"I have a responsibility to volunteer in the Next-PrEP study"

My support for PrEP up until now has been solely offered sitting at this keyboard.

Now, it's time to step back into the street one more time.

 by Daniel MacDonald


I knew I was gay since I was 13.

This was back in 1977, so being gay wasn't as socially acceptable then as it is now, but I didn't care even then. I liked guys, that was that, and I didn’t care who knew it. When you knew someone who was gay, well, “gay” was always said in a hushed whisper. I lost my virginity that year to a much older man I would spend the next nine years with. The sex was a fantastic event with him every single time, and being a healthy teenager, my sex drive was nonstop. We would spend the day shagging like dogs, and because we were in an open relationship we would invite others to come join us for the naked festivities.

Things would take a dramatic turn when a scary illness and rare cancer began to show it's face before I hit 25 years old. The flow of information stunk at that time, and there was far more misinformation than actual fact being shared, and it would quite a while before the disease had a name (and we all thought it sucked back then, too.) Great. Now anyone in the family who didn't care for my being a big ol' homosexual now had ammunition. If you don't settle down and get a girlfriend you're gonna get that gay plague and die. It'll be God's punishment for what you're doing.

Please. I tried girls, and the only way I enjoyed them was if they brought their boyfriends along for the fun and we had a bisexual romp. I’ve given more than one curious couple a night to remember for both of them. Told you: I'm a total horndog.

The name of the gay plague changed to something a bit more acceptable, but it was no less scary. My friends were dying, nobody was helping us at any level, and the only protection we had at our disposal if we didn't want to become HIV positive was to wear a condom. Now, let me tell you a bit more about me: I'm a big guy. When I finally stopped growing, I landed on 6 foot 6 inches. Nature also blessed me with a nice set of muscles on this gargantuan frame, and an appropriately sized cock - a true 10 inches and 7 around. That made me the most popular guy at the dance - a fact that I used to my advantage in my personal sex life, as well as rounding up tricks I "escorted" and a brief career in porn. All the sex I want? For money? And how many people will be watching? Well, sure – what the hell. Count me in. My most memorable scenes are probably in that box in your attic.

Finding a condom that I could actually get on was a ridiculous lesson in futility. When I could find one that had possibilities, it felt like my cock was being mugged.

Need a picture? Think of stuffing five pounds of sausage in a three-pound casing. I got them on - barely. They were painful, hard to roll down, and slid off while I was fucking. So the fear of HIV dictated a very uncomfortable, unsatisfying sex life for years. And because I couldn’t get a condom to fit me, I went from being versatile to total bottom. Sex was losing that wonderful fascination and becoming more of a scary chore than anything, and I funneled all that pent up sexual energy into HIV/AIDS advocacy; a passion that's followed me to this day. If there was a demonstration, speech or action taking place that I could get to, I was going to be there. I'd watched too many of my friends die, and too many senseless seroconversions involving people who didn't know all the facts about HIV.

Flash forward a few years to the mid-1990s. The man who took my virginity is out of the picture and now I'm with a wonderful man who I love intently. He's HIV positive--a fact I knew about him before I could spell his last name. And I'm HIV negative.

Together we had to find ways of discovering a satisfying sex life without my seroconverting. The meds of the day weren't what they are now, and I knew from my boyfriend’s complete transparency around his HIV status that he was sporting a big viral load. The word “undetectable” in regard to his HIV didn’t come up much those days. While there was no reason for us not to have sex, it came with a lot of caveats. We tried mutual masturbation. We tried me on top wearing a rubber. We tried him on top, wearing a rubber, which totally killed it for him.

Could you stay in the saddle with the question of "what if the condom breaks?" lurking in the back of your head? He couldn't either; especially on the day it did break.

He pulled out, and as was his habit he’d inspect the condom and damned if it didn’t happen. We spent the next few days waiting for my HIV test results and my boyfriend was in a morbid funk, and understandably so. He was overwrought with guilt at the prospect of my contracting HIV from him, and I had resigned myself to getting my results and hearing that I was positive. It was nobody’s “fault” and if it happened, it happened; so be it. The test came back negative; as did all the other subsequent tests I took afterward as a safeguard. During every single wait period for results, my heart broke for my boyfriend and the self-imposed guilt he was swimming in. Finally, we tried him watching while I fucked with other negative guys, which was probably the worst, most alienating idea of them all. His participation in those romps wasn’t nearly what it needed to be, and it wasn’t satisfying for either of us.

