really touch someone like I want to with a piece of latex separating us. |
| I dated an HIV-plus man for a while, and every sexual experience was an awkward moment – though neither of us ever talked about it. He has since died. He used to remark that he was surprised I wasn’t HIV-plus as well. I think it was good luck. Now that I am on PrEP, the obsessive thoughts about HIV have disappeared. I’m confident that as long as I take Truvada on a daily basis, I will be free from HIV. | I dated an HIV-plus man for a while, and every sexual experience was an awkward moment – though neither of us ever talked about it. He has since died. He used to remark that he was surprised I wasn’t HIV-plus as well. I think it was good luck. Now that I am on PrEP, the obsessive thoughts about HIV have disappeared. I’m confident that as long as I take Truvada on a daily basis, I will be free from HIV. |
| —Robert Rimac, Palm Springs, California | |
| Gay manConsidering TruvadaUses condoms | Gay manConsidering TruvadaUses condoms |
| The side effects are very much my No1 concern. It troubles me to take some drug on which long-term side effects are not known when I’m perfectly healthy. | The side effects are very much my No1 concern. It troubles me to take some drug on which long-term side effects are not known when I’m perfectly healthy. |
| The effectiveness of the drug also makes me anxious – if it’s not closer to 100 percent effective, it kind of seems pointless. The cost of the drug is also a concern, as well as the fact that it’s a pill a day. | The effectiveness of the drug also makes me anxious – if it’s not closer to 100 percent effective, it kind of seems pointless. The cost of the drug is also a concern, as well as the fact that it’s a pill a day. |
| —Name withheld, Plainfield, Illinois | |
| ManTruvada userSometimes uses condoms | ManTruvada userSometimes uses condoms |
| Since starting Truvada, I’ve actually had fewer sexual partners than before, and the quality of the sex has been generally better – I’m less anxious. I haven’t had any side effects except for strange dreams, which I get pretty frequently. Not bad dreams, just strange. | Since starting Truvada, I’ve actually had fewer sexual partners than before, and the quality of the sex has been generally better – I’m less anxious. I haven’t had any side effects except for strange dreams, which I get pretty frequently. Not bad dreams, just strange. |
| My major concern is this: the Proud trial, where pretty much everyone in the UK gets PrEP from, has limited funding and some of us are due to ‘graduate’ out soon. As things are now, we won’t have access to the drugs anymore. What happens to us now that we’re used to having that safety net – how will removing it impact our mental and physical health? | My major concern is this: the Proud trial, where pretty much everyone in the UK gets PrEP from, has limited funding and some of us are due to ‘graduate’ out soon. As things are now, we won’t have access to the drugs anymore. What happens to us now that we’re used to having that safety net – how will removing it impact our mental and physical health? |
| There’s also concern about why a drug which is proven to be very effective and is likely to have a pretty major impact on the epidemic, isn’t available to those who need it in this country. | There’s also concern about why a drug which is proven to be very effective and is likely to have a pretty major impact on the epidemic, isn’t available to those who need it in this country. |
| —Name withheld, London, UK | —Name withheld, London, UK |
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