Sexual Revolution

It is 2017, and a new Sexual Revolution has begun. I am sad however at how many people are unaware of the many safer sex options available to them. I am going to go in to detail about PrEP, PEP and how the face of prevention is changing.
Before you read any of this, I want to state clearly that I  AM NOT A DOCTOR, and you should always consult your physician when starting a new medication.

Condoms…once the pillar of safer sex. Unfortunately, as time goes on, the reasons to not use them are starting to outnumber the reason for using them. Condoms have been a prevention staple for the last 30 years. Sexually Transmitted Diseases (or Infections, depending on whose company you keep) can be prevented by using that lovely latex barrier. The excuses for not using them: too tight, too small, uncomfortable, allergic to latex, unable to “finish”, it feels like a plastic bag on me, guys who are “sure” they don’t have any STD, or “I promise, I’ll pull out.” First of all, don’t buy any crap anyone uses when they say this stuff. Unless they are actually allergic to latex, they’re selling you a pile of horse manure. And trust me, many people will lie and say they’re allergic, when they are not actually. (Like me when I say I’m allergic to shellfish…it’s just gross). Condoms are effective at preventing STDs, and aside from abstinence(what?) is the safest way to have sex.

PrEP- Pre Exposure Prophylaxis. A pill you take once a day, around the same time of day to prevent yourself from becoming infected with HIV, should you be exposed to it.  Currently in the United States Truvada is the only medication used (and FDA approved) for PrEP and it is made by Gilead. Truvada is made up of emtricitabine and tenofovir disoproxil fumarate….not that you care, but there it is. Now, when the pill is taken as prescribed it has been proven over 92% effective at preventing HIV. Basically the medication make it impossible for the HIV virus to replicate itself inside your body.  For Anal sex, the medication must be taken for 7 days first before it is effective. Vaginal sex(eww) it’s 21 days, and for injection we recommend 30 days. Truvada does not prevent anything else however. So if you are going to the Black Party, and your preparation consist of prep and poppers, you are pretty sure to not become HIV infected. However, from what I have witnessed, don’t be too surprised if you do take home Syphilis, Gonorrhea and/or Chlamydia. Trust me, as someone who has worked in public health for so long, the “Captain’s Platter” can happen to you. This is why we encourage using condoms and PrEP together, to make sure you have the best control of your sexual health.

Example time: So, if you’re in the Meat Rack in FIP, 2 hot hung tops are eyeing you, y’all engage in appropriate behavior for the Meat Rack( I can’t really describe details here, the internet would block me), and if a condom should break, you can rest assured that you are HIV negative because you have taken your PrEP according to your doctors orders. YAY! While one is taking PrEP it is vitally important to get tested every 3 months, this test is for STD’s as well as your kidneys and liver, and your bone density will be checked every 6 months. These test are run to make sure that the medication is not hurting you on the inside, and to verify the medication is preventing HIV. Also if you get one STD, you are at a higher risk of getting HIV, so get tested and get treated.

I know a major questions is COST??? It can be very expensive, up to $1800 a month if you don’t have insurance. Luckily most insurances covers the medication, so that’s good news. As all insurance companies are assholes, it is not going to be easy, but it can be done. If you have high deductibles, or high copays, you could end up paying a lot of money. Luckily there is the Gilead Advancing Access Copay Card. This is a card that will cover up to $3,600 worth of Truvada every year. This card is free to get, and incredibly easy. This is the link to get The COPAY CARD.  Use this card, its free money.

Another question I hear is “What about side effects?” When a new medication is introduced in to your body, your body will have an adjustment time. While your body is getting to know the new medication, you might experience: nausea, diarrhea, dry mouth, sleeplessness, vivid dreams, etc. The sides effects should not last any longer than 7 days, and if they do, consult your physician.

Next Up: PEP, or Post Exposure Prophylaxis

PEP is a morning after type of medication for HIV. Usually made up of Truvada and Tivicay, you must take these pills for 28 days after an exposure to HIV. Time is a necessity here, so you must start taking the regimen within 72 hours of the exposure. I cannot stress this enough, you have 72 Hours from the time of exposure to start taking PEP. Pep has proven effective at preventing HIV for someone who has come in contact with HIV.

Where to get it? Any Emergency Room in NYC & Boston can get you these medications 24 hours a day. So if you go out drinking with friends on Friday night, meet a hottie at the bar, go back to his place, have a wonderful orgasmic night and then the next morning he tell you that he is HIV positive. Then the night you can’t remember comes flashing back, and you cant remember if he used a condom or not. He tells you no, but he’s undetectable, so its ok (I’ll get to that later). Get your ass to the ER ASAP. Getting the medication can take time, so don’t put it off to the last-minute because literally every minute counts in this situation.

If you are having troubles finding the ER, I suggest using Google. Your PCP should be able to write you the prescription too, so if you’re able to get in to see your doctor, please do. There are a number of clinics that can also assist with this, but the ER is going to be the safest bet for you during this situation.

Now, let me back track for a moment. Undetectable, it’s a very good thing. that means a person who is HIV positive is taking great care of their health. If someone is HIV Undetectable it does not mean they do not have the virus or that it can not be passed on. That person is always HIV positive, and although being undetectable reduces the chances of spreading HIV, it is not impossible. I have heard too many stories from guys who were told that their partners are undetectable so they didn’t use condoms. As great as it is that someone who is HIV positive is undetectable, you have to ask, when was the last time they were tested? How do they know they are still Undetectable.

Lets be real guys, men are pigs, and as sexy as some of those pigs can be, their grindr profile was created out of lust and hormones. They don’t care about your health, they care about fucking you they way they want.  So, if you need it get PEP, if you are sexual active, get PrEP.  Many good changes and advancements are happening soon, so keep your eyes open.

As a HIV tester, I get too many guys coming to get tested because of a recent incident. So please tell your friends, tell your families, tell your hookups about PEP. Every gay man should have that in their back pocket. We can end the transmission of HIV. Lets be the generation to stop the spread.

Any questions? Please email me.

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