You get the idea? We loved each other but our sex life at the start left a lot to be desired
These days, meds are better if you're HIV positive, and condoms come in more varieties. And I'll tell you a secret: I don't always use them. I know that’s blasphemy for me to say as an HIV/AIDS advocate but there it is. Sometimes the waves of testosterone come crashing ashore, and common sense goes out with the tide. I still have some issues finding ones that will fit, and female condoms aren't as universally accessible as I'd like. I have no problems negotiating whether or not we use them when the time comes. If I'm with someone who says they're negative I expect them to prove it; I'm not naive enough to take someone at their word. It takes more than a guy giving me a hardon before the gloves come off - if you get the drift.

Enter PrEP.

CDC "Cheat Sheet" on PrEP - Fast Facts for Providers

Check out CDC's Interim Guidance on PrEP for providers in this handy "cheat sheet" below. For more info on PrEP via CDC, click here.

click to enlarge

 

PrEP – How did I end up here? [Part 2 of 3, by Marc-André LeBlanc]

bv Marc-André LeBlanc
Gatineau, Canada

• Multiple sex partners? Check

• History of STIs? Check

• Partners of unknown or HIV-positive status? Check

• Inconsistent condom use? Check

This is the second installment of a three-part series.
Click here to read the first installment. Click here for Part 3.

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). How did I end up in this situation where I feel like I need PrEP? 

As I mentioned in my previous post, a look back at the phases of my sex life gave me some clues about why PrEP makes sense for me now. After more than 20 years of being sexually active, I only recently found myself veering away from perfect 100% condom use.

How did that happen?

Ironically, this is in part because I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. I know what the research is telling us about HIV transmission. I know what proportion of new infections is driven by people who are undiagnosed. I know what undetectable viral load means for transmission risk.

I started serosorting, but not in the conventional sense. More and more, I’ve been dividing guys up into 3 categories.

1. The first category is small. With HIV-negative guys I know and completely trust, we arrive at a form of negotiated safety—if we have been tested for HIV and all STIs recently, and not yet had sex with others, we usually have condomless sex.

2. The second category has been steadily growing—positive guys. We have discussions about treatment, viral load, STIs and decide how to proceed from there. Sometimes without condoms.

3. The third category is basically everyone else—HIV unknown or undisclosed, and HIV-negative men I don’t know well. I consider guys from this third category as potentially being in the acute infection phase, whether they know it or not. This is the category of men with whom I am most adamant about condom use. All too often, their prevention strategy is dubious at best (e.g., “r u clean? how big r u? wanna bb?”). If I see another highly stigmatizing "disease free"/"no poz" message on an online profile, meant to be some kind of stand-alone, ill-informed HIV prevention strategy, I might reach through the screen and cyber-throttle someone.

So gradually, I’ve found myself feeling much less worried about having condomless sex with a positive guy after a conversation with him about treatment and viral load and STIs than about having condomless sex with a guy who says he is negative, but could be in the acute infection phase with sky-high viral load without even knowing it.

Paranoia? Rational, effective, evidence-based risk-reduction strategy? Both? You be the judge.

But let’s be honest. I also started “slipping up” more and more often because, well… sex feels better without condoms. *gasp* That’s right folks. Sex without condoms feels freaking amazing. You heard it here first.

So while I still maintained a relatively high rate of condom use, I found myself having condomless sex every once in a while. Of course, I also know how effective inconsistent condom use is over time (i.e., not very).

 

An illuminating peek inside the Little Black Book

Three years ago, I started to keep track of my sexual encounters in a proverbial little black book. (OK fine, it’s blue and has a Global Campaign for Microbicides logo and a Rectal Pride for Microbicides sticker on it. It’s super pretty and seemed appropriate). Every time I have sex, I write down what we did, what I know about my sex partner’s HIV status, and whether or not we use condoms. Yup, every time for 3 years. I do this partly so I have very accurate information at my fingertips to relay when I get tested for HIV and STIs. Partly so I have very accurate information at my fingertips when I start to worry. I can look at my list since my last tests and say: look, you had this many encounters, this is what you did with whom, this is how often you used condoms, and this is what you know about his HIV status. Sometimes that helps alleviate the occasional panic attack and insomnia. Sometimes.

I had never seen myself as being “high risk” for the first 20+ years of my sex life. But I’ve been working in HIV for 20 years. So I know the behavioural characteristics of “those people” at high risk. Armed with about 3 years of hard data about my own newly evolving behaviour (i.e., my stylish little blue book), I decided to look at it objectively.

