Photographed Exclusively for A&U by Freedom G Photography
[dropcap]T[/dropcap]ruvada for PrEP has been increasingly securing its place in the LGBT community—and in our culture—as an HIV prevention tool. Gradually, interest in PrEP among heterosexual couples is growing. In a series of straightforward conversations, we went searching for answers. What’s different for straight people taking PrEP? Is it more challenging for women than men? And why are so few straight people on PrEP coming out of the closet about taking it? Here is what we found.
June Martinez-Bailey, fifty-one, and Harry Bailey-Martinez, thirty-eight, were married in Philadelphia in 2014. She’s an HIV-positive trans woman; he’s an HIV-negative man on PrEP. Once Harry began taking PrEP, June decided it was time for her to start speaking publicly about her HIV status.
“When you hold secrets, it destroys lives,” she says. “I’m comfortable in my own skin. This is who I am; this is what I have; and we need to work together to fight this.” Before he started on PrEP, Harry remembers seeing the fear in June’s eyes when they would be intimate. “PrEP is to protect both parties so you can enjoy life and enjoy your sexual experiences without that thought in the back of your head.”
When they first got together, they used condoms. Then they started having condomless sex: things became tense, and their lovemaking became less frequent. Now the couple agrees their relationship and sex life are better because of PrEP. “I’m not worried about contracting HIV from my wife and she’s not worried that I’m going to catch HIV from her,” Harry declares. June affirms it’s given her reassurance. “He gives me a certain look, and reminds me that we’re going to be okay.”
Linda, thirty-one, and Brian, forty-six, (not their real names), another serodiscordant couple in the Philadelphia area, consented to be included in this article if we would not identify them. Brian does not disclose his status publicly and declined to be interviewed for this piece.
After the couple met in 2010, “He disclosed his HIV status to me on our third date, and it was a complete shock,” Linda recalls. “It was a bit terrifying because I didn’t know anything about it.” Coming from what she describes as “a very sheltered religious world,” she didn’t know anybody who was HIV-positive. Eventually, she was able to temper her trepidation and decided she wanted to get to know Brian better. She became more educated about HIV and she fell in love with him. Linda’s fears about HIV gradually subsided, but they didn’t go away altogether. In 2014, she started taking PrEP. Even though they had been practicing safe sex all along, she says there was always a nagging fear. “Now I feel like a huge weight has been lifted off my shoulders. We used to think about HIV like twenty-three out of twenty-four hours of the day. Now we hardly think about it at all.” She adds that there’s no downside for her being on PrEP, and that the couple’s emotional connection has improved remarkably. “PrEP allows us to feel like we can be normal people in a normal relationship and have sex the way it should be.”
In 2015, Linda and Brian were married; they plan to start a family in the next few years. “My life has changed for the better in so many ways being with him. I’m really glad that I chose to fight for us, and that we even have a chance because of medical advances I never knew about.”
These medical advances are certainly changing the game for HIV-negative women trying to conceive with their HIV-positive partners. Before PrEP, a number of serodiscordant couples wanting to have children were offered “sperm washing,” a technique that involves separating the fertilizing sperm from the infectious seminal fluid, followed by artificial insemination or in vitro fertilization. It’s complicated, impersonal and expensive, at a cost of $20,000 or more per procedure.
Now female partners of HIV-positive men can have HIV-negative children the old-fashioned way with the assistance of PrEP. This is where Jennifer, thirty-five, and Mark, thirty-three, come into the story. Like Linda and Brian, they live in suburban Philadelphia. She’s negative; he’s positive and keeps his HIV status confidential. They agreed to be a part of this article if we did not use their real names, and only Jennifer would be interviewed. In 2013, soon after she and Mark became a couple, Jennifer asked her gynecologist about PrEP. “She gave me this look like I was a piece of crap.” Then the doctor said to her in a condescending tone, “We don’t do that here. You will have to go somewhere else.” Jennifer then went to her primary care physician for PrEP, expecting resistance there as well, but the doctor wrote Jennifer a prescription for Truvada after her second appointment.
A few months after starting on PrEP, Jennifer got pregnant, which was the beginning of a dream come true for the couple. In 2015, Jennifer and Mark welcomed HIV-negative twin girls into the world. “It was somewhat a feeling of disbelief that we made these babies and they’re so perfect and so beautiful,” she says about taking her newborn daughters home. “I felt so happy and hopeful. They’re like medical miracles!” Beyond the joy of their precious cargo, Jennifer says PrEP helped bring more pleasure into their relationship too. “PrEP was key in helping us feel more intimate together. He wasn’t as afraid; I wasn’t as nervous,” she tells A&U. “The biggest side effect of PrEP is peace of mind. You can’t put a price tag on that.”
Despite all the benefits of PrEP, the stigma around it—especially for women—is very real. “Almost all of the women who are on PrEP are in a relationship. They’re not on the dating scene,” says Shannon Weber, director of HIVE, a reproductive and sexual health clinic in San Francisco for people affected by HIV. By disclosing that they are on PrEP, Weber explains, these women are essentially disclosing their partner’s HIV status. She points out that this becomes an even more complicated situation when families and children are involved. Jennifer shares that in her community, stigma around HIV/AIDS is as pervasive as ever. “It’s still seen as a gay disease. People believe that only gay men and drug addicts get it, and it’s their fault.”
“We have to change this culture and empower more women with safe spaces to share their stories,” says Weber. “Gay men on PrEP have done such a fabulous job of championing each other. Women on PrEP are very isolated and don’t have the same community to rally around each other. We now have the data and the science to end sexual and perinatal transmission,” Weber maintains, noting that changing attitudes and eliminating shame is essential in making this happen. “What we have to be able to do is to get that information into the hands of people who can use it.”
Jennifer hopes that her daughters will grow up in a more open and accepting world. “Maybe we can play a part in decreasing this stigma for the next generation.”
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Chip Alfred, A&U’s Editor at Large, is based in Philadelphia.