I first found out about PrEP after being slut shamed at my school's clinic.
I had been having some yeast issues before my menstrual cycles back in September of last year and was advised to come back to get rechecked in October. I kept having weird symptoms in November and came back again, but this time under a different nurse's supervision. After looking at my visits on my chart she told me I should consider rethinking my habits because the clinic did not test every month. As a person who had paid her insurance and is putting herself through school, it took everything in me not to tell her that I thought she should've rethought her choice in wardrobe, never mind her career path of women's health.
Luckily, the HIV clinic was away from Cruella. This was my first time getting tested having started at my new school and I not only got the chance to tell on her and her unprofessionalism, but speak freely to a counselor about my thoughts on safe sex and the importance of safe sex environments. I had always had the idea that outside of using condoms there were other ways to practice safe sex and I was frustrated that these teachings weren't being encouraged. In return, I learned about PrEP— an antiretroviral medicine for people who were HIV negative, and wished to reduce their risk of contracting HIV.
This wasn't my first time hearing about it, I had first heard about the drug from a friend who had gotten on it after an ex-boyfriend tested positive for HIV and decided to remain on it after their break up, but it seemed too good to be true. Despite what the nurse thought about me, what she didn't understand was that I was a stickler for safe sex and a safe yoni.
When I was in undergrad, I conducted research for an article I was doing on STD's on campus and noted that African American men and women had the highest percentage of STD's and HIV in the state of North Carolina where my school was located. According to the Centers for Disease Control and Prevention (CDC), in 2014 Black/African American's had the highest rates of HIV in the United States, with a 49.4% infection rate, which was an estimated amount of 17,592 cases, majority being men who have sex with men, followed by heterosexual sexual contact. Recently, an article in TIME noted that "women make up more than half of the nearly 37 million people worldwide living with HIV."
Knowing this intrigued but scared me. Did I visit the doctor too much? Maybe, but to hear that their was a medicine that could create prevention excited me and I decided to make my first appointment for my consultation to see what this was all about.
Before making my decision to go on PrEP I did research and this is what I learned:
- PrEP (also known as Truvada), stands for Pre-Exposure Prophylaxis—meaning to prevent disease. The U.S. Food and Administration approved the drug in 2012, which was shocking to me because that would make it almost five years in which the drug was out but not advertised to the masses.
- The medicine is made up of a combination of Viread (Tenofovir) and Emtriva (FTC or Emtricitabine), which are two medicines used in HIV medication for someone who is positive yet are not sustainable to treat HIV as independent medicines. If infected with HIV while on Truvada you must stop taking it because it will make you resistant to HIV medicine.
- Being that I am on birth control pills one of my concerns was how it would affect my fertility and reproductive health. Luckily, there are no side effects and similar to birth control pills, the effectiveness of Truvada is based on the consistency of taking it daily. However, unlike birth control it does not have to be taken at the same time everyday. According to data from the iPrEx trial PrEP taken daily, reduced HIV risk by at least 92-99%. For those who took the medicine between two and four times out of the week their chances of contracting were still reduced by 76-86%.
- Although not heavily advertised, the pill is accessible to everyone. Part of the reason it may or may not have been pushed to the masses was because the pill was originally designed to protect people at high risks of contracting HIV: men who have sex with men, those dating someone HIV positive, anyone who was not in a mutually monogamous relationship with a partner who is HIV negative but is gay, bisexual, and has had sex without a condom. People who had recently been diagnosed with a STD within the past six months and/or heterosexual men or women who did not use condoms regularly and or were having sex with partners known to be at risk for HIV.
- Side effects include kidney function decrease, loss of bone density, gastrointestinal issues such as nausea, diarrhea, and headache and fatigue but these are rare. There is regular kidney testing for someone on Truvada to ensure proper function. 1 out of every 200 people might see a reduction in their kidney function. For people who are presumably healthy, if there is an issue you can stop Truvada and your health should resume back to normal.
- Gilead— the company that makes Truvada—works with people on cutting the cost for PrEP up to $3,600.00 annually with no monthly limit through their Gilead Co-pay Assistance program, which in most cases makes it free regardless of income, insurance or citizenship documentation.
- The timing of effectiveness for the medicine works differently depending on gender and body parts. For full protection of anal tissue it takes up to seven days and for vaginal between 20-21. Studies from 2010 in Africa have shown that men who are circumcised have less risk in transmission because the skin around the penis becomes harder, making it less likely to have tears. Oral sex also has less risk of HIV transmission and vaginal sex compared to anal sex has less risk of transmission due to the higher risks of tearing in the anal area.
- When going on the medicine you must test negative for HIV, get a screening for kidney function and hepatitis. After your lab tests your doctor should provide you the medicine.
At first I contemplated about the necessity of me getting on the pill because I didn't think I had fit into the high risk category, but according to PrEP specialist Damian Bird of the HEAT Program in Brooklyn—a program that works with young adolescents ages 13-24—PrEP is a safety precaution for everyone.
“Anyone who is having unprotected sex I think is in the run of eligibility. I think people a lot of times want to say it's only for these groups, but we have women as well who are on PrEP. We really want to make sure it's something that is available to everyone. Yes, a lot of the research was done with the high risk populations, men who have sex with men, people working in commercial sex trade, but again if you're having unprotected sex and you're not sure of your partners status, I would tell that person why not use PrEP, just to protect yourself," said Bird.
Although in my biased opinion, that nurse could kick rocks and break toes, outside of the side effects and finances I was concerned about what stigma this would place on me. Being that the medicine hasn't been publicized all over feared that most people wouldn't understand.
“Anytime anything is new it's a little bit scary for people, " said Bird.
Like some, I prefer to not use condoms, and like some there are occasions in which I do not. I try to practice safe sex by going to the doctors every three to six months or whenever I have a new partner. I also implement talks about STD's and HIV testing in my sexual relationships and so far they have been successful, but the reality is that although many would claim they are in great sexual health you never really know.
[Tweet "Although many would claim they are in great sexual health you never really know."]
PrEP is not an excuse to not protect myself during sex, or to engage in unhealthy practices but it is simply an extra safety precaution to maintain control over my sex life, and health. Safe sex is also allowing people the right to choose what works for them and to go to the doctor when they feel something is wrong without judgment. Bird agrees, “It's another tool in the toolbox of safer sex practices."
Meagan Jordan is a graduate student at Columbia Journalism School in New York City.