Culture

(Op-Ed) Why Is PrEP Prevention Not Being Discussed in Nashville?

(Op-Ed) Why Is PrEP Prevention Not Being Discussed in Nashville?

Josh Robbins, founder of HIV blog imstilljosh.com, questions why Nashville’s LGBT community isn’t buzzing about PrEP and HIV Prevention pill Truvada?

By Josh Robbins –

Call it being naive or maybe just too ambitiously involved in real HIV-prevention discussions since I was diagnosed as HIV-positive on January 24, 2012, but I simply do not understand why PrEP (pre-exposure prophylaxis) is not being discussed more in this city.

For those of you that are not aware yet of PrEP, it “involves taking daily medication that helps to prevent the transmission of an HIV infection. It also includes other risk-reducing techniques, such as treatment for drug addicts or education about safe sex practices.” (source: Healthline)

With new HIV infections hovering around the 50,000 mark, according to the most recent CDC data, and according to statistics provided fromNashville CARES, there are over 5,200 individuals living with HIV/AIDS in Greater Nashville, the discussion of PrEP is more than timely. The time is now!

But there is this new stigma associated with HIV-negative folks that are considered at the highest risk of HIV-infection (gay men who have anal sex) to begin such a preventative method — PrEP. WHY? Is it because that many are worried about the costs associated with the prevention method? Most insurance plans just require a co-pay. Is it because these drugs are from pharmaceutical companies and some feel they are a big money-hungry establishment? These are the drugs that are keeping some of our friends and family living with HIV alive! It is no longer just a last option. It’s insane to not, at the least, allow and foster a discussion of all the methods that are available, in my opinion. And the fact of the matter remains that PrEP is the ONLY FDA tested and FDA approved prevention method for men that have anal sex with men. Condoms are still an important and necessary tool, of course. But there are no condoms that have the FDA stamp of approval on them for anal sex.

On my blog, I have an Open Letter on PrEP from HIV influencers that has over 50 signatures from high profile advocates in the country, including local Nashville CARES CEO Joseph Interrante and Street Works’ Robbie Maris, agreeing that the time is now for our community and others to support a healthy and much needed opportunity to discuss, between a patient and their physician, if the use of PrEP is advantageous.

I do not believe that PrEP is an option for everyone. However, I do believe that we, as a community, should foster these discussions between individuals and their doctors sooner than later — and allow those informed decision makers the right to weigh the options.

Many of you may be confused by the different voices in the debate on the practicality, safety, adherence requirements and benefits of this prevention tool. While not minimizing any of these concerns, we believe that individuals should be empowered to make informed decisions about their use of PrEP as a, FDA-approved prevention strategy. Moreover, I do not believe it is necessarily a matter of choosing between PrEP or condom use/other forms of behavior change. PrEP can and should be viewed as an addition to, not a substitution for, our current arsenal of prevention strategies. These may or may not be used in combination depending upon the individual situation. I do also recognize the importance of safer sex counseling and regular HIV and STI testing, provided by authorized organizations and methods.

Let’s get off our asses, community, and recognize that the time is now for all of us to stand up, again, agree that discussions about this modern tool is necessary, effective, needed. Please discuss PrEP with your physicians.

This article originally appeared on OutandAboutNashville.com.

(Op-Ed) What PrEP Means for People Living with HIV

(Op-Ed) What PrEP Means for People Living with HIV

Brenden Shucart, Editor-at-Large for PositiveFrontiers, shares how Truvada PrEP for HIV prevention can changes everything for those already living with the virus.

This article first appeared on Frontiers LA, on 1/7/2014. You can view the original publication here.

By: Brenden Shucart,

I was born in 1981, the same year AIDS was recognized by the Center for Disease Control, and as far back as I can remember fear of contracting HIV has been a part of me. A gnawing anxiety lurking in my heart. Growing up in the ’80s and ’90s there was plenty to feed that fear—unexpectedly deep pop lyrics, made for teevee Lifetime movies, endless fear-based safe-sex campaigns and the odd, half-understood joke on the Kids in the Hall—and precious little to keep it at bay. I knew that AIDS was something that happened to dudes who loved dudes, and when I was being honest with myself, I knew that I was one of those dudes. It felt almost inevitable.