• Multiple sex partners? Check

• History of STIs? Check

• Partners of unknown or HIV-positive status? Check

• Inconsistent condom use? Check

Well then. It’s hard to ignore what this spells.

I like to think I’m at least moderately intelligent. I know how HIV is transmitted. I know how effective condoms are.

I like to think I understand the consequences and the stakes. Yes, people living with HV are doing much better today. But I saw my dad die of AIDS in front of my eyes. I saw countless other friends, colleagues and clients become HIV-positive or die of AIDS. That leaves an impression, to say the least.

I like to think I’m a responsible person. I get tested frequently. I stay informed.

I like to think I have high self-efficacy. I have several years of experience using condoms consistently, and I am more often than not the one wearing the condom, so little to no negotiation is required.

I’m not depressed. I never drink. I don’t so drugs. My judgement is not clouded by any of those.

I’m not in denial. I know that the combination of inconsistent condom use, multiple partners, history of STIs and having partners of a different/unknown HIV status is a very strong predictor of seroconversion over the course of a few years.

If all of this doesn’t make me an ideal candidate for consistent condom use, I don’t know what more it would take, short of using Super Glue to permanently bond a condom to Mr. Happy.

Yet here I am.

So as a smart, responsible, well-informed, sexually active gay man with good self-efficacy and good access to healthcare and accurate information, I’ve come to the conclusion that PrEP makes sense for me at this point in my life. I don’t know how long this new “PrEP phase” will last. But I am glad it is available to me while I need it.

***

There are a million other things I have to say about PrEP. Well OK, maybe only half a million. But luckily others have already addressed many of them, and have done it so eloquently. I encourage everyone to check out the following remarkable first-person accounts:

• Len Tooley did a series of interviews on PositiveLite.
• Jake Sobo has been writing a whole series of articles on his blog, “My Life on PrEP”.
• Several other first-person accounts can be found right here on the “My PrEP Experience” blog.

Len and Jake are so friggin’ smart and insightful and articulate, I want to marry both of them. It has been a tremendous source of help and support to read the thoughts of everyone who shared their stories publicly. A big hairy thanks to Jim Pickett for starting the “My PrEP Experience” blog because he recognized that amidst all the heated debates and discussions and policy decisions about PrEP, we weren’t hearing the voices of real-life flesh-and-blood people actually using PrEP.

Community Talk Show in Chicago May 22 - Can a Pill Revolutionize Sex for Gay and SGL Men of Color?

Join your hosts – social guru David Dodd and award winning vlogger Ken Like Barbie – and special guests 4 an all-ages, interactive, FREE community talk show to discuss sex, love, lust, and relationships.

Learn about a fresh, safer-sex option for ourselves and our partners.

Featuring dynamic performances by Vocalist, Poet, Actor and Humorist ButtaFlySouL, star of ButtaFlySouL for President. Don’t miss his beautiful spirit!

Community. Sexy. Fun. Free. Healthy. Real.

Appetizers from the Hearty Boys! Raffles!

DETAILS:
Get Ready. Get Set. PrEP!
Date: Wednesday, May 22, 2013
Time: Reception with light appetizers begins 6:00 p.m., show begins 7:00 p.m.
Location: Center on Halsted
3656 North Halsted in Chicago
3rd floor, Hoover-Leppen Theatre.

This Project RSP! community forum has been brought to you through a collaboration between Blackstone Avenue Marketing, Clubhouse Productions, Gilead Sciences, High Society Entertainment Group, John Stroger Hospital, K Dock Media, My PrEP Experience, National Youth Pride Services, PrideIndex.com, Rails Marketing Group, United Black Pride, and AIDS Foundation of Chicago.

PrEP – Is this just a phase I’m going through? [Part 1 of 3]

bv Marc-André LeBlanc
Gatineau, Canada

This is the first installment of a three-part series. Click here for Part 2. Click here for Part 3.

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP).

So many questions were swirling in my head at that point, and had been for weeks and months. As I was about to swallow my first pill, I gazed outside the window and wondered…

• How did I end up in this situation where I feel like I need PrEP?

• How is it possible that it was this easy for me to access PrEP when so many people don’t have access to ARVs to stay alive?

• How did I go from being a major PrEP skeptic 4 years ago to actually taking PrEP now?

• What would people think if they knew I was taking PrEP and therefore by implication putting myself more at risk than I’d even been willing to admit to myself?

• Will I be taking this pill every morning for the rest of my life?

• Will I start taking more risks than I did before?

• Will I experience side effects?

• When will this damn winter end? I know this is Canada and everything, but enough already with the grey skies and slush and dreariness.

