Health/Fitness » HIV/AIDS

PrEPing for Pride

by Jill Gleeson
EDGE Media Network Contributor
Saturday Mar 31, 2018

It's almost the most wonderful time of the year. Temperatures are warming, trees are budding, and fake bake salons have lines out the door as everyone begins working on their base tan. But with Pride season approaching there's more to think about than stepping up ab training at the gym and revisiting that waxing professional.

Thanks to Pre-Exposure Prophylaxis (PrEP), it's now possible to significantly reduce the risk of HIV infection by taking a daily pill. The FDA approved Truvada in 2012 but this wonder drug comes with some important caveats. In its 2014 clinical practice guideline, the Center for Disease Control and Prevention noted that "when PrEP is prescribed, clinicians should provide access, directly or by facilitated referral, to proven effective risk-reduction services."

As we get set to crack the champagne on Pride, here's the straight dope on PrEP.

The Good News

According to the CDC, "when taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent." And it works fast, too. For people engaging in anal intercourse, it only takes seven days for Truvada (PrEP's brand name moniker) to become effective, although the receptive partner in vaginal intercourse must wait 21 days before they are fully protected.

Full protection with PrEP, according to Felipe Flores, Manager of PrEP Benefits & Navigation, San Francisco AIDS Foundation, means condoms are no longer the end-all be-all in the fight against HIV infection. "The discussion around what constitutes 'safe sex' is an ever-changing conversation," Flores notes. "Safe sex does not just mean sex with condoms anymore, condomless sex on PrEP is safe sex... People need to know PrEP works so that they'll consider it for themselves."

But, Flores is quick to add, "Neither PrEP or condoms are infallible; however with some healthy behaviors like regular testing and good adherence and use of your different prevention tools, individuals can safely enjoy their sexual practices with little fear or anxiety."

Stay Informed

Just because PrEP guards against HIV infection doesn't mean it does so against sexually transmitted diseases. In a study released last year, the CDC found that sexually transmitted infections in the U.S. are at an all-time high, with more than two million cases reported in 2016. While STI trends tend to be local, some cities are seeing the same diseases spike within their borders that are increasing nationally.

"Here in New York City, syphilis, gonorrhea, and chlamydia seem to be on the rise," says Dr. Andrew Goodman, associate director of medicine at Callen-Lorde, New York City's LGBT community health center. "Although it isn't clear if this is due to more infections or just more testing."

For those on PrEP -- whether or not you consider healthy behavior to still include condoms, STD and HIV testing -- taking the pill at the same time every day is critical. "One major concern is that some individuals do not take their medication daily, or start and stop PrEP without the supervision of a medical provider," says Flores. "It is crucial that individuals on PrEP take their medication every day to insure its effectiveness. Often times providers have different tools or tricks to help with daily pill taking." Sites such as PrEP SQUAD are a great reminder to consistently take medication.

Affordability and Access

It's important to consider the risks with any medication. While Truvada can cost some users upwards of $1,500 a month for people without insurance, many private health plans as well as Medicaid and support for the uninsured from the drug's manufacturer, Gilead, can offer financial assitance. The drug's side effects, like drowsiness and nausea, are typically tolerated and usually subside quickly.

There have been anectdoal reports of lactic acidosis (a build-up of lactic acid in the blood stream), with side effects ranging from liver and kidney problems as well as bone density loss. "Some people have minor kidney problems with using PrEP," notes Goodman, "but that's something we watch for with regular check ups for bloodwork to monitor function."

Goodman believes "that an HIV/AIDS free generation is possible... I hope that we can continue to educate providers and the public while advocating for equal access to healthcare for everyone so that we make this hope a reality."

Per Goodman's point, one of the challenges has been a lack of concerted effort in policy and practice in the healthcare community. According to a 2016 Vice article, Harvard Medical School researchers suggest that one of the delays is that PrEP was typically only prescribed by HIV specialists. Building stronger relationships between primary care doctors and their patients may be the future of creating open dialogues about safe sex practices and celebrating Pride through responsible, thoughtful actions.

Jill Gleeson is a travel and adventure journalist based in the Appalachians of Central Pennsylvania. Find her on Facebook and Twitter at @gopinkboots.


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