PrEP Is A Really Horrible Idea…
If you’re not familiar with PrEP you should read the article in The Daily Beast. The guy who wrote the article contacted me a couple weeks ago, but I didn’t have much of anything interesting to say other than the fact that I’m completely against it…
If you’ve never heard of PrEP here’s a little history… It comes out of the concept of PEP (Post Exposure Prophylaxis) where they give people who are exposed to HIV drugs for a month after exposure to prevent HIV from taking hold in their bodies. It’s a particular mix of the same anti-retroviral drugs (ARVs) that people with HIV take. It was proven effective in hospital workers and then they started giving it more broadly to guys who had guilt after a night of raw sex.
Well, PrEP takes that a step further and thinks if ARVs are good after exposure then maybe negative guys who are barebacking regularly should just be on ARVs all the time. It’s PRE Exposure Prophylaxis.
Let me put this bluntly – you should only take powerful drugs like ARVs when you have a serious medical problem and you have no other option. Taking highly toxic drugs when you don’t need to take them is just stupid. Think about all the side effects and the damage they can be doing to your body. Developing a resistance to ARVs before you need to be taking them is stupid as well. Don’t be stupid.
Personally I think that PrEP is a product of guilt and fear. Guilt from having unprotected sex, and fear of HIV. It’s never smart to make decisions based on guilt or fear. You need to live a life where you don’t regret your decisions. If you’re going to bareback (especially if you’re bottoming), be honest with yourself and accept the risks. Barebacking is a risk/reward situation like all of the others you encounter in your life. If you can’t deal with the risk, don’t bareback. It’s really that simple. If you’re living a life you’re ashamed of, taking loads and then regretting it the next day – then I pity you… You should be getting off on the loads that are leaking out of your ass… 
It’s really a choice of a long life filled with fear and shame or a somewhat shorter life where you feel good about yourself and your choices, and you make the most of every moment – including every moment of your sex life. To me it’s not even something I have to think twice about. I’d rather live to 70 and enjoy the moment than live to 85 and feel like I missed out.
I’ve heard poz guy after poz guy say that becoming poz changed them for the better. While they wish they were still negative, finding out they were poz changed their outlook on life and they get more joy out of their life now than they did when they were neg. My boyfriend who died of AIDS years ago had a note on the fridge that said “Don’t Postpone Joy”. That is how you should be living your life – whether you’re neg or poz.
For some of you a life of no regrets means a life using condoms. That’s fine if that works for you. For the rest of you – embrace the risk (don’t fear it), and understand that it’s what comes with the reward of a fulfilling sex life – find the right balance of risk and reward, go forward and don’t look back… And for god’s sake, don’t fuck up your health by taking toxic meds you don’t actually need when there’s nothing wrong with you (other than guilt).
Dude, seriously:
1.) You are not a doctor, so don’t give medical advice.
2.) You are not a psychologist, so don’t give psychological advice.
3.) You are not a drama queen, so leave god out of it
Regarding 1.): People are different. Depending on your genetic code, it can take 5 months or 15 years for HIV to cause “serious medical problems”. Some people can handle medications very well, other can’t. For the former, PrEP seems to be the preferable option, for the latter not. You seem to be one of the lucky that are not very susceptible to HIV (if you haven’t been infected yet, likelyhood is that if you get infected you won’t develop serious symptoms within months like a friend of mine). So don’t pretend you’ve got all the answers. Because that would indeed be stupid.
Regarding 2.): You say: “I’ve heard poz guy after poz guy say that becoming poz changed them for the better.” Yeah, well, that’s one half, probably a majority. The rest just vanishes. Having been prone to depression already, they use the HIV as an excuse to commit a drawn-out suicide by omission (i.e. not taking care of their health).
Conclusion: Everybody should be presented with fact-based, sound information and afterwards be free to choose for himself. Instead of telling other people how to life their lives (what are we – Palin-adoring conservatives?) we should support our friends’ decisions no matter what. We should enjoy the fucking and not politicize it. The sex is great, but what makes life really worth living even during old age is basic human kindness.
