Just*in Time: November 2015

by Justin B. Terry-Smith

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[dropcap]H[/dropcap]ey Justin—

Does PrEP give you a false sense of security that you can engage in more risky behavior, such as bare sex for instance?

It has to a certain degree, but I’d say no more or less concern than before I started taking PrEP. Before PrEP, I had very few sex partners and I knew my HIV status and my partners knew their HIV status. We were all negative. We would not use condoms because we were in our minds safe and being responsible by getting tested regularly and limiting the number of guys we had sex with regularly. My doctor asked why I was getting tested every three months (the window of infection) for HIV. I explained that I had a couple of sex partners that I was having bare sex with and wanted to be sure I knew my status at all times.

Photo by Don Harris © Don Harris Photographics, LLC. All rights reserved.
Photo by Don Harris © Don Harris Photographics, LLC. All rights reserved.

I personally feel nothing with a condom on and cannot maintain erection to completion. It’s very frustrating and that’s the real reason I chose bare sex with limited partners. After talking to one of my sex partners who just went on PrEP and explained it to me, I went back to my doctor and brought PrEP up in conversation. He immediately thought I was a good candidate for it and should go on it considering my confessed sexual activity.

My doctor surprised me by saying that undetectable HIV-positive men were likely a better sex partner because they were on meds to block it and I was on PrEP to block HIV, too, so the likelihood of contracting it was very low, versus having sex with a guy who thinks he’s HIV-negative but is in fact positive and highly infectious. Since that talk, I’m less apprehensive about engaging in sex with poz undetectable men, so I guess the answer would be yes. I do feel more at ease and probably have a false sense of security, but at least I’m proactive and taking PrEP to provide a barrier against HIV. I no longer am afraid to love someone who is HIV undetectable and no longer afraid to have sex with them.
—The Chad

Thank you for writing me. I do not believe that it does give you a false sense of security; whether or not you engage in risky behavior is based on whether you make that decision, PrEP or not. One of the concerns for researchers and activists is that PrEP will give people an excuse to engage in riskier sexual behaviors. According to Guest et al (2008), the overall sexual risk behavior did not increase during a PrEP trial. The number of sexual partners and rate of unprotected sex acts decreased across the twelve-month period of study enrollment. The data also indicates that the HIV prevention counseling associated with the trial was effective.

Good for you for being tested and having open communication with your sexual partner and your doctor. This is a prime example how many of us should be talking to our sexual partner(s) and physicians. I agree with your doctor on how it might be easier to have a partner who is HIV-positive, but love is love and attraction is attraction—you can’t control that. But if you do get involved with someone who is HIV-positive and on medication it might help with adherence to PrEP as well. According to Ware et al (2012), if one partner is on PrEP and the other was also taking medication (ART or cotrimoxazole as prophylaxis against opportunistic infections), they might match their own dosing schedules to their spouse’s, as a way of promoting adherence (for both).


 

References:
Guest, G., Shattuck, D., Johnson, L., Akumatey, B., Clarke, E. E. K., Chen, P. L., & MacQueen, K. M. (2008). Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sexually transmitted diseases 35(12), 1002-1008.

Ware, N. C., Wyatt, M. A., Haberer, J. E., Baeten, et al. (2012). What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples. Journal of acquired immune deficiency syndromes (1999), 59(5).


 

Justin B. Terry-Smith, MPH, has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal.blogspot.com. Presently, he is working toward his doctorate in public health. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at [email protected].