To find clues about how I got here and how long I might need PrEP, I took a sexy stroll down memory lane. Or as I like to call it…

My Sex Life: A Tale of HIV Risk in Five Phases

Phase 1: “In the Beginning”, lasted 8 years. I grew up in Moncton NB, a small town on the East
coast of Canada, and stayed there until my mid-20s. Let’s just say there were not very many opportunities to participate in activities that would have put me at high risk. This was pre-interwebz and smartphones, folks. In a town with one gay bar. I don’t do bars. Ever. All my experiences were very low risk. I didn’t even want to experiment with high risk behaviours. I was much too scared. I watched my father, an out gay man, progressively get sicker and eventually die of AIDS, desperately gasping for breath in his last hours, right in front of my eyes. I was 18 when we learned he already had AIDS and he died when I was 20. Trust me, this leaves an indelible impression on a young gay man who is just beginning to have sex, and who has not even come out yet. I did come out very shortly thereafter, and I ended up in a long-term relationship pretty much immediately.

PrEP would have made no sense for me then. I didn’t even need condoms. That would come later.

Phase 2: “Spreading my Wings”, lasted 9 years. I moved to the Ottawa/Gatineau region where I still live now, a sprawling metropolis compared to what I’d known until then. I was here by myself for a while. I decided it was time to explore and play around. Even after my partner joined me. But I was still not at high risk for HIV. This was largely because I was frankly uninterested in activities that would have put me at high risk. Partly out of personal preference. Partly out of concern about “bringing something home” to my partner (oh ya, I was suuuch a considerate adulterer!). Partly because at this stage my fear of getting HIV still considerably outweighed any desire to do anything even moderately risky.

PrEP would have made no sense for me then. I didn’t even need condoms. That would come later.

Phase 3: “Letting Loose”, lasted 1.5 years. After the end of my 14-year relationship, I decided it was time to explore and play around even more. Not that I’d been an angel before. Far from it. But now I was ready for some adventure. Through it all, I can honestly say that I managed to maintain absolutely 100% condom use. Each and every time. How did I manage that? For one thing, while my fear of getting HIV no longer outweighed my desire to explore activities that happen to be more risky, it still was strong enough to reinforce my resolve around condom use. It also helps that negotiating, convincing, or cajoling are rarely required when you’re almost always the one actually wearing the condom.

PrEP would have made very little sense for me then. That would come later.

Phase 4: “The Dark Ages”, lasted 1.5 years. Through a very severe depression, there was nothing going on. Nothing.

PrEP would have made no sense for me then. I didn’t even need condoms. That would come later.

Phase 5: “The Renaissance”, lasted 5 years. I was back to a life of adventure as a single gay man in a mid-size city, and on very frequent travel. At first, I still managed to maintain 100% condom use. But gradually, over the course of the last 2-3 years, I started to veer away from 100% condom use for reasons that I will explain in my next installment. As a sneak preview—it has to do with the current state of knowledge about HIV transmission, and, well… because sex feels better without condoms! *GASP* Stay tuned for the shocking next episode.

So now, for the first time in my life, at the age of 43, and after 25 years of active sex life (minus a brief depression-induced hiatus), PrEP makes sense for me. How long will this new phase last? How long will I be on PrEP? I don’t know. But luckily it exists and I can access it.

***

There are a million other things I have to say about PrEP. Well OK, maybe only half a million. But luckily others have already addressed many of them, and have done it so eloquently. I encourage everyone to check out the following remarkable first-person accounts:

• Len Tooley did a series of interviews on PositiveLite.
• Jake Sobo has been writing a whole series of articles on his blog, “My Life on PrEP”.
• Several other first-person accounts can be found right here on the “My PrEP Experience” blog.

Len and Jake are so friggin’ smart and insightful and articulate, I want to marry both of them. It has been a tremendous source of help and support to read the thoughts of everyone who shared their stories publicly. A big hairy thanks to Jim Pickett for starting the “My PrEP Experience” blog because he recognized that amidst all the heated debates and discussions and policy decisions about PrEP, we weren’t hearing the voices of real-life flesh-and-blood people actually using PrEP.

VIDEO - HIV Positive Men: Having a Healthy Sex Life and a Healthy Family

This informative video, from our friends at the Bay Area Perinatal AIDS Center, talks about how HIV+ men, with HIV-negative female partners, can avoid HIV transmission - even if they want to have a baby.

The video includes info on the prevention benefits of treatment as well as PrEP. Click to watch.