PrEP ain’t for you…or is it?

 

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Jake: I just wanted to ask a PrEP question.

Greg Owen: www.iwantprepnow.co.uk If it’s not on there I’ve failed. lol

Jake: You didn’t fail but I want an answer in slightly more detail. Event based PrEP. Say someone like me who never has unprotected sex… and I can’t remember the last time I slept with someone who didn’t know their qualified status… I don’t want or need to take PrEP. But say I wanted to try unprotected sex with my boyfriend or someone else on one occasion… so taking PrEP just when I needed it. Is this safe? Is it enough to stay neg. I just read all the options… and you say that taking a pill a day is the safest.

Greg Owen: I have a burden of responsibility to actively promote the safest – ie large study (PROUD) tried and tested daily method. That is why it is positioned like that on the site. The EBD (event based dosing) system has been trialled in France. It is called IPERGAY and yes – it is safe. Official figures suggest 86% reduced risk of HIV infection. However there are variables with this method and so therefore requires a conversation like this so that the PrEP user can be educated properly.

I don’t have capacity to do that with everyone and I really would want to because this method opens up the possibility of risks. I hate the word risk used alongside the word PrEP. The variables are the time between 1st dosing and actual sexual interaction (because studies and tests have found that there is not sufficient HIV protection in the anal tissue until about 8 hours after the 1st dose of PrEP) and you also need to address and fully understand doseage etc and by that I mean the number of pills taken, when and duration. And some people say that the study was based on the minimum amount of time and PrEP required for protection so you could expand on your protection by increasing the time between the 1st dose and sex and the length of time you dose after the sex.

The problem I have with this is that info gets relayed from gay to gay and gets muddled in the middle – a bit like chinese whispers. That makes me uncomfortable when the thing being jeopardised is a person’s HIV negative status.

Jake: I’ll refer other gays to your website – I promise.

Greg Owen: I don’t go into these details on the IWPN site for that reason. At the point when it becomes technical and requires someone of authority to advise on this method we direct our users to their local sexual health clinic to discuss it face to face with a clinician. You are a friend , someone I know personally which is why I am discussing it now.

Back to the point… with event based dosing you don’t have that 100% peace of mind that comes with daily PrEP. So in a way you are running the HIV gauntlet again and that negates one of the key benefits of PrEP. But EBD/IPERGAY is a tried and tested method and the whole point of what I do is to share information and although I don’t personally feel comfortable promoting this method of using PrEP, it still offers protection (up to 86% if used properly) that might very well work for someone and so I put it out there.

I guess it boils down to this – any HIV protection is better than none.

But for you Jake – I don’t think PrEP is perhaps the best thing. It’s people who are already involving themselves in high risk behaviour that need to think about it imminently.

If you like using a condom every time you have sex – stick with it. It’s working for you. 

Don’t muddle it. You have good condom adherence. I’m happy that is the case with you. I would be conflicted in advocating PrEP for you if it were to potentially diminsh your condom use.

Jake: Of course. That’s how I feel. It’s not an issue for me. But I’ve never had unprotected sex with my boyfriend. Just thought it might be nice to try. We both think that we’re negative and of course we both need to get tested. But it would be reassuring for both of us if we also did PrEP.

Greg Owen: I disagree. If that really is the case then you don’t need PrEP. Unless you – or you suspect your boyfriend is having BB sex and not being honest about it. If you aren’t and you trust he isn’t…get tested (full screening) and go for it. You really need to weigh up the landscape on a person (or couple) specific basis. If you don’t trust him and don’t wanna discuss that within your relationship there is another option. You can take PrEP on an EBD/IPERGAY system and just don’t tell him.

PrEP empowers the individual.

Jake: He’s not having BB sex. And he doesn’t lie to me. There’s absolutely no reason for him to lie because we’re totally open. That’s the sole purpose of having an open relationship, so that we don’t have to tell lies.

Greg Owen: If that’s how it works in your open relationship I’m happy for you. That is not the way it works in all open relationships.

Jake: Really?

Greg Owen: Yes – from my personal experience and from what I have ascertained through discussing sex and sexual behaviour with many different types of guys in various different situations.

Jake: Why not?

Greg Owen: I’m generalising now but here we go –

Gay men LIE (some not all)
Gay men take risks (most not all)
Gay men do not tell their boyfriends any of the above (some not all)

Also – I can’t imagine you would be too happy informing your boyfriend that you have had sex with me – a HIV positive guy. Protected or not, undetectable or not. You might not feel 100% comfortable telling him this and I understand that.

Jake: But that’s the structure of my relationship. We said we didn’t want any lies or games. So we’re open from the outset and we’re totally honest. It really works. I don’t understand being open and then lying about being open. Makes no sense.

Greg Owen: I agree Jake but you can only be accountable for yourself. You cannot control or dictate what another person does. Regardless if you have made an agreement or not. If your relationship is structured and works like that I am happy for you both. I’m just saying that some people find certain topics difficult to discuss with their partner. That’s why I mentioned the HIV thing as an example. You in effect removed his choice of introducing HIV into his sex life.

Jake: I totally don’t understand what you’ve just said to me. Introducing HIV to our relationship?

Greg Owen: My point is that some guys wouldn’t sleep with a positive guy and that is totally cool with me. If your boyfriend wouldn’t sleep with a positive guy – if that is just one of his sexual boundries and then you sleep with me as an extra in your open relationship, in effect you introduced HIV or more specifically a HIV positive sexual partner into the mix and I don’t think that’s 100% fair. You took a little bit of his choice away. Of course we are speaking hypothetically here as I don’t know your boyfriend or his opinions or prefernces on HIV positive sexual partners. But I find that when it comes to HIV – even though it’s ME that is positive and not you or your boyfriend, we all still need to mindful and considerate towards each other and that extends to how your boyfriend would feel about you having sex with a positive guy ie me. Regardless if you were at risk or not – which you weren’t because I’m undetectable and we wore condoms. I’m just saying some guys dont like it. And that’s not some strange manifestation of internalised HIV shame on my part. I have none. It’s just being considerate towards other people’s feelings. That’s all. I’m just trying to illustrate a point. Sometimes what we get up to in our sex lives isn’t always easy to discuss with one another for a lot of very understandable reasons.

Jake: Well, as I demonstrated. I’m not like that. But I might be introducing HIV every single time I have sex with another man. If I
sleep with a guy who doesn’t know his status though… which is more dangerous.

Greg Owen: Bingo! But an undiagnosed guy is not stigmatised. Even though 80% of new HIV infections come from undiagnosed ‘negative’ guys. You are preaching to the converted.

Let’s put it this way… when I was HIV negative I happily slept with HIV positive guys that I knew were undetectable and who I knew well enough to know that they took their meds regularly and I was even aware enough to try not to put myself in that position on the Tuesday after a Bank Holiday weekend when a HIV positive guy might have been out partying and high since Friday and not taken his meds for 3-4 days therefore resulting in a viral spike above the (generally accepted) 400 mark which starts to become HIV infectious again. I KNEW all of this stuff and I played by those rules ‘most’ of the time but I also slept with other ‘negative’ guys who were ‘definitely sure’ they were negative. I knew the risks and I took them. I’ve told you I can’t pin down the point when I contracted HIV but what I can categorically tell you is this….

I did not get HIV from a HIV positive guy…. I got HIV from a HIV negative guy!

Of course the exchange was from a person that had the virus in their system and technically was HIV positive but there is no doubt in my mind that he was still under the illusion that he was HIV negative.

So I get you. xx

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