I agree that it is rather odd, that they have this PrEP program now when they advocate safe sex, and if you aren’t willing to take the risk, then don’t take the risk. It is a good idea, but it is also a step in the wrong direction, and if safe sex advocating groups start to condone the PrEP program, I see it as a way of them giving in to barebackers. I don’t condone barebacking but I am certainly not against it, I too bareback, and I’m only 18, however I do take precautions, checking up on sexual partners history before barebacking, because I would like to stay negative, but I have looked at statistics and I do see a very little risk of contracting HIV at my age, especially since my sexual partners are my age too. Just my 2 cents.
Rawtop: “Personally I think that PrEP is a product of guilt and fear. Guilt from having unprotected sex, and fear of HIV. It’s never smart to make decisions based on guilt or fear. You need to live a life where you don’t regret your decisions. If you’re going to bareback (especially if you’re bottoming), be honest with yourself and accept the risks.”
That doesn’t make any sense. “If I can take some action to prevent something bad from happening to me, I shouldn’t do it because it means I’m really feeling guilty.” Ridiculous. HIV is most certainly a bad thing: it’s costly in terms of insurance, treatment is not a sure thing, and side effects of long term medications can be horrendous (thus, my friends take medication vacations). There’s no shame or guilt in not wanting to remain HIV negative. Under the circumstances, preventive medical action is good and frankly probably socially beneficial. If someone on my company’s insurance plan takes PrEP instead of going poz, that’s probably better for our premiums.
@Rawtop I still can’t figure out why some people read your blog. They clearly don’t get you and they are not a fan of yours.
I’m not sure I can completely agree with you on your feelings on PrEP. There isn’t enough research and if people want to be guinea pigs for a drug that might one day evolve and cure or prevent HIV then good for them. I have been approached in the past to participate in some of these drug trials as I’m sure others have on this site. I haven’t bit the bullet yet but I might, not because I have guilt but because I would like there to someday be a cure. It might do me more harm than good, I don’t know but I’m willing to take a gamble for a good cause.
@Adam – Let me be clear – I’m not at all against being in a research study for PrEP. Actually at one point I was on the Community Advisory Board of a place here in NYC that did drug trials of HIV vaccines. I’m very much in support of research.
What I’m against is doctors illegally giving powerful, toxic medications for “off-label” uses like PrEP, and guys feeling so guilty about their sexual activities that they take those unproven meds without thinking about how they might harm them.
@Martin – When patients think they’re not qualified to make medical decisions about their own bodies we have serious problems. I’ve worked in pharmaceutical marketing. I’ve seen first hand how pharma companies influence doctors to prescribe drugs. I’ve seen how so many doctors don’t question what the pharma companies tell them.
I’ve even had a doctor who was among the elite in her specialty (she was the chair of her department at Memorial Sloan Kettering Cancer Center) tell me that I had to stay on Dilantin for the rest of my life or find another doctor when I didn’t even need to be on drugs at all. (I’ve been off Dilantin for 10+ years without a problem). Dilantin has a 100 year history (unlike the ARVs that are prescribed for PrEP) it’s side effects are really well known, and I had both physical and social side effects (social in that I could only drink one drink a night). Every time I brush my teeth and think about the permanent damage that Dilantin did to my gums for no good reason I just get angry at doctors like her…
Taking control of your own life and doing things like making decisions about your own body is at the heart of what this blog post is all about.
“Taking control of your own life and doing things like making decisions about your own body is at the heart of what this blog post is all about.”
First of all, that’s what I’m saying. You on the other hand use phrases like:
“Let me put this bluntly – you should…”
“Don’t be stupid.”
“And for god’s sake, don’t fuck up…”
and my personal favorite:
“That is how you should be living your life.”
That is the same kind of pressuring rhetoric the Jerry Falwells of this world use. Maybe you don’t notice, because you speak from a place of anger (“Every time I brush my teeth…”).
The truth is: It’s a gamble. If you (i.e. one) have the right genes and psychological stability, you (i.e. rawtop) might be right. If not – and I know quite a number of guys who progressed to AIDS rapidly, HIV or any other chronic disease can fuck you up big time. And we don’t know the outcome before we have taken the gamble. That makes pretty much all of us morons, patients and doctors alike. Just because your doctor is a fool doesn’t mean you yourself know any better, the only difference is that it’s your “god-given” right to decide over your body.
