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Thursday, May 2, 2013

PrEP – What have I done to deserve this? (Part 3 of 3)

This is the third and final installment of a three-part series. Click here to read the first installment. Click here to read the second installment.

I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. 

bv Marc-André LeBlanc
Gatineau, Canada

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). I won’t deny it. I’ve been feeling very conflicted about starting PrEP.

Why do I have access to Truvada when the majority of people who need antiretroviral medication to stay alive don’t have access? I got my hands on this bottle relatively easily. The social injustice is not lost on me. I don’t have relatively easy access to this medication because I deserve it more than anyone else.

So what HAVE I done to deserve access to PrEP? Well, a lot of it is sheer luck, actually.

•    Nearly every time I see the news, I am amazed at how lucky I am. I was born in Canada. Talk about winning the lottery. Out of 7 billion people, I am one of only 34 million people living in Canada. Trust me, it’s a great place to live!

•    I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. This provides me with ongoing access to the latest information.

•    I make a good living. I can access healthcare relatively easily and generally for free or at a cost that has little impact on my standard of living.

•    I have a doctor. He’s young (My age. That’s young. Shut up.), gay, and sees a lot of people living with HIV in his practice. So talking to him about my sex life and about PrEP was not difficult. He keeps up to date on research. After a good discussion, he agreed to prescribe PrEP.

•    Not only do I live in Canada, but I live in Québec, the only province to have a universal public drug plan. As long as the drugs my doctor prescribes are on the provincial drug formulary, I am covered for most of the cost. I pay $500 into the drug plan annually, and PrEP will cost me less than $1,000/year on top of that. And if I ever need other drugs for any reason, I will not pay for them. Because $992/year ($82.66/month to be precise) is the most I would have to pay for all my drugs combined.

I’m not trying to be disingenuous. I know that beyond being lucky and privileged, I have access to PrEP because I’ve taken some very concrete steps as well. I did lots of introspection. I tried to reduce my risk as much as possible through other means. I did a lot of research. I actively sought out access. I make sure I’m very diligent about taking my pills.

I always have been very diligent about that. I take all my antibiotics when I need them. I take vitamins daily. When I was on antidepressants, I never missed a dose in 1.5 years. I follow advice from medical professionals to the letter. Case in point: I’ve needed physiotherapy twice. Both times, the conversation during my second visit went something like this:
Physiotherapist: Wow, you’re made remarkable progress in one week. I’ve never seen anyone progress so quickly with this type of injury. Which exercises did you do?
Me: All of them, like you showed me.
PT: You did ALL the exercise I gave you?! How often?
Me: Every day, like you told me.
PT: You did ALL your exercise EVERY day?! How many times a day?
Me: Twice, like you told me.
PT: You did ALL your exercises, EVERY day, TWICE a day?! I’ve never seen this in all my years of practice! No wonder you’re doing so well!

*SLAP* You’re at risk of HIV!

I might make jokes, but I don’t take this lightly.

Every morning when I wake up it’s the first thing I think about. That might stop after a while. But two weeks into taking PrEP, it’s the same thing. I wake up, and as I ponder about whether I want to go back to sleep again for a little longer, I can’t do it. I immediately think: when I get up I have to take my Truvada pill. Because I’m at risk of HIV.

Each and every time I open the cupboard and grab the bottle, I think: how is it possible that I am so lucky to have such easy access to this medication when millions of people who need it to stay alive don’t have access?

Who needs a coffee? I get a slap in my face every morning. Two of them in fact.

*SLAP* You’re at risk of HIV and STIs!

*SLAP* You’re one of the lucky few who has access to this medication and to this prevention option!

I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. I’m not there yet by any stretch. But at least I get some measure of comfort from knowing that I’m putting chances on my side by reducing my risk as much as I can in my current situation. Doing my best to stay healthy seems like the right thing to do to honour those who don’t have access to this drug.


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.


  1. It's interesting that you use reminding yourself that you are at risk for HIV as a means to remind yourself to take your Truvada. One would think that one of the great advantages of PrEP would be not having to think about HIV quite so much.

    As an HIV-positive guy who is also a star of adherence (without being perfect, mind you), I work to minimize the space that those pills take in my life: I can organize my pills for the day in minutes and take them together as a handfull.

    Thanks for sharing this experience with us with all the cheeky humanity and humour you bring to it. And I realize this is part 3 of 3, but I would love to hear about your partners' reactions if you tell them you are on PrEP...

  2. Thanks for your comment, Ken. It's not that I use reminding myself that I am at risk for HIV as a means to remind myself to take my Truvada pill. I remember to take my pill because it's part of my morning vitamin-taking routine anyways. But every time I remember that Truvada is part of that, it reminds me that the reason I am taking it is because I am at risk. That still happens now, but it's no longer stopping me from falling back asleep to snooze longer. :)

    As far as one advantage of PrEP being that one doesn't have to think about HIV quite so much, that is not the case for me so far. Quite the opposite. It's an additional daily reminder, and on a very personal level. [Of course if I didn't also work in HIV every day, that might make a difference...]

    Having said that, I think my anxiety and fear after some sexual encounters might be lessened, but it's still early days. It's likely to be something I'll write about in the future. The topic you propose is another one I will write about. I already have half a dozen topics in mind for future posts. This 3-part series was just about my decision-making process around starting PrEP and my emotional response to that.

  3. On behalf of a fellow PrEPper:

    "Marc-André: another lovely posting that exposes your very thoughtful, sensitive and self reflective nature. For me, it wasn't PrEP per se that reduced my anxiety around HIV. It really isn't a magical pill that suddenly changes everything. That being said, it did open up a new set of possibilities that allowed me to re-asses my relationship to HIV and do some really important introspection about how my fear of HIV had so significantly impacted all aspects of my life. It's a long, winding road...and at best PrEP is a cart-and-buggy that might just help make the journey a little less grueling. Thanks for sharing!!! –Len"



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