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there is nothing punk about upholding systems of oppression
THOUGHTS ABOUT PrEP AND WHY IT ISN’T THE ANSWER (YET)
So, there’s this thing that everyone is really excited about called PrEP (Pre-Exposure Prophylaxis), which is an HIV prevention treatment that consists of taking Truvada, an HIV treatment med. It’s really exciting, right? You could just take a little pill, and then you’d be able to bareback all you like without risk of seroconverting (becoming HIV-positive).
When I first heard about it, I was like “WHOA, THAT’S AWESOME.” And then I attended a couple of information sessions on it, and read some studies.
Now, I’m not so thrilled about it. In fact, I think that it may cause considerably more harm than good for several reasons.
So, first up: information on the treatment is limited. We only know what the short-term effects are for taking it for a short amount of time (usually 6 months). We do not know the long-term effects of Truvada and other PrEP drugs on the body. And it is not recommended for taking over long periods of time.
"But wait!" you exclaim. "I thought it was like the Pill, and you could just be on it indefinitely!"
Oh no, dear reader. That is not what’s happening here. PrEP is recommended for “exposure windows” — those periods of time when you feel you may be at greater risk. For example, if you are a mainstream gay dude and want to go to circuit party, that circuit party is your exposure window.
Now, for PrEP to work during that exposure window (in this case, a single weekend), you must take it with perfect consistency (ie, every single day at the same time) for AN ENTIRE MONTH before it starts working. That perfect consistency must be maintained for the entire time you are on the medication. If you miss a day, or miss the time significantly, your protection goes down to zero. Do not pass Go, do not collect $200. You must start your initial month over again.
So, just to recap: you must take PrEP consistently for a month before your exposure window, and it’s only for short-term use, and the health effects of taking it are almost entirely unknown.
So, who is PrEP being marketed to? While gay men do figure largely into it, I want to talk about the other “risk group” most cited. Sex workers.
It sounds like a good deal, right? You can take PrEP and do sex work without worrying about condoms breaking or getting HIV in other ways. Except we run into a few problems when we actually look at how the sex industry works. As many sex workers will tell you, lots of clients are always looking for a way to get around using condoms. When PrEP floods the market, it’s pretty likely that clients will begin expecting sex workers to be using PrEP. This will make it significantly more difficult for some sex workers (particularly street-based workers) to negotiate condom usage. Clients tend to communicate with each other through Escort Review Boards online, and share information — so, information about workers using PrEP will be widely known to most “hobbyist” clients. This will put many sex workers in a position where using PrEP (a potentially dangerous medication) will not be a choice.
What else is wrong with PrEP?
It’s expensive. Like many medications, PrEP is ridiculously expensive. While I’m sure there will be ways to get it cheaper, it’s still a big cost to factor into the lives of those who are considered “most at risk” who largely live in poverty.
Another thing to consider is that PrEP only protects against HIV. The use of PrEP discourages condom use (and other safer sex materials), which will increase the number of other STIs a person is exposed to. Syphilis is on the rise these days, and drug-resistant strains of gonorrhoea have recently been discovered. While I’m not sayin’ y’all shouldn’t bareback, I am saying that PrEP creates an illusion of safety that will cause a lot of people to unknowingly expose themselves to greater health risks than they otherwise would’ve taken.
And this is why I don’t recommend PrEP. I am really excited for PrEP to be advance further into a medication that is safe for long-term use, doesn’t need perfect consistency, and is affordable. But that is not what PrEP is right now, from the data that I’ve seen.