When I came out of the closet in 1997 the first thing my dad said to me was, “I don’t want you to die of AIDS by the time you are 21.” But that fear was already a deeply ingrained piece of my subconscious. Not that it stopped me from having sex. On the contrary, once I had a taste I was insatiable, and I found many, many opportunities to slake my appetite. And I didn’t always use protection. In fact, I was less and less safe as time went by, always dancing closer and closer to the flame. But that fear of getting AIDS was so deeply ingrained in me that whether I used condoms or not almost all of my sexual encounters left me sleepless and sweating, staring at the ceiling and wondering if this was the time that my luck would run out.

Of course it did give out eventually. Play with fire long enough and it’s kind of inevitable that you are going to get burned.

My HIV diagnosis hit me like a ton of bricks. I became severely depressed, and my drug habit became a full-fledged problem. I resigned myself to a lifetime of doctor visits and dependence on antiretroviral medication to keep myself alive, and the pitying/fearful looks that people give you when they think you aren’t paying attention. But I thought, At least there is nothing left to be afraid of. The worst thing that could possibly happen to me has happened.
That was really just a remarkable lack of imagination on my part.

I moved to a new city and fell in love with a guy that was HIV-negative. I started building a new life for myself, and for the most part I was happy. But there was still an anxiety lurking deep down inside.

My fear hadn’t really gone away, it just changed shape. Instead of being afraid I would contract HIV, I found myself living in the fear that I might pass HIV on to someone else.

And when my boyfriend showed up at my place of work, fresh from the clinic with tears in his eyes, that fear consumed me whole.

Contracting HIV wasn’t the worst thing that could possibly happen to me. Letting it get past me was.

To this day I don’t know if I am directly responsible. I was on medication, my viral load was suppressed and we almost always used condoms. Over the course of our three years together we weren’t always monogamous.

But I felt responsible.

I felt toxic.

I felt like a monster.

After that I become a sero-sorter of the strictest kind. It was years before I could bring myself to have sex with a guy who was HIV-negative. Even when I finally did, I was so on guard, so concerned with vigilantly keeping my partner from any possible contamination, performance became an issue. Combined with trouble I had staying hard when I was using a condom, I rarely made the effort.

I took my fear and used it to build a wall between myself and every guy who hadn’t contracted HIV, and buttressed it with my guilt and shame. At some point I accepted, “This is the way it’s always going to be,” just as I had accepted a lifetime of doctor visits and shady looks.

That’s the way it went for quite some time, me deftly avoiding even the opportunity that I might develop feelings for someone who was HIV-negative. Until one day my roommate Kevin came home and told me he signed up for the iPrEx study, a clinical trial to test the efficacy of the antiretroviral drug Truvada as a Pre-Exposure Prophylaxis, or PrEP.

I remember being vaguely hostile to the idea—simultaneously concerned that my friend was being used as a guinea pig, and that this study might somehow get my hopes up only to knock them down.

But as the trial proceeded, and I watched my HIV-negative friend eat his daily dose of medication, and sat and talked with him before and after his regular visits with the clinicians running the study, my suspicion and hostility were gradually supplanted by a kind of hope.

For many of us living with HIV, that’s what the FDA’s approval of Truvada for use as PrEP means—hope. Hope that one day we can let our guard down, be less than perfectly vigilant and love without fear.

Not necessarily Truvada itself, but the promise of things to come that Truvada represents—first a once-a-day pill, then perhaps a pill once a week, or once a month. Maybe an injection that will protect you from HIV for a whole year. Or even a vaccine that will keep a person from contracting HIV for the rest of their lives, and allow those of us who have HIV to set aside our fear forever.

I think I might give anything to make that vaccine a reality. But just having the hope of it means the world to me.

I invite you to follow me on Twitter at twitter.com/brenshu and join me on Facebook.


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