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Should I take PrEP?

Should I take PrEP?

L-R: Dan Beeson and David Hudson

NHS England recently announced that it was to fund PrEP for 10,000 people most at risk of contracting HIV in the UK. This will predominantly, but not exclusively, include gay men. Here, two GSN writers examine their own conflicting thoughts on whether to sign up for the medication.

Dan Beeson

I’m 26 years old and I’ve been having sex with other men for nine years.

I think I want to be one of the 10,000 people the NHS provides PrEP to during the UK trial.

The recent reports that PrEP – widely purchased on the internet in the UK – is likely responsible for the 40% drop in HIV diagnoses in London in recent months fills me with hope for an end to the epidemic.

In my personal life, I believe PrEP would end the brief irrational replaying of each sexual interaction I have – applying fear to enjoyment in the process – in search of any possible way I might’ve contracted HIV; a process that remains in my mind for some days.

All I want from the drug is protection for my mental wellbeing.

But wait: while others share this notion what if they apply it in ways that provide a new set of concerns to take into account?

While I would use PrEP as an added level of protection, one that has health and mental benefits, I do not see it as an excuse – as others might – to ditch condoms and other safer sex practices.

PrEP does not prevent other STI infections and just because the risk of contracting the most highly stigmatized STI is virtually eradicated by the drug it doesn’t mean we should relieve our concern for other infections, like the potentially life-threatening Hepatitis C.

If I came across someone who was using PrEP instead of condoms, putting them at high risk of other STDs, would I consider my use of the drug more important as condoms?

I’ll say this: I don’t fancy a reintroduction to symptomatic gonorrhea in my ass: it’s not fun.

Will my reason for wanting to take PrEP – fear of infection and mental impact – become void if the wider gay community uses PrEP as an excuse to make bareback sex the norm?

If PrEP is used to facilitate community-wide bareback sex, the game will change for me and make condoms the most important tool for combatting fear – just like right now.

Is it as important for people like me – who would continue to use condoms while on PrEP – to take it anyway if the above happens?

No. They’re protecting themselves and me by taking PrEP. I’m protecting myself by insisting on condom use.

But, do I want it because slipups happen and I want insurance for future mistakes?

I have a lot to think about.

David Hudson

I’m 47 years old and I’ve been having sex with other men for almost 30 years.

I’m a big supporter of PrEP, and have been impressed with the way its use is already driving down HIV infections among LGBTI communities. Do I want to put myself on the medication now that it will soon be more widely available in the UK?

My first thought was: Why take medication if I don’t need it? I know how to avoid contracting HIV and have no aversion to using condoms.

Secondly, I already take daily medication: statins for cholesterol. Do I want to needlessly add another medication to the mix? All drugs can have side effects, and no-one really knows yet if there will be a long-term side-effect from being on PrEP.

Thirdly, if I put myself on PrEP, will I find myself tempted to break a lifetime habit of using condoms for sex? PrEP only protects from HIV, not from other STIs. If I’m being brutally honest, I think the temptation would be there.

For all these reasons, I thought I probably wouldn’t put myself forward for PrEP treatment. I’ve managed without it so far, so why not continue?

When NHS England announced it was to extend its PrEP trial, I found myself looking at other sides of the argument.

For my whole adult life, despite wearing condoms, my sex life has been overshadowed by the fear of contracting HIV. What would sex be like if that fear was not there?

Secondly, I’m passionate about staying healthy. I spend a questionable amount of money each month on supplements from Holland & Barrett: garlic for my heart, vitamin D, vitamin C, etc, etc. It’s all in the hope of prolonging a healthy quality of life.

That’s when it hit me: If I could buy PrEP over the counter at my local health food store or pharmacy, for the price of an NHS prescription, would I buy it?

‘Yes’, was the immediate answer. If I could buy it alongside all the other pills and potions I purchase at Boots or H&B, I probably wouldn’t think twice. At least this was one pill that I could be sure I wasn’t wasting my money upon.

That’s when I realized: perhaps my resistance to PrEP isn’t just the feeling that I don’t need it. Maybe it’s more the feeling that I’m somehow pathologizing my sex life: Going to a clinic to ask for medication in order to have sex. Maybe I should just look at it as something else to take to maximize my chances of living and long and healthy life.

The decision to go on PrEP is a very personal one. If it were readily and easily available, I’m more inclined to use it that not. I consider myself lucky to have the choice. I know many guys, some of whom sero-converted only recently, who may envy the fact some should even see it as a dilemma.

The only other thing that gives me pause for thought is that the NHS is only providing funding for 10,000 people. Given I manage OK with condoms, maybe I should allow priority to go to someone else; someone who may need it more.