Just*in Time: August 2014


Just*in Time
by Justin B. Terry-Smith

I have a question regarding PrEP as a way to prevent someone from contracting HIV. Can a poz male who wants to have kids with a HIV-negative female on PrEP have children without passing HIV to her and the kid? I know of the protocol before PrEP was approved by the CDC, but what about after they approved it?
—Ruben Bermudez

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

Thank you so much, darling, for this question. Many of my readers may not know what pre-exposure prophylaxis (PrEP) is. According to the CDC (2014) one way to possibly prevent HIV infection is for people who do not have HIV (but who are at substantial risk of contracting it) to take a pill every day. The pill, which is named Truvada, contains two HIV medicines combined, named tenofovir and emtricitabine, that have long been used in combination with other medicines to treat HIV. Now, however, Truvada is also indicated as a prevention tool. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. (For further information, log on to www.cdc.gov/hiv/prevention/research/prep for further information.)

Basically PrEP is used when there is a one partner who is HIV-negative and one who is HIV-positive. This medication is used so that the HIV-negative person does not become infected when having sex without a condom (though the CDC is not advocating condomless sex). Simply put it is a new preventative measure used to decrease incidence of HIV in high-risk groups, such as sex workers, sexually active MSM, and couples, both gay and straight, where one is positive and one is negative, among others. By the way, when the news broke that Truvada would be made available, many in the gay community had already known about the medication.

If one is put on this medication, one must remember to see his or her primary care physician every three months to not only to get checked for HIV exposure but also to be checked for any damage to the liver or any organs. Remember, our bodies were not meant to be medicated for a long period of time; sometimes even medication can leave wear and tear on the body.

Now, back to your question, which can be very tricky, but I’m very glad you asked it. The partner who has HIV has to have had an undetectable viral load for six months or more and is adherent to HIV treatment. There is great evidence that shows that, through adherence to HIV treatment, one can have an undetectable viral load, greatly reducing how infectious a person is. Also, some physicians suggest that, if you are thinking about doing this, you have condomless sex with the female when she is ovulating. Now some physicians might suggest that one use post-exposure prophylaxis (PEP), which is another prevention tool but a little different from PrEP. PEP is a short course of anti-HIV drugs that are meant to prevent HIV infection and administered at the earliest time possible after exposure to the presumed HIV infection.

Now back to PrEP…We must be very careful and not jump in the deep end without testing the waters first. I am a supporter of PrEP and I think it will help greatly in the decrease of HIV infections around the world. But, we have to make sure that we keep in the back of our minds that PrEP does not protect against other diseases, such as chlamydia, gonorrhea, herpes and hepatitis viruses. Condoms seem to be the other sure thing at the moment to protect humans from both HIV and other STIs. One thing is that future parents might want to be aware of that carrying other STIs leads to a greater risk for unborn children to carry them as well. Do not get me wrong—I’m not saying, don’t conceive if you have a incurable STI; I’m just saying take the proper precautions.

Know, too, that there are other methods for mitigating the risk of HIV/STI infection during conception. My husband and I are planning on having two more kids, and if we do surrogacy, I’ve volunteered to be the bio-dad and my sperm would have to be sent to a facility to be cleansed then sent back down to us, where another agency would have to find a willing surrogate to carry our child, then fertilize her egg with my sperm. Simple, right? Not really, but parenting is one of the most rewarding things a person can do.

Being HIV-positive is no longer necessarily the obstacle it once was—now, you can be a bio-parent.

Justin B. Terry-Smith 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. Now, with this column, Justin has found a way to give voice to the issues that people write to him about. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at [email protected].