You are right that all of us should learn to make good, informed decisions and then live with them (it’s more or less the secret to good karma and acheiving a zen state of mind). But it doesn’t mean that the decision you reached for yourself applies to even a single other person beside you.
So make your point but tone down the pressure. Otherwise you’ll come across as overly agressive to hide the doubts you have about your own decision. So lay back, relax, fuck around and remember:
EVERYBODY’S FREE TO WEAR SUNSCREEN!
Rawtop, I think you’re wrong on this one. People should make the choice they’re comfortable making. If you can’t enjoy sex without it being bareback, if you have disposable income to the tune of $2000/month and you want to take PrEP to avoid getting sick, then you should. If any of those things aren’t true, then PrEP isn’t a good option.
People who take PrEP should definitely take the newer stuff (maybe Raltegravir and Truvada) that has fewer side effects. But if there’s an option out there that gives people the opportunity to have hot, bare sex without worry – then why NOT do that?
Adam
I’m with Martin. There’s a whole lot of preaching on rawtop.com. It may not come from the far right, but that doesn’t make it a different species.
Why are bber’s who take PrEPs to reduce the risk of infection doing it out of guilt. If they had a vaccine, would those who got the shot be doing it because of guilt?
In all likelyhood, PrEPss are somewhat effective in at least delaying infection – 2% is better than 0% but I think it’s likely to be much higher. I think there is a mind-set about using PrEPs that is similar to theories on how infectious poz guys are when they are on meds and have an undetectable viral load. It seems to me that doctors and authorities don’t want to run studies to prove/disprove this theory because they are afraid more men will bb. RT, even you have said, and I’m paraphrasing here, that you feel it is more risky to bb with a bber who doesn’t know his status vs. one on meds and with and undetectable viral load.
Many talk about risks – I know the risks if I smoke, drink , party, drive without a seatbelt, ore bareback. Why is any different if some one chooses to take the risks of using PrEPs? Besides, wouldn’t the increase in in drug users help reduce the cost of drugs?
As a psychologist at an HIV/AIDS primary care clinic, I have to say that I have yet to come across a person with HIV/AIDS who feels that the diagnosis has changed him/her for the better. Such people are certainly the minority. That is the only part of this I wanted to reply to.
Adam,
Just an aside, why not? A major reason is the many complications of these treatments, the long-term use of which can cause dementia, among other illnesses.
Additionally, PREP is not a gaurantee that a person will not contract HIV.
But, it is likely that PREP will build resistance to these treatments. Should a person on PREP contract HIV, the drugs he/she needs may no longer be effective.
RawTop, I wanted to reply to this as well. You said, “What I’m against is doctors illegally giving powerful, toxic medications for “off-label” uses like PrEP, and guys feeling so guilty about their sexual activities that they take those unproven meds without thinking about how they might harm them.”
While I am not in favor of PrEP for a variety of reasons, this statement of yours is making two assumptions that I don’t think are founded. 1. Men who choose to utilize PrEP do so out of guilt for engaging in BB sex. If anything, this may be a projection of your own feelings. For some men who engage in high-risk behavior may not choose to use PrEP due to any guilt but of caution. 2. Many people who do choose PrEP think about how the medications may harm them. But, like you say, you have to weigh the risks, just as BB sex that can cause harm.
John,
The mechanics of resistance aren’t that simple. Anyone who takes PrEP should practice appropriate adherence, and if they do, there’s very little risk that they would develop resistance.
And, assuming you’re the same John, I certainly know that most HIV+ guys I know DO feel like it has changed us for the better (though of course we don’t want everyone to run out and get it!). I’d suggest that the majority of your sample set would OF COURSE feel otherwise, which is why they would seek your help in the first place. Would life be better without it? Sure. But having gone through it, I wouldn’t change it, which I never would have thought I’d say.
Adam
PrEP is a bad idea because it will make more people become HIV+ instead of saving lives.
Plus who knows what it will do to your body? HIV meds ARE NOT good for your body